肾移植术后肾功能正常患者肾内动脉阻力指数的影响因素分析

A study on the impact factors on renal arterial resistance index in patients with stable renal function after kidney transplantation

目的探讨彩色多普勒超声检测肾移植术后肾内动脉阻力指数(RI)的影响因素。方法回顾性分析428例尸肾移植术后1月且血清肾功能指标正常的患者,对临床可能影响RI的指标进行分析。结果影响RI的因素有受者年龄和24 h尿蛋白量,而供者年龄、热缺血时间、冷缺血时间、人类白细胞抗原(HLA)错配位点、收缩压、舒张压、脉压差、空腹血糖、血清肌酐、甘油三酯、血清总胆固醇、FK506及Cs A浓度均非RI的影响因素。结论移植肾动脉RI与受者外周血管顺应性和移植肾脏病理改变等因素相关,而非单纯反应肾血管床阻力和肾脏病理改变的指标,临床解读应避免RI完全替代肾血管阻力。

Objective To investigate the impact factors on renal artery resistance index （resistive index, RI） after kidney transplantation with color Doppler ultrasound. Methods We retrospectively analyzed the RI of 428 cadaver kidney transplant patients within the first month with stable renal function during January 2010 to December 2014. Logistic regression analysis was performed to assess and rank the impact of potential variables on RI, such as donor age, cold ischemia time, human leukocyte antigen （HLA） mismatch, recipient age, gender, systolic blood pressure, diastolic blood pressure, pulse pressure, serum creatinine, serum cholesterol, ciclosporin or tacrolimus trough level, arterial blood pressure, number of HL Amismatches, anti-hypertensive medications and proteinuria. Results The relative factors with high impact on RI value were recipient age and proteinuria. The other variables, such as donor age, cold ischemia time, HLA mismatch, gender, systolic blood pressure, diastolic blood pressure, pulse pressure, serum creatinine, serum cholesterol, ciclosporin or tacrolimus trough level, arterial blood pressure, number of HL Amismatches, and anti-hypertensive medications, were shown to have little impact. Conclusion Renal arterial resistance index is a complexity composed of artery vascular compliance, and renal pathological changes etc rather than as an indicator of renal vascular bed resistance or renal pathological changes. Interpretation of renal arterial RI evaluated with color Doppler ultrasound in clinical practice should not be used as the only renal vascular resistance measurement.