CAJ | 학술논문

目的探讨影响肝移植术后慢性肾功能损伤(CRD)的危险因素.方法回顾性分析2007年1月至2008年1月于中国人民武装警察部队总医院接受肝移植术后生存时间＞3年的101例患者的临床资料,应用MDRD公式计算术前以及术后1、3年的肾小球滤过率(GFR).根据术后GFR是否＜60 ml/min将患者分为CRD组(16例)和对照组(85例).采用x2检验或t检验对可能影响肝移植术后肾功能的16项危险因素(性别、年龄、高血压、糖尿病、肌酐、尿素氮、他克莫司浓度、术前GFR、热缺血时间、冷缺血时间、国际标准化比值、TP、TBil、ALT、AST、ALP)进行单因素分析,将差异有统计学意义的因素进行Logistic多因素回归分析.结果 101例肝移植患者手术前GFR为(103±22) ml/min,其中3例患者术前GFR＜60 ml/min；101例患者肝移植术后l、3年GFR分别为(91 ±22) ml/min和(83 ± 21) ml/min,其中7例患者肝移植术后1年GFR＜ 60 ml/min,16例患者术后3年GFR＜ 60 ml/min.单因素分析结果表明:高血压、糖尿病、肌酐、尿素氮、他克莫司浓度和术前GFR是肝移植术后CRD的危险因素(x2=9.400,21.917,f =51.024,91.620,41.381,99.000,P＜0.05).多因素分析结果表明:高血压、糖尿病和术前GFR是肝移植术后CRD的独立危险因素(OR=65.438,17.903,0.911,P＜0.05).结论 GFR降低和手术前合并高血糖和高血压是肝移植术后CRD的危险因素.
목적 탐토영향간이식술후만성신공능손상(CRD)적위험인소.방법 회고성분석2007년1월지2008년1월우중국인민무장경찰부대총의원접수간이식술후생존시간＞3년적101례환자적림상자료,응용MDRD공식계산술전이급술후1、3년적신소구려과솔(GFR).근거술후GFR시부＜60 ml/min장환자분위CRD조(16례)화대조조(85례).채용x2검험혹t검험대가능영향간이식술후신공능적16항위험인소(성별、년령、고혈압、당뇨병、기항、뇨소담、타극막사농도、술전GFR、열결혈시간、랭결혈시간、국제표준화비치、TP、TBil、ALT、AST、ALP)진행단인소분석,장차이유통계학의의적인소진행Logistic다인소회귀분석.결과 101례간이식환자수술전GFR위(103±22) ml/min,기중3례환자술전GFR＜60 ml/min；101례환자간이식술후l、3년GFR분별위(91 ±22) ml/min화(83 ± 21) ml/min,기중7례환자간이식술후1년GFR＜ 60 ml/min,16례환자술후3년GFR＜ 60 ml/min.단인소분석결과표명:고혈압、당뇨병、기항、뇨소담、타극막사농도화술전GFR시간이식술후CRD적위험인소(x2=9.400,21.917,f =51.024,91.620,41.381,99.000,P＜0.05).다인소분석결과표명:고혈압、당뇨병화술전GFR시간이식술후CRD적독립위험인소(OR=65.438,17.903,0.911,P＜0.05).결론 GFR강저화수술전합병고혈당화고혈압시간이식술후CRD적위험인소.
Objective To investigate the risk factors for chronic renal dysfunction (CRD) after liver transplantation.Methods The clinical data of 101 patients who survived more than 3 years after liver transplantation at the General Hospital of Armed Police Forces from January 2007 to January 2008 were retrospectively analyzed.The glomeruar filtration rate (GFR) before operation and at postoperative year 1 and 3 were calculated by the modification of diet in renal disease (MDRD) formula.All the patients were divided into the CRD group (16patients) and the control group (85 patients) according to whether the GFR was under 60 ml/min.Risk factors (gender,age,diabetes mellitus,creatinine,urea nitrogen,tacrolimus level,preoperative GFR,warm ischemia time,cold ischemia time,international normalized ratio,total protein,total bilirubin,alanine transaminase,aspartate transaminase,alkaline phosphatase) for CRD after liver transplantation were analyzed using chi-square test or t test,and multivariate analysis was done using Logistic regression models.Results The mean preoperative level of GFR of the 101 patients was (103 ± 22) ml/min,and the preoperative levels of GFR of 3 patients were under 60 ml/min.The mean levels of GFR of the 101 patients at postoperative year 1 and 3 were (91 ± 22)ml/min and (83 ± 21) ml/min,and the levels of GFR at postoperative year 1 of 7 patients were under 60 ml/min,and the levels of GFR at postoperative year 3 of 16 patients were under 60 ml/min.The results of univariate analysis showed that hypertension,diabetes mellitus,creatinine,blood urea nitrogen,tacrolimus level and preoperative GFR were risk factors for CRD after liver transplantation (x2=9.400,21.917,t =51.024,91.620,41.381,99.000,P ＜ 0.05).The results of multivariate analysis showed that hypertension,diabetes mellitus and preoperative GFR were independent risk factors for CRD after liver transplantation (OR =65.438,17.903,0.911,P ＜ 0.05).Conclusion Decrease of GFR,higher blood pressure and diabetes mellitus are risk factors that contributing to the development of CRD.