肾移植术后一年贫血危险因素分析

doi:10.3877/cma.j.issn.1674-3903.2017.01.004

目的

探究肾移植受者术后发生肾移植后贫血(PTA)的危险因素。

方法

回顾性分析2013年12月至2015年5月武汉大学中南医院肝胆外科75例行同种异体肾移植受者临床资料。观察和监测受者术前及术后1、3、6、12个月血常规指标及他克莫司血药浓度。根据受者术后1年是否发生PTA，分为PTA组(16例)和非PTA组(59例)。采用Spearman秩相关对受者术后1、3、6、12个月血红蛋白与血清肌酐、他克莫司血药浓度进行相关性检验。采用χ²检验比较两组受者性别、术后使用血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂、输注红细胞、发生AR及使用抗病毒药物的比例；采用t检验比较两组受者年龄和血清肌酐水平。P<0.05为差异有统计学意义。

结果

75例受者术后1个月血清肌酐水平基本恢复正常，术后3个月内血红蛋白均恢复至100 g/L以上，术后3个月至1年红细胞计数、他克莫司血药浓度基本稳定。术后第1、3、12个月受者血红蛋白与血清肌酐呈负相关(r＝－0.369、－0.245、－0.226，P均<0.05)，术后第6个月受者血红蛋白与血清肌酐无相关性(r＝－0.225，P>0.05)。受者术后第1、3、6、12个月血红蛋白与他克莫司血药浓度均无相关性(r＝－0.051、0.124、0.059、－0.002，P均>0.05)。术后1年PTA发生比例为21%(16/75)。PTA组与非PTA组受者相比，术后血清肌酐差异有统计学意义(t＝18.27，P<0.05)。

结论

肾移植术后PTA发生比例较高，降低受者血清肌酐水平可能对减少肾移植受者术后PTA的发生具有改善作用。

关键词: 肾移植, 贫血, 危险因素, 血清肌酐

Objective

To investigate the risk factors for anemia within the first year post renal transplantation.

Methods

The clinical data of 75 recipients getting renal transplantion in Zhongnan Hospital of Wuhan University during December 2013 and May 2015 was analyzed retrospectively. Blood parameters and tacrolimus plasma concentration of preoperative and postoperative 1, 3, 6, 12 months were observed. The patients were divided into PTA group (n=16) and non-PTA group (n=59) at 1 year after operation. The differences of sex, ACEI/ARB, infusion of erythrocytes, acute rejection and antiviral drugs between PTA group and non- PTA group were compared by χ² test. The age and serum creatinine levels were compared by t test. The correlation between hemoglobin and serum creatinine and tacrolimus was evaluated by Spearman rank correlation. P<0.05 was deemed statistically significant.

Results

The levels of serum creatinine in the recipients were normal at 1 month after operation. Hemoglobin was restored to more than 100g/L within 3 months after operation. The red blood cell count and tacrolimus plasma concentration were basically stable from 3 months to 1 year after operation. There was a negative correlation between hemoglobin and serum creatinine at 1, 3, and 12 months postoperatively (r=-0.369, -0.245, -0.226, P all<0.05). There was no correlation between hemoglobin and serum creatinine at 6 months after operation (r=-0.225, P>0.05). There was no correlation between hemoglobin and tacrolimus plasma concentration at 1, 3, 6, and 12 months after operation (r=-0.051, 0.124, 0.059, -0.002, P all>0.05). The incidence of PTA was 21% (16/75) 1 year after operation. The difference of serum creatinine between the PTA group and the non-PTA group was significant (t=18.27, P<0.05).

Conclusions

The incidence of anemia after renal transplantation is high. Reducing serum creatinine level of renal transplant recipients may have an improved effect on reduction of PTA.

Key words: Renal transplantation, Anemia, Risk factor, Serum creatinine

表1 75例肾移植受者不同时期血常规、血清肌酐及他克莫司血药浓度比较(±s)

时间	血红蛋白(g/L)	MCV(fL)	MCH(pg)	红细胞计数(1×10¹²/L)	血清肌酐(μmol/L)	他克莫司血药浓度(ng/mL)
术前	104±19	92± 8	30±3	3.5±0.6	964±305	－
术后1个月	102±18^a	93± 8	30±3	3.4±0.6	122± 55^a	9.6±2.9
术后3个月	122±21^ab	90± 8	29±3	4.2±0.8^ab	107± 34^a	8.4±2.2^b
术后6个月	129±22^ab	88± 8	29±3	4.6±1.0^abc	112± 59^a	7.7±2.6^b
术后12个月	134±27^ab	87±10	29±3	4.7±1.0^abc	107± 43^a	7.6±2.4^bc

表1 75例肾移植受者不同时期血常规、血清肌酐及他克莫司血药浓度比较(±s)

时间	血红蛋白(g/L)	MCV(fL)	MCH(pg)	红细胞计数(1×10¹²/L)	血清肌酐(μmol/L)	他克莫司血药浓度(ng/mL)
术前	104±19	92± 8	30±3	3.5±0.6	964±305	－
术后1个月	102±18^a	93± 8	30±3	3.4±0.6	122± 55^a	9.6±2.9
术后3个月	122±21^ab	90± 8	29±3	4.2±0.8^ab	107± 34^a	8.4±2.2^b
术后6个月	129±22^ab	88± 8	29±3	4.6±1.0^abc	112± 59^a	7.7±2.6^b
术后12个月	134±27^ab	87±10	29±3	4.7±1.0^abc	107± 43^a	7.6±2.4^bc

表2 肾移植受者术后1年发生PTA危险因素分析结果

组别	例数	性别(例，男/女)	年龄(岁，±s)	ARB/ACEI(例，是/否)	抗病毒药物(例，是/否)	术后输注红细胞(例，是/否)	AR(例，是/否)	血清肌酐(μmol/L，±s)
PTA组	16	11/ 5	49± 9	5/11	7/ 9	5/11	4/12	134±65
非PTA组	59	46/13	40±11	18/41	12/47	12/47	10/49	99±31
χ²/t值	－	χ²＝0.19	t＝0.83	χ²＝0.00	χ²＝2.51	χ²＝0.35	χ²＝0.14	t＝18.27
P值	－	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

表2 肾移植受者术后1年发生PTA危险因素分析结果

组别	例数	性别(例，男/女)	年龄(岁，±s)	ARB/ACEI(例，是/否)	抗病毒药物(例，是/否)	术后输注红细胞(例，是/否)	AR(例，是/否)	血清肌酐(μmol/L，±s)
PTA组	16	11/ 5	49± 9	5/11	7/ 9	5/11	4/12	134±65
非PTA组	59	46/13	40±11	18/41	12/47	12/47	10/49	99±31
χ²/t值	－	χ²＝0.19	t＝0.83	χ²＝0.00	χ²＝2.51	χ²＝0.35	χ²＝0.14	t＝18.27
P值	－	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

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Risk factors analysis for anemia within the first year post renal transplantation

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Risk factors analysis for anemia within the first year post renal transplantation