CAJ | 학술논문

目的评估肾癌根治术后肾功能的影响因素以及肾功能的变化趋势.方法 2007年1月至2011年12月苏州大学附属第一医院行肾癌根治术连续入组356例患者,因失访、重大数据缺失等原因,最终参加研究分析的样本185例.男性121例,女性64例,年龄30 ～ 88岁,平均(58±12)岁.合并糖尿病34例,高血压病82例;开放手术132例,腹腔镜手术53例.连续监测患者术后3、6、9、12、24、36、48、60、72个月血清肌酐,通过肾脏病饮食调整方程(MDRD方程)计算出估计肾小球滤过率(eGFR),以线性混合模型分析术后eGFR的连续变化,以多因素回归分析影响术后肾功能变化的预后因素.结果总体患者术后肾功能在持续恢复状态,直线斜率(β)为0.099(95％ CI:0.07～0.13,P＜0.01),即每月恢复0.099ml·min-1·(1.73 m2)-1.不同预后因素患者组与该因素参照组直线斜率(β)存在差异,多因素回归分析后,以下三组间差异具有统计学意义,结果分别为:糖尿病和非糖尿病患者直线斜率(β)分别为-0.02及0.12(P＜0.01),高血压和非高血压人群直线斜率(β)分别为0.08及0.11(P ＜0.05),≤50岁、＞50 ～ 65岁、＞65岁人群直线斜率(β)分别为0.15、0.09及0.05(P ＜0.05).术后新发慢性肾病13例,其中慢性肾病Ⅲ期9例,慢性肾病Ⅳ期4例.结论肾癌根治术后肾功能随访期间一直处于恢复状态.肾功能预后良好因素包括低龄、无高血压及无糖尿病.
목적 평고신암근치술후신공능적영향인소이급신공능적변화추세.방법 2007년1월지2011년12월소주대학부속제일의원행신암근치술련속입조356례환자,인실방、중대수거결실등원인,최종삼가연구분석적양본185례.남성121례,녀성64례,년령30 ～ 88세,평균(58±12)세.합병당뇨병34례,고혈압병82례;개방수술132례,복강경수술53례.련속감측환자술후3、6、9、12、24、36、48、60、72개월혈청기항,통과신장병음식조정방정(MDRD방정)계산출고계신소구려과솔(eGFR),이선성혼합모형분석술후eGFR적련속변화,이다인소회귀분석영향술후신공능변화적예후인소.결과 총체환자술후신공능재지속회복상태,직선사솔(β)위0.099(95％ CI:0.07～0.13,P＜0.01),즉매월회복0.099ml·min-1·(1.73 m2)-1.불동예후인소환자조여해인소삼조조직선사솔(β)존재차이,다인소회귀분석후,이하삼조간차이구유통계학의의,결과분별위:당뇨병화비당뇨병환자직선사솔(β)분별위-0.02급0.12(P＜0.01),고혈압화비고혈압인군직선사솔(β)분별위0.08급0.11(P ＜0.05),≤50세、＞50 ～ 65세、＞65세인군직선사솔(β)분별위0.15、0.09급0.05(P ＜0.05).술후신발만성신병13례,기중만성신병Ⅲ기9례,만성신병Ⅳ기4례.결론 신암근치술후신공능수방기간일직처우회복상태.신공능예후량호인소포괄저령、무고혈압급무당뇨병.
Objective To evaluate continuous change in renal function by various clinical factors after radical nephrectomy(RN).Methods Patients after RN from January 2007 to December 2011 in the First Affiliated Hospital to Soochow University were enrolled,356 cases continuously enrolled throughout the follow-up process,because of lost,missing data and other material reasons,185 cases meet the requirements,eventually,including 121 male and 64 female patients,aged from 30 to 88 years(average age:(58 ± 12) years).There were 34 diabetes mellitus,82 hypertension patients.Open surgery for 132 cases,laparoscopic surgery for 53 cases.Continuous checked serum creatinine at 3,6,9,12,24,36,48,60,72 months after RN and calculated to estimated glomerular filtration rate(eGFR) by Modification of Diet in Renal Disease equation.Linear mixed models were carried out to analyze postoperative continuous change in eGFR in multivariate regression analysis postoperative risk factors for changes in renal function.Results Overall,there was a subsequent restoration of renal function over the follow-up period.The slope (β) for the relationship between the eGFR and the time since RN was 0.099 (95％ CI:0.07-0.13,P ＜ 0.01) indicating that each month after RN was associated with an increase in eGFR of 0.099 ml · min-1 · (1.73 m2)-1 · month-1.The slope (β) was different between the group with clinical factor and its reference group,but the difference in the next three groups with statistically significant after multivariate regression analysis:diabetic and non-diabetic mellitus patients with a slope (β) of-0.02 and 0.12 (P ＜ 0.01).Hypertension and non-hypertensive patients with a slope (β) of 0.08 and 0.11 (P ＜ 0.05).Age ≤ 50 years,＞ 50-65 years and ＞ 65 years patients with a slope (β) of 0.15,0.09 and 0.05 (P ＜ 0.05),respectively.There were 13 new-onset of chronic kidney disease (CKD) after RN,including 9 patients with CKD Ⅲ and 4 patients with CKD Ⅳ.Conclusions Renal function recover continuously during the follow-up period after RN.Preoperative predictors of an increase in eGFR after RN are young age,no diabetes mellitus,no hypertension.