肾癌根治术后肾功能连续变化的趋势研究

发布时间：2018-03-24 08:00

本文选题：肾癌根治术　切入点：肾功能不全　出处：《苏州大学》2014年硕士论文

【摘要】：四十多年以来，，肾癌根治术已作为肾癌的标准治疗方式并取得良好的肿瘤疗效。但随着时间的推移，关于健侧肾脏的肾功能变化越来越得到重视，是渐进性改善还是损害，结论不一，同时诸多临床预后因素如糖尿病、高血压、年龄等因素对肾功能的影响力大小也未知，本研究旨在分析肾癌根治术后患者肾功能的总体恢复趋势，并定量分析不同预后因素对肾功能的影响。研究目的：评估肾癌根治术后临床因素对肾功能的影响以及肾功能的变化趋势，探讨根据不同的预后因素筛查出术后慢性肾病的高危人群，对临床治疗方案的制定提供参考。研究方法：收集苏州大学附属第一医院自2007年开始肾癌根治患者，经严格的入组标准筛选后，分析185例肾癌根治术后的病人，通过连续监测术后的血浆肌酐，用肾脏病饮食调整研究公式（MDRD）计算得出eGFR，以线性混合模型分析术后eGFR的连续变化，以多因素回归分析术后肾功能变化的危险因素。结果：1、到随访截止，总体患者术后肾功能在持续恢复状态，直线斜率为0.099（95%CI：0.07~0.13），表示每月恢复0.099mL·min-1·(1.73m2)-1。2、分析不同临床因素对肾功能恢复的影响时，表明术前存在糖尿病，高血压及高龄（65岁），术后出现eGFR下降或维持在恒定水平，无明显改善。3、肾功能预后良好因素包括：低龄，无高血压、无糖尿病。结论：1、肾癌根治术后肾功能随访6年期间一直处于恢复状态。2、术后肾功能的变化受多种因素的影响，治疗方式的选择是应将诸多因素考虑在内，需充分评估后确定治疗方案。
[Abstract]:For more than 40 years, radical nephrectomy has been the standard treatment for renal cell carcinoma and has achieved good curative effect. However, over time, more and more attention has been paid to the change of renal function of healthy kidney, whether it is progressive improvement or damage. At the same time, the influence of many clinical prognostic factors such as diabetes, hypertension and age on renal function is unknown. The purpose of this study is to analyze the general recovery trend of renal function after radical nephrectomy. The effects of different prognostic factors on renal function were analyzed quantitatively. Objective: to evaluate the influence of clinical factors on renal function and the trend of renal function after radical nephrectomy, and to find out the high risk population of chronic nephropathy according to different prognostic factors, and to provide reference for the formulation of clinical treatment. Methods: 185 patients with renal cell carcinoma were collected from the first affiliated Hospital of Suzhou University in 2007. After screening by strict criteria, 185 patients with renal cell carcinoma after radical nephrectomy were analyzed, and the plasma creatinine levels were continuously monitored. The eGFR was calculated by the formula of diet adjustment in kidney disease. The continuous changes of eGFR were analyzed by linear mixed model and the risk factors of renal function were analyzed by multivariate regression analysis. Results at the end of follow-up, the renal function of the overall patient was in a sustained state of recovery, with a linear slope of 0.09995% 0.07 / 0.13, which indicated that 0.099mL min-1 was restored to 1.73 m ~ (-2) -1.2 per month. The analysis of the effects of different clinical factors on the recovery of renal function showed that diabetes existed before operation. EGFR decreased or maintained at a constant level after operation. There was no significant improvement in renal function. The prognostic factors of renal function included: low age, no hypertension, no diabetes. Conclusion: the renal function has been recovering during the follow-up period of 6 years after radical nephrectomy. The changes of renal function after operation are affected by many factors. The choice of treatment mode should take many factors into account, and the treatment plan should be determined after full evaluation.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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