移植肾动脉狭窄的临床危险因素和保护因素

A high level of high-density lipoprotein cholesterol is a protective factor against transplant renal artery stenosis

目的分析影响移植肾动脉狭窄的相关因素。方法回顾性分析26例移植肾动脉狭窄(TRAS)患者(TRAS组)的临床资料,与40例同期肾移植非TRAS患者(非TRAS同期组)对照;TRAS组患者中的14例患者(TRAS同供组),其同一供肾的另一位受者(未发生TRAS),组成巢式对照(非TRAS同供组)。结果与非TRAS同期组比,TRAS组急性排斥反应发生率更高(P=0.004),供肾热缺血时间更长(P=0.015)、受者移植后5个月高密度脂蛋白胆固醇(HDL-C)水平更低(P=0.009);Logistic回归结果表明,AR(P=0.007)、热缺血时间延长(P=0.046)为TRAS危险因素,高HDL-C水平(P=0.022)为保护因素;近年来,越来越多的TRAS患者能够得到早期诊断,移植至TRAS确诊时间逐年缩短,TRAS确诊时e GFR呈上升趋势。结论除外科手术因素外,急性排斥反应、热缺血时间延长是TRAS发生的危险因素,而高HDL-C水平为保护因素;超声技术对TRAS诊断水平的提高是近年来TRAS得到早期诊断的主要原因。

Objective To investigate the factors associated with the occurrence of transplant renal artery stenosis（TRAS）.Methods A retrospective analysis was conducted in 26 recipients who developed TRAS and 40 concurrent renal recipients without TRAS.We also conducted a nested case-control study in 14 patients with TRAS（TRAS-SD group） and another 14 nonTRAS recipients who received the allograft from the same donor（non-TRAS-SD group）.Results Compared with those in the concurrent recipients without TRAS,acute rejection（AR） occurred at a significantly higher incidence（P=0.004） and the warm ischemia time（WIT） was significantly longer（P=0.015） and the level of high-density lipoprotein cholesterol（HDL-C）significantly lower（P=0.009） in the recipients with TRAS.Logistic regression analysis suggested that AR（P=0.007） and prolonged WIT（P=0.046） were risk factors of TRAS while HDL-C（P=0.022） was the protective factor against TRAS.In recent years early diagnosis of TRAS had been made in increasing cases,the interval from transplantation to TRAS diagnosis became shortened steadily,and the recipients tended to have higher estimated glomerular filtration rate at the time of TRAS diagnosis.Conclusion Apart from the surgical technique,AR and prolonged WIT are also risk factors of TRAS while a high HDL-C level is the protective factor against TRAS.The improvement of the diagnostic accuracy by ultrasound is the primary factor contributing to the increased rate of early TRAS diagnosis in recent years.