肾移植术后心血管事件发生的危险因素及其对移植肾功能的影响

Risk factors for postoperative cardiovascular events after renal transplantation and their impact on transplant kidney function

目的分析肾移植患者发生术后心血管事件(PCE)的危险因素及其对移植肾脏功能的影响。方法回顾性分析首都医科大学宣武医院2020年3月至2022年3月120例行肾脏移植患者的临床资料。其中,发生PCE 23例(PCE组),未发生PCE 97例(非PCE组)。记录患者术前和术后相关资料,采用多因素Logistic回归分析影响肾移植患者发生PCE的独立危险因素。结果肾移植患者PCE发生率为19.17%(23/120)。两组性别构成、术前血脂异常率、术前高血压率和免疫抑制剂使用情况比较差异无统计学意义(P>0.05);PCE组年龄、术前体质量指数>30 kg/m^(2)率、术前透析时间>12个月率、术前糖尿病率、术前心血管疾病率、术前糖尿病肾病率、尸体供肾肾移植率、术后血脂异常率、术后血清肌酐>200μmol/L率、术后新发糖尿病率、术后延迟性衰竭率和术后急性反应率明显高于非PCE组,差异有统计学意义(P<0.01或<0.05)。多因素Logistic回归分析结果显示,年龄、术前糖尿病、术前心血管疾病、术前糖尿病肾病、术后血清肌酐>200μmol/L和术后急性反应是影响肾移植患者发生PCE的独立危险因素(OR=2.40、3.42、3.85、1.98、2.62和2.11,95%CI 1.67~3.58、1.61~7.05、2.61~5.55、1.05~3.85、1.25~4.52和1.20~4.78,P<0.01或<0.05)。两组术后3个月血清肌酐比较差异无统计学意义(P>0.05);PCE组术后6和12个月血清肌酐明显高于非PCE组[(139.58±31.54)μmol/L比(105.36±21.05)μmol/L和(198.32±40.12)μmol/L比(107.63±24.64)μmol/L],差异有统计学意义(P<0.01)。结论肾移植患者PCE发生率较高,导致PCE的危险因素较多。若是采取相关措施来校正或去除危险因素,或可降低肾移植患者PCE发生率,延长生存时间。

Objective To analyze the risk factors for postoperative cardiovascular events(PCE)after renal transplantation and their impact on transplant kidney function.Methods The clinical data of 120 patients who underwent kidney transplant at Xuanwu Hospital,Capital Medical University from March 2020 to March 2022 were retrospectively analyzed.Among them,23 cases occurred PCE(PCE group),and 97 cases did not occur PCE(non-PCE group).The relevant preoperative and postoperative data were recorded.Multivariate Logistic regression was used to analyze the independent risk factors of PCE in kidney transplant patients.Results The incidence rate of PCE in kidney transplant patients was 19.17%(23/120).There were no statistical differences in the gender composition,preoperative dyslipidemia rate,preoperative hypertension rate and immunosuppressant use between two groups(P>0.05);the age,preoperative body mass index>30 kg/m^(2) rate,preoperative dialysis time>12 months rate,preoperative diabetes rate,preoperative cardiovascular disease rate,preoperative diabetic nephropathy rate,cadaver kidney transplant rate,postoperative dyslipidemia rate,postoperative serum creatinine>200μmol/L rate,postoperative new-onset diabetes rate,postoperative delayed failure rate and postoperative acute reaction rate in PCE group were significantly higher than those in non-PCE group,and there were statistical differences(P<0.01 or<0.05).Multivariate Logistic regression analysis showed that age,preoperative diabetes,preoperative cardiovascular disease,preoperative diabetic nephropathy,postoperative serum creatinine>200μmol/L and postoperative acute reaction were independent risk factors of PCE in kidney transplant patients(OR=2.40,3.42,3.85,1.98,2.62 and 2.11;95%CI 1.67 to 3.58,1.61 to 7.05,2.61 to 5.55,1.05 to 3.85,1.25 to 4.52 and 1.20 to 4.78;P<0.01 or<0.05).There was no statistically significant difference in serum creatinine 3 months after surgery between two groups(P>0.05);the serum creatinine 6 and 12 months after surgery in PCE group was significantly higher than that in non-PCE group:(139.58±31.54)μmol/L vs.(105.36±21.05)μmol/L and(198.32±40.12)μmol/L vs.(107.63±24.64)μmol/L,and there were statistical differences(P<0.01).Conclusions The incidence of PCE in kidney transplant patients is higher,and there are many risk factors for PCE.If relevant measures are taken to correct or remove risk factors,it may reduce the incidence of PCE and prolong survival time in kidney transplant patients.