多指标评价贫血在肾移植术前后对移植肾功能的影响

The Evaluation of the Effect of Anemia on Renal Function Before and After Renal Transplantation

目的探讨肾移植患者在术前和术后贫血的发生对移植肾功能的影响。方法收集2018年8月至2019年4月入我院移植外科需要肾移植的患者,根据临床诊断(医生查体、化验、影像)分为肾移植术前贫血组、肾移植术前未患贫血组、肾移植术后贫血组、肾移植术后未患贫血组,检测尿素氮、血肌酐、胱抑素C、铁、叶酸、维生素B12、血红蛋白、转铁蛋白、促红细胞生成素、视黄醇结合蛋白、同型半胱氨酸等指标,对所有数据进行分析。查询262例在我院移植外科肾移植患者的病例资料,筛选出患者移植后1~5年的血细胞分析指标及生化分析指标结果进行统计学分析。结果肾移植术前贫血组患者和术前未贫血组患者比较促红细胞生成素(P<0.05)存在明显差异,具有统计学意义,而肌酐、尿素氮、胱抑素C、转铁蛋白、视黄醇结合蛋白、同型半胱氨酸、铁、叶酸和维生素B12两组间差异不显著,无统计学意义(P>0.05);肾移植术前贫血组和术前未贫血组在肾移植术后1周时患者肾功能恢复情况的检测结果比较发现促红细胞生成素、肌酐、胱抑素C比较存在明显差异(P<0.05),具有统计学意义,而尿素氮两组间差异不显著,无统计学意义。肾移植术后贫血组患者和术后未贫血组患者的肌酐、尿素氮、胱抑素C、促红细胞生成素、转铁蛋白、视黄醇结合蛋白、同型半胱氨酸均存在明显差异(均P<0.05),具有统计学意义,而铁、叶酸和维生素B12两组间差异不显著,无统计学意义(P>0.05)。肾移植术后贫血的发生与血肌酐、胱抑素C及促红细胞生成素有明显相关性(P<0.01),肾移植术前贫血组贫血的发生与肌酐、尿素氮、胱抑素C、转铁蛋白、视黄醇结合蛋白、同型半胱氨酸、铁、叶酸和维生素B12水平均无相关性。肾移植术后第一年贫血的发生率是五年中最高的(为50.67%),同时随着年限增加贫血率有增加的趋势,第5年的贫血发生率(12.11%)要明显高于第3年(8.79%)和第4年(8.52%)。结论血肌酐、胱抑素C及促红细胞生成素在肾移植术后贫血的早期诊断和移植肾功能的监测中有着明显的优势,肾移植术后贫血发生率高,需要及时预防和治疗。促红细胞生成素在肾移植术前可用于贫血的诊断,在肾移植术前如尽早纠正贫血,有利于肾移植后移植肾功能的及早恢复。

Objective To investigate the effect of anemia on renal transplantation function in patients undergoing renal transplantation before and after operation.Methods We collected patients who needed renal transplant in the people’s liberation army medical center from August,2018 to April,2019.According to the clinical diagnosis(doctors′physical examination,laboratory test,image),these patients were divided into the renal transplantation preoperative anemia group,renal transplantation preoperative tumor anemia group,anemia after kidney transplantation group,and no anemia after kidney transplantation group.Urinary inhibition testing was used to test urea nitrogen,serum creatinine and C,iron,folic acid,vitamin B12,hemoglobin,transferrin,erythropoietin,retinol binding protein,homocysteine and other indicators,so to analyze all the data.In total,the data of 262 cases of renal transplantation in our hospital were investigated,and the results of blood biochemical and routine examination of 1-5years after transplantation were recorded and analyzed.Results There was a significant difference in erythropoietin between the anemia group and non-anemia group before renal transplantation(P<0.05),while creatine,urea nitrogen,cystine C,transferrin,retinol binding protein,homocysteine,iron,folic acid and vitamin B12 showed no difference between the two groups(P>0.05).The levels of creatine,urea nitrogen,cystine C,erythropoietin,and transferrin showed differences between the anemia group and non-anemia group after renal transplantation(all P<0.05).There were significant differences in retinal alcohol binding protein and homocysteine(P<0.05),while there was no significant difference in iron,folic acid and vitamin B12 between the two groups(P>0.05).The occurrence of anemia after renal transplantation was significantly correlated with serum creatinine,cystine C and erythropoietin.Anemia was associated with creatinine,urea nitrogen,cystine C,transferrin and retinol binding protein in the pre-renal transplantation group.There was no significant correlation between homocysteine,iron,folic acid and vitamin B12 items.The incidence of anemia in the first year after renal transplantation was the highest in the past five years.At the same time,the anemia rate in the fifth year was significantly higher than those in 3-4 years with the increase of the number of years.Conclusion Serum creatinine,cystine C and erythropoietin have promising advantages in the early diagnosis of anemia after renal transplantation and the monitoring of renal transplantation function.The incidence of anemia after renal transplantation is high and needs to be prevented and treated in time.Anemia should be adjusted as soon as possible before renal transplantation,which is beneficial to the early recovery of renal function after renal transplantation.