肾移植非糖尿病患者血浆置换或透析的危险因素

Risk factors for plasmapheresis or dialysis in non-diabetic patients with kidney transplantation

目的探讨肾移植非糖尿病患者血浆置换或透析的危险因素。方法回顾性研究,收集2019年1月至2020年12月在西安交通大学第一附属医院接受肾移植的507例患者临床资料,其中男349例,女158例,年龄15~65岁。根据移植后1年内有无血浆置换或透析,分为有治疗组(49例)和无治疗组(458例)。采用非参数检验、χ^(2)检验/连续校正χ^(2)检验和Fisher确切概率法比较两组一般资料,多因素logistic回归分析血浆置换或透析的独立危险因素。结果与无治疗组相比,有治疗组术后第8天空腹血糖(FPG)≥7.8 mmol/L与移植肾功能延迟恢复(DGF)患者比例较高,术后第8天胱抑素C(CysC)和肌酐水平较高,肾小球滤过率较低(χ^(2)=5.202、5.030,Z=-4.676、-5.002、-4.937,均P<0.05)。多因素logistic回归分析发现术后第8天FPG≥7.8 mmol/L[OR=1.216,95%置信区间(CI)1.003~1.473,P<0.05]和术后第8天CysC(OR=1.610,95%CI 1.300~1.995,P<0.05)是血浆置换或透析的独立危险因素。结论术后第8天FPG和CysC两个临床指标可用来评估是否增加肾移植非糖尿病患者血浆置换或透析的风险,以便早期评估、早期防治。

Objective To investigate the risk factors of plasmapheresis or dialysis in non-diabetic patients in kidney transplantation(KT).Methods A retrospective study was conducted to collect the clinical data of 507 patients who received KT in the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to December 2020,including 349 males and 158 females,aged 15 to 65 years.According to the occurrence of plasmapheresis or dialysis within 1 year after KT,the patients were divided into a treated group(49 cases)and an untreated group(458 cases).The general data of the two groups were compared by non-parametric test,chi-square test,continuity correction chi-square test,or Fisher exact probability method.The independent risk factors of plasmapheresis or dialysis were analyzed by multivariate logistic regression analysis.Results Compared with those in the untreated group,the treated group had a higher proportion of fasting plasma glucose(FPG)≥7.8 mmol/L on the 8th day after KT,a higher proportion of delayed graft function(DGF),higher levels of cystatin C(CysC)and creatinine on the 8th day after KT,and a lower glomerular filtration rate(χ^(2)=5.202 and 5.030,Z=-4.676,-5.002,and-4.937;all P<0.05).Multivariate logistic regression analysis found that the ratio of FPG≥7.8 mmol/L on the 8th day after KT[OR=1.216,95%confidence interval(CI)1.003-1.473,P<0.05]and CysC on the 8th day after KT(OR=1.610,95%CI 1.300-1.995,P<0.05)were independent risk factors for plasmapheresis or dialysis.Conclusions FPG≥7.8 mmol/L and CysC on the 8th day after KT are the independent risk factors of plasmapheresis or dialysis in non-diabetic patients with KT,so as to facilitate early assessment,prevention,and treatment.