肾功能衰竭肾移植治疗患者腹膜形态的变化及意义

发布时间：2018-03-16 01:27

本文选题：肾功能衰竭　切入点：肾移植　出处：《广东医学》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨肾功能衰竭肾移植治疗患者腹膜形态的变化及其与术后急性排斥反应和远期预后的关系。方法选取进行肾移植治疗的慢性肾功能衰竭患者68例为移植组,术前患者均采用腹膜透析1年以上,另选取同期行血液透析治疗的慢性肾功能衰竭患者30例为对照组,同期进行腹膜活检的健康志愿者10例为健康组。观察腹膜活检标本的形态,以健康组腹膜形态为正常标准,分析移植组腹膜形态正常率和异常率。采用Kaplan Meier生存曲线分析随访3年期间的人/肾生存率,并比较移植组不同腹膜形态患者的术后急性排斥反应发生率和术后1、3年人/肾存活率。采用Spearman秩相关分析法和logistic多因素回归分析法分析肾功能衰竭肾移植治疗患者腹膜形态与其术后急性排斥反应和远期预后的关系。结果对照组患者均无腹膜形态的明显变化,移植组58例(85.29%)患者存在腹膜形态异常。移植组中,与术前腹膜形态正常患者比较,术前腹膜形态异常患者急性排斥反应的发生率升高,术后1、3年人/肾存活率则均降低(P0.05)。Spearman秩相关分析结果显示肾功能衰竭肾移植治疗患者腹膜形态异常与其术后急性排斥反应发生率无明显的相关性(r=0.342,P0.05),与其术后1、3年人/肾存活率则呈负相关(r=-0.752、-0.783,P0.05)。Logistic多因素分析结果显示,腹膜形态为肾功能衰竭肾移植治疗患者术后1年和术后3年人/肾存活率的独立影响因素。结论肾功能衰竭肾移植治疗前采用腹膜透析常可导致腹膜形态的改变,而其腹膜形态可明显影响患者的预后情况,这可能与腹膜透析破坏对腹腔内环境维持具有重要作用的间皮细胞而移植肾的存活受腹腔内环境影响较大有关。因此肾功能衰竭患者肾移植术前应尽量减少腹膜透析,改用血液透析或其他维持治疗方法,防止腹膜形态异常及不良预后的发生。
[Abstract]:Objective to investigate the changes of peritoneal morphology and its relationship with postoperative acute rejection and long-term prognosis in patients with renal failure after renal transplantation. Methods Sixty-eight patients with chronic renal failure undergoing renal transplantation were selected as transplantation group. All patients were treated with peritoneal dialysis for more than one year before operation. 30 patients with chronic renal failure who were treated with hemodialysis were selected as control group. Ten healthy volunteers who performed peritoneal biopsy at the same time were healthy group. The morphology of peritoneal biopsy specimen was observed, and the normal form of peritoneal biopsy was taken as normal standard. Kaplan Meier survival curve was used to analyze the survival rate of human / kidney during the follow-up period of 3 years. The incidence of postoperative acute rejection and 1,3-year survival rate were compared in patients with different peritoneal morphology in the transplantation group. Spearman rank correlation analysis and logistic multivariate regression analysis were used to analyze the renal transplantation patients with renal failure. Results there were no significant changes in peritoneal morphology in the control group. In the transplantation group, the incidence of acute rejection in the patients with abnormal peritoneal morphology was higher than that in the patients with normal peritoneal morphology before operation. The results of rank correlation analysis showed that there was no significant correlation between the abnormal peritoneal morphology and the incidence of postoperative acute rejection in patients with renal failure, and there was no significant correlation between the rate of postoperative acute rejection and that of 1, 3 years postoperatively. The results of logistic multivariate analysis showed that the renal survival rate was negatively correlated with r-0.752U -0.783U P0.05N. Peritoneal morphology is an independent factor influencing the human / renal survival rate in patients with renal failure 1 year and 3 years after renal transplantation. Conclusion Peritoneal dialysis before renal failure renal transplantation can lead to the change of peritoneal morphology. However, the peritoneal morphology could significantly affect the prognosis of the patients. This may be related to the destruction of mesothelial cells that play an important role in the maintenance of peritoneal environment and the survival of the transplanted kidney is greatly affected by the peritoneal environment. Therefore, peritoneal dialysis should be minimized before renal transplantation in patients with renal failure. Hemodialysis or other maintenance therapy was used to prevent abnormal peritoneal morphology and poor prognosis.
【作者单位】：海南省农垦总医院泌尿外科;
【基金】：海南省重点科研课题(编号:1421320.27A1004)
【分类号】：R699.2

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