Objective To further evaluate the effect of hypertension on renal graft function, and the relationship between hypertension, hyperlipoidemia and ischemic heart disease. Methods 102 renal transplant recipients with a f...Objective To further evaluate the effect of hypertension on renal graft function, and the relationship between hypertension, hyperlipoidemia and ischemic heart disease. Methods 102 renal transplant recipients with a functioning renal graft for more than 1 year were enrolled in this study. Renal function was followed for the further 24 months. Results The overall prevalence of hypertension was 89.2%(91/102) and 36.2%(33/91) hypertensive patients had uncontrolled blood pressure. After 24 months those with high blood pressure had significantly higher Scr levels than normotensive patients (P<0.05). The number of different antihypertensive classes required was related to Scr (P<0.05). Plasma cholesterol levels in hypertension patients especially in blood pressure uncontrolled group were significantly elevated (P<0.01). Ischemic heart disease was more common in hypertensive patients (P<0.05). Cyclosporine A was associated with hypertension more frequently than azathioprine and FK506, whereas low-dose prednisolone did not appear to influence blood pressure. Conclusion The data further confirmed that hypertension was associated with hyperlipidemia and ischemic heart disease, and emerged as a predictor of renal graft dysfunction. Whether cyclosporine A should be converted to new immunosuppressive agents and which class of antihypertensive medication is more effective in this population remain open questions.展开更多
公民死亡器官捐献正在成为我国器官移植供体的主要来源。虽然有研究表明心脏死亡器官捐献(donation after cardiac death,DCD)来源肾移植的长期预后和脑死亡器官捐献(donation after brain death,DBD)肾移植的长期预后相近,但相比DBD移...公民死亡器官捐献正在成为我国器官移植供体的主要来源。虽然有研究表明心脏死亡器官捐献(donation after cardiac death,DCD)来源肾移植的长期预后和脑死亡器官捐献(donation after brain death,DBD)肾移植的长期预后相近,但相比DBD移植,DCD来源肾移植的移植物功能延迟恢复(delayed graft function,DGF)发生率增加。目前临床广泛应用诱导治疗应对DGF。维持治疗通常是给予钙调神经磷酸酶抑制剂延迟给药或减量方案,同时加强其他免疫抑制剂,如麦考酚酸(mycophenolic acid,MPA)类药物。同时需要注意的是,DGF的状态下,MPA类药物浓度-时间曲线下面积(area under concenration-time curve,AUC)受到抑制,因此,在合并DGF的DCD肾移植受者中,MPA类药物的剂量更难以把握,需要加强MPA类药物浓度监测。展开更多
文摘Objective To further evaluate the effect of hypertension on renal graft function, and the relationship between hypertension, hyperlipoidemia and ischemic heart disease. Methods 102 renal transplant recipients with a functioning renal graft for more than 1 year were enrolled in this study. Renal function was followed for the further 24 months. Results The overall prevalence of hypertension was 89.2%(91/102) and 36.2%(33/91) hypertensive patients had uncontrolled blood pressure. After 24 months those with high blood pressure had significantly higher Scr levels than normotensive patients (P<0.05). The number of different antihypertensive classes required was related to Scr (P<0.05). Plasma cholesterol levels in hypertension patients especially in blood pressure uncontrolled group were significantly elevated (P<0.01). Ischemic heart disease was more common in hypertensive patients (P<0.05). Cyclosporine A was associated with hypertension more frequently than azathioprine and FK506, whereas low-dose prednisolone did not appear to influence blood pressure. Conclusion The data further confirmed that hypertension was associated with hyperlipidemia and ischemic heart disease, and emerged as a predictor of renal graft dysfunction. Whether cyclosporine A should be converted to new immunosuppressive agents and which class of antihypertensive medication is more effective in this population remain open questions.
文摘目的分析肾移植受体发生脑卒中的危险因素。方法回顾性分析376例规律随访的肾移植受体的临床资料,按照是否发生脑卒中分为脑卒中组(39例)和非脑卒中组(337例)。采用单因素分析和COX比例风险回归模型分析脑卒中的危险因素。结果 376例受体的中位随访时间55个月,共有39例发生脑卒中,其累积发生率为10.4%。单因素分析发现,脑卒中组与非脑卒中组之间移植时年龄≥40岁、移植前透析时间≥12个月、估算肾小球滤过率(e GFR)<30 m L/(min·1.73 m2)、高血压、糖尿病、脂代谢异常的发生率比较,差异均有统计学意义(均为P<0.05)。多因素分析发现,影响肾移植受体脑卒中发生的独立危险因素为年龄≥40岁[风险比(HR)=1.110,95%可信区间(CI)为1.067~1.154,P=0.000]、移植前透析时间≥12个月(HR=1.044,95%CI为1.021~1.067,P=0.000)、e GFR<30 m L/(min·1.73 m2)(HR=2.448,95%CI为1.197~5.005,P=0.014)。结论肾移植受体发生脑卒中的独立危险因素包括年龄≥40岁、移植前透析时间长和肾功能减退。
文摘公民死亡器官捐献正在成为我国器官移植供体的主要来源。虽然有研究表明心脏死亡器官捐献(donation after cardiac death,DCD)来源肾移植的长期预后和脑死亡器官捐献(donation after brain death,DBD)肾移植的长期预后相近,但相比DBD移植,DCD来源肾移植的移植物功能延迟恢复(delayed graft function,DGF)发生率增加。目前临床广泛应用诱导治疗应对DGF。维持治疗通常是给予钙调神经磷酸酶抑制剂延迟给药或减量方案,同时加强其他免疫抑制剂,如麦考酚酸(mycophenolic acid,MPA)类药物。同时需要注意的是,DGF的状态下,MPA类药物浓度-时间曲线下面积(area under concenration-time curve,AUC)受到抑制,因此,在合并DGF的DCD肾移植受者中,MPA类药物的剂量更难以把握,需要加强MPA类药物浓度监测。
