肾移植患者肾炎复发对其远期生存时间的影响研究
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摘要
目的研究肾移植患者肾炎复发对其远期生存时间的影响。方法对80例成功完成肾移植患者进行随访观察,根据是否发生肾炎复发将其分为复发组(n=23)与对照组(n=57),比较肾移植后6个月时两组血清肌酐(SCr)、尿素氮(BUN)及24 h尿蛋白定量(24 hUPE)等肾功能指标,并随访两组5年内移植肾存活及患者生存情况。结果本研究术后中位随访时间49(26～74)个月,结果显示,复发肾炎23例(28.75%);复发组SCr、BUN及24 hUPE高于对照组(P <0.05);两组移植肾第1年存活率比较无明显差异(P> 0.05),但复发组第3、5年存活率低于对照组(P <0.05);肾移植后1年及3年,两组生存率无明显差异(P> 0.05),但复发组5年生存率低于对照组(P <0.05)。结论肾炎患者肾移植后肾炎复发率较高,且有较高风险导致移植肾肾功能丧失,并降低患者远期生存时间。
Objective To study the effects of recurrence of nephritis on long-term survival in renal transplant recipients.Methods A total of 80 patients having undergone renal transplantation successfully were followed up and divided into a recurrence group(n=23) and a control group(n=57). The renal function indicators [serum creatinine(SCr), blood urea nitrogen(BUN) and urinary protein after 24 hours(24 hUPE)] were compared six months after the renal transplantation. The survival of transplanted kidneys and patients in the two groups were followed up for five years. Results The median follow-up time of this study was 49(26-74) months.The results showed that 23 cases(28.75%) had recurrent nephritis, and the SCr, BUN and 24 hUPE in the relapsed group were higher than those in the control group(P < 0.05); there was no significant difference in the one-year survival rate between the two groups(P > 0.05), but the three-year and five-year survival rates in the relapsed group were lower than those in the control group(P < 0.05);there was no significant difference in the one-year and three-year survival rates between the two groups(P > 0.05). The five-year survival rate in the relapse group was lower than that in the control group(P < 0.05). Conclusion The recurrence rate of nephritis after renal transplantation is higher in patients with nephritis, and there is a higher risk of renal transplantation failure, with the long-term survival of patients reduced.
Objective To study the effects of recurrence of nephritis on long-term survival in renal transplant recipients.Methods A total of 80 patients having undergone renal transplantation successfully were followed up and divided into a recurrence group(n=23) and a control group(n=57). The renal function indicators [serum creatinine(SCr), blood urea nitrogen(BUN) and urinary protein after 24 hours(24 hUPE)] were compared six months after the renal transplantation. The survival of transplanted kidneys and patients in the two groups were followed up for five years. Results The median follow-up time of this study was 49(26-74) months.The results showed that 23 cases(28.75%) had recurrent nephritis, and the SCr, BUN and 24 hUPE in the relapsed group were higher than those in the control group(P < 0.05); there was no significant difference in the one-year survival rate between the two groups(P > 0.05), but the three-year and five-year survival rates in the relapsed group were lower than those in the control group(P < 0.05);there was no significant difference in the one-year and three-year survival rates between the two groups(P > 0.05). The five-year survival rate in the relapse group was lower than that in the control group(P < 0.05). Conclusion The recurrence rate of nephritis after renal transplantation is higher in patients with nephritis, and there is a higher risk of renal transplantation failure, with the long-term survival of patients reduced.
引文
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[7]文吉秋,王维,徐峰,等.移植肾单克隆IgG相关的增生性肾小球肾炎临床病理特点及预后[J].中华器官移植杂志,2017,38(12):719-725.
[8]郭君其,凌志杰,王科,等.移植肾肾病复发和新发患者的临床病理分析[J].临床泌尿外科杂志,2011,26(1):28-31.
[9]Lionaki S,Panagiotellis K,Melexopoulou C,et al.The clinical course of IgA nephropathy after kidney transplantation and its management[J].Transplant Rev,2017,31(2):106-114.
