探讨中国西北地区肾移植术后腹泻临床诊治及危险因素。

回顾性分析2019年1月至2024年12月在空军军医大学第一附属医院泌尿外科实施同种异体肾移植术并规律随访的230例受者临床资料。根据受者肾移植术后是否发生腹泻，将其分为腹泻组(n＝72例)和非腹泻组(n＝158例)。记录受者一般资料及治疗情况。正态分布计量资料组间比较采用成组t检验。计数资料组间比较采用卡方检验。将单因素分析中P<0.05的变量纳入多因素Logistic回归分析。P<0.05为差异有统计学意义。

急性腹泻受者共67例(93.1%)，腹泻对其肾功能的总体影响及转归情况相对较轻，其中2例合并新型冠状病毒感染，1例合并CMV感染，1例粪便转铁蛋白阳性。5例(6.9%)慢性腹泻受者中1例因严重低钾血症死亡；3例出现肾功能恶化，其中2例考虑为局灶节段性肾小球硬化和IgA肾病复发，经积极治疗后进展为移植肾失功并恢复透析，1例经过治疗后血清肌酐稳定在200~300 μmol/L；1例经过治疗后完全恢复。此外，5例慢性腹泻受者中1例发生CMV感染、2例粪便潜血阳性、1例艰难梭菌感染。腹泻发生在肾移植术后1年以上的有12例(16.7%)，其余均发生于肾移植术后1年内。腹泻组和非腹泻组肾移植受者住院时间、体质指数、存在高脂血症、手术时间、术后并发移植肾功能延迟恢复(DGF)、术前末次血清钾、术前末次血清肌酐、霉酚酸类药物种类和吸烟史差异均有统计学意义(t/χ²＝4.100、2.441、2.548、3.688、4.076、－2.197、2.755、7.530和－2.135，P均<0.05)。多因素Logistic回归分析示，住院时间(OR＝1.062，95%CI: 1.008~1.118)，存在高脂血症(OR＝2.796，95%CI: 1.427~5.478)、手术时间(OR＝1.023，95%CI：1.010~1.036)、术后并发DGF(OR＝3.057，95%CI: 1.414~6.607)、术前末次血清钾(OR＝0.556，95%CI: 0.372~0.830)、术前末次血清肌酐(OR＝1.002，95%CI: 1.001~1.003)、应用吗替麦考酚酯(OR＝7.493，95%CI：3.528~15.913)和有吸烟史(OR＝2.167，95%CI: 1.102~4.259)均为肾移植术后并发腹泻独立危险因素(P均<0.05)。

西北地区肾移植受者术后腹泻受多种因素影响，深入理解这些因素有助于制订更具针对性的防治策略。

To evaluate the risk factors and clinical diagnosis and treatment strategies for post-kidney-transplantation diarrhea in the Northwest China.

A retrospective analysis was conducted among 230 kidney transplant recipients from the Department of Urology, the First Affiliated Hospital of Air Force Medical University from January 2019 to December 2024. Recipients were divided into the diarrhea group (n=72) and non-diarrhea group (n=158). General information and treatment of the recipients were recorded. Comparisons were made using the group t-test for normally distributed continuous variables, and the chi-square test was used for categorical variables. Variables significant at P<0.05 in univariate analysis were included in multivariate Logistic regression analysis. Statistical significance was set at P<0.05.

Among the 67 recipients (93.1%) with acute diarrhea, overall renal impact and clinical outcomes were relatively mild. Of these acute cases, 2 had SARS-CoV-2 infection, 1 had CMV infection, and 1 had positive fecal transferrin. Chronic diarrhea occurred in 5 cases (6.9%): 1 recipient died of severe hypokalemia; 3 recipients experienced deterioration of renal function, with 2 developed focal segmental glomerulosclerosis and IgA nephropathy recurrence who gradually leading to graft failure and returning to dialysis; 1 maintained stable serum creatinine of 200-300 μmol/L; 1 achieved completely recovery after treatment. Among the 5 cases with chronic diarrhea, 1 had CMV infection, 2 had positive fecal occult blood, and 1 had clostridioides difficile infection. Diarrhea occurred beyond the first year posttransplant in 12 cases (16.7%), while the remaining cases manifested within the first year after transplantation. Significant differences were observed between groups in duration of hospital stay, body mass index, presence of hyperlipidemia, operation time, complicated with delayed graft function (DGF) after transplantation, last preoperative serum potassium and creatinine, mycophenolic acid type and smoking history (t/χ²=4.100, 2.441, 2.548, 3.688, 4.076, -2.197, 2.755, 7.530 and -2.135, all P<0.05). The results of multivariate Logistic regression analysis showed that hospital stay (OR=1.062, 95% CI: 1.008-1.118), hyperlipidemia (OR=2.796, 95% CI: 1.427-5.478), operation time (OR=1.023, 95% CI: 1.010-1.036), postoperative DGF (OR=3.057, 95% CI: 1.414-6.607), last preoperative serum potassium (OR=0.556, 95% CI: 0.372-0.830), last preoperative serum creatinine (OR=1.002, 95% CI: 1.001-1.003), application of mycophenolate mofetil (OR=7.493, 95% CI: 3.528-15.913), and smoking history (OR=2.167, 95% CI: 1.102-4.259) were all independent risk factors for diarrhea after kidney transplantation (all P<005).

Post-kidney transplantation diarrhea is influenced by multiple complex factors in Northwest China. In-depth understanding of these factors may facilitate the development of targeted and precise prevention and treatment strategies.