肾移植受者术前甘油三酯代谢对移植肾早期功能恢复的影响

Effects of recipient's pre-transplant triglyceride abnormalities on early renal function recovery after kidney transplantation

目的探讨肾移植受者术前甘油三酯(TG)代谢对其移植肾早期功能(EGF)恢复的影响。方法回顾性分析2011年1月-2014年12月170例在解放军309医院接受活体肾移植受者的临床资料,经排除标准筛选后最终纳入154例受者,其中男124例,女30例,年龄31.9±8.4岁。根据受者术前TG水平分为TG正常组(0.40<TG≤1.70mmol/L,n=107)及TG异常组(TG>1.70mmol/L或需服用降脂药控制血脂者,n=47),观察两组患者中移植肾功能恢复不佳(PEGF)、肾功能延迟恢复(DGF)和肾功能缓慢恢复(SGF)的发生率,进一步比较移植肾功能顺利恢复(IGF)的两组受者术后3、7及30d的肌酐(Scr)水平。绘制以TG为诊断指标的ROC曲线,以获得预测肾移植术后发生PEGF、SGF、DGF风险的最佳TG值。结果与TG正常组相比,TG异常组的受者术后PEGF及DGF的发病率较高,差异有统计学意义(P<0.05)。IGF的受者中,TG异常组术后7、30d的Scr值高于TG正常组,差异有统计学意义(P<0.05)。术前TG预测PEGF、SGF及DGF的ROC曲线下面积(AUC)分别为0.774、0.704、0.818,均明显大于机会参考下面积(P<0.05),最佳临界值均为1.37mmol/L。结论受者术前TG代谢异常对移植肾早期功能恢复可能具有负性影响。术前受者TG在正常高值时(>1.37mmol/L),其发生PEGF、SGF和DGF的风险便已增加。

Objective To investigate the effect of recipient＇s pre-transplant triglyceride （TG） abnormalities on early graft function （EGF） after kidney transplantation. Methods According to the inclusion and exclusion criteria, 154 identified living-kidney transplant recipients in the 309 Hospital of Chinese PLA from Jan. 2011 to Dec. 2014 were enrolled in present study, including 124 males and 30 females, and aged of 31.9 ± 8.4 years. The cohort was divided into two groups： TG normal group （0.40〈TG≤1.70mmol/L, n=107） and TG abnormalities group （TG〉1.70mmol/L or require lipid lowering therapy, n=47）. The incidences of poor early graft renal function （PEGF）, slow graft function （SGF） and delayed graft function （DGF） were compared between the two groups, and then the serum creatinine （Scr） levels were compared among the patients showing immediate graft function （IGF） at 3rd, 7th and 30th day after transplantation. The ROC curve was drawn up taking TG as diagnosis index to explore the optimal cut-offvalue for predicting PEGF, SGF and DGF after transplantation. Results Compared with the TG normal group,the TG abnormalities group showed significantly higher incidence of PEGF and DGF （P〈0.05）. Among the IGF patients, the TG abnormalities group showed higher Scr level at the 7th and 30th day after transplantation （P〈0.05）. The area under ROC curve （AUC） reflected TG levels for PEGF, SGF and DGF were 0.774, 0.704 and 0.818, respectively （P〈0.05）. The optimal cut-offvalues were all 1.37mmol/L. Conclusions Recipients with abnormal pre-transplant TG level may have worse EGF after renal transplantation. The risk of developing PEGF, SGF and DGF tends to emerge when pre-transplant TG level is higher than 1.37mmol/L.