[10]边琪,何薇,张陵艳,等.单中心自体肾经皮肾穿刺活检临床病理特点的10年总结[J].第二军医大学学报,2017,38(6):788-793.
[11]Plantinga LC,Patzer RE,Drenkard C,et al.Association of Time to Kidney Transplantation with Graft Failure among U.S.Patients with End-Stage Renal Disease Due to Lupus Nephritis[J].Arthritis Care&Research,2015,67(4):571-581.
[12]尤冰,陈劲松.肾移植术后IgA肾病复发[J].肾脏病与透析肾移植杂志,2018,27(1):84-88.
[13]季曙明,倪雪峰,谢轲楠,等.肾移植术后IgA肾病复发并非总是良性预后[J].器官移植,2016,7(2):94-99.
[14]Lenihan CR,Lockridge JB,Tan JC.A new clinical prediction tool for 5-year kidney transplant outcome[J].American Journal of Kidney Diseases,2014,63(4):549-551.
[15]李翠,谢轲楠,周敏林,等.狼疮性肾炎患者肾移植的远期预后[J].肾脏病与透析肾移植杂志,2016,25(4):324-329.
[2]Delville M,Sigdel TK,Wei C,et al.A circulating antibody panel for pretransplant prediction of FSGS recurrence after kidney transplantation[J].Science Translational Medicine,2014,6(256):256ra136.
[3]文吉秋,陈惠萍.肾移植术后常见的复发性肾小球疾病(一)[J].肾脏病与透析肾移植杂志,2012,21(4):384-389.
[4]覶eltik A,Sen S,Tamer AF,et al.Recurrent lupus nephritis after transplantation:clinicopathological evaluation with protocol biopsies[J].Nephrology,2015,21(7):601-607.
[5]Van Stralen KJ,Verrina E,Belingheri M,et al.Impact of graft loss among kidney diseases with a high risk of post-transplant recurrence in the paediatric population[J].Nephrology Dialysis Transplantation,2013,28(4):1031-1038.
[6]黄洪锋,梁倩,兰兰,等.银杏叶提取物对移植肾血流动力学干预及临床保护机制的研究[J].中华器官移植杂志,2015,36(11):652-656.
[7]文吉秋,王维,徐峰,等.移植肾单克隆IgG相关的增生性肾小球肾炎临床病理特点及预后[J].中华器官移植杂志,2017,38(12):719-725.
[8]郭君其,凌志杰,王科,等.移植肾肾病复发和新发患者的临床病理分析[J].临床泌尿外科杂志,2011,26(1):28-31.
[9]Lionaki S,Panagiotellis K,Melexopoulou C,et al.The clinical course of IgA nephropathy after kidney transplantation and its management[J].Transplant Rev,2017,31(2):106-114.
[10]边琪,何薇,张陵艳,等.单中心自体肾经皮肾穿刺活检临床病理特点的10年总结[J].第二军医大学学报,2017,38(6):788-793.
[11]Plantinga LC,Patzer RE,Drenkard C,et al.Association of Time to Kidney Transplantation with Graft Failure among U.S.Patients with End-Stage Renal Disease Due to Lupus Nephritis[J].Arthritis Care&Research,2015,67(4):571-581.
[12]尤冰,陈劲松.肾移植术后IgA肾病复发[J].肾脏病与透析肾移植杂志,2018,27(1):84-88.
[13]季曙明,倪雪峰,谢轲楠,等.肾移植术后IgA肾病复发并非总是良性预后[J].器官移植,2016,7(2):94-99.
[14]Lenihan CR,Lockridge JB,Tan JC.A new clinical prediction tool for 5-year kidney transplant outcome[J].American Journal of Kidney Diseases,2014,63(4):549-551.
[15]李翠,谢轲楠,周敏林,等.狼疮性肾炎患者肾移植的远期预后[J].肾脏病与透析肾移植杂志,2016,25(4):324-329.