肾移植术后高尿酸血症与中医体质类型及相关危险因素的Logistic回归分析

Logistic Regression Analysis of Traditional Chinese Medicine Constitution Types and Related Risk Factors in Hyperuricemia Patietns After Renal Transplantation

【目的】研究肾移植术后高尿酸血症(HUA)患者的中医体质分布规律及其相关危险因素。【方法】对221例肾移植术后患者(术后HUA组98例,术后非HUA组123例)进行中医体质判定,运用Logistic回归法分析肾移植术后HUA患者易感体质与包括实验室指标在内的各项临床资料的关联性。【结果】(1)临床资料方面,2组患者血清肌酐(Scr)水平比较,差异有统计学意义(P<0.05),而其他指标比较,差异均无统计学意义(P>0.05);单因素分析中,经校正后,术后HUA组与术后非HUA组的各项指标比较,差异均无统计学意义(P>0.05);多因素Logistics分析中,术后HUA组的CD3^+CD4^+%低于术后非HUA组[P<0.05,95%CI(1.003,1.062),OR=1.032],且既往肾结石病史者术后更易患HUA[P<0.05,95%CI(1.032,30.540),OR=0.046]。(2)中医体质分布方面,与术后非HUA组患者相比较,术后HUA组患者的阳虚质有所减少(P<0.05),但仍为最主要的中医体质类型;多因素回归分析结果显示,肾移植术后HUA患者中阳虚质分布较多,为发病的易感体质因素,且呈正相关(P<0.05)。(3)肾移植术后HUA的危险因素方面,多因素Logistic回归分析结果显示,CD3^+CD4^+%[OR=1.032,95%CI(1.003,1.062),P=0.029]、阳虚质[OR=2.000,95%CI(1.120,3.570),P=0.019]是肾移植术后患者HUA发病的危险因素。【结论】阳虚质为肾移植术后高尿酸血症患者发病的易感因素,高尿酸、肾结石及免疫功能失调为发病的高危因素,也可能是导致慢性移植肾失功的高危因素之一。

Objective To explore the distribution of traditional Chinese medicine(TCM)constitution types and related risk factors in patients with hyperuricemia(HUA)after renal transplantation.Methods This retrospective study was carried out in 221 patients after renal transplantation(including 98 postoperative HUA cases and 123 postoperative non-HUA cases).The TCM constitution types of the studying subjects were classified,and then Logistic regression was used to explore the correlation of the susceptible constitution types for HUA after renal transplantation with the clinical data including laboratory indicators.Results(1)The difference of serum creatinine(SCr)level between the postoperative HUA group and postoperative non-HUA group was statistically significant(P<0.05),while the differences of other indicators were insignificant(P>0.05).Single factor analysis showed that after correction the differences of various indicators between the postoperative HUA group and postoperative non-HUA group were insignificant(P>0.05).The multivariate regression analysis showed that the percentage of CD3^+CD4^+in the postoperative HUA group was lower than that in the postoperative non-HUA group[P<0.05,95%CI(1.003,1.062),OR=1.032],and the patients having the medical history of renal calculi were more susceptible to HUA[P<0.05,95%CI(1.032,30.540),OR=0.046].(2)The percentage of yang deficiency constitution in the postoperative HUA group was lower than that in the postoperative non-HUA group(P<0.05),but it was still the main constitution.Multivariate regression analysis showed that yang deficiency constitution was the predominant constitution type in the patients with HUA after renal transplantation,and was the susceptible constitution to HUA,being positively correlated with HUA after renal transplantation(P<0.05).(3)Multivariate regression analysis showed that the percentage of CD3^+CD4^+[OR=1.032,95%CI(1.003,1.062),P=0.029]and yang deficiency constitution[OR=2.000,95%CI(1.120,3.570),P=0.019]were the risk factors of HUA after renal transplantation.Conclusion Yang deficiency constitution is the predisposing factor for the onset of HUA after renal transplantation.High uric acid,renal calculi and immune dysfunction are the risk factors for HUA after renal transplantation,which probably result into the failure of renal transplantation.