边缘供肾在亲属活体肾移植中应用的临床效果分析

发布时间：2018-04-05 14:16

本文选题：边缘供肾　切入点：亲属活体肾移植　出处：《新乡医学院》2017年硕士论文

【摘要】：背景随着外科技术的提高、移植免疫基础研究的进展以及新型免疫抑制剂的不断问世,肾移植已成为终末期肾病(end-stage renal disease,ESRD)患者的最佳替代治疗方法。自1954年首例肾移植手术在人体成功开展至今,肾移植已经挽救了无数ESRD患者的生命。随着供肾来源的短缺与等待肾移植患者人数不断增加的矛盾日益加剧,亲属活体肾移植已成为解决供肾来源短缺的重要途径之一。据不完全统计,每年我国肾移植数7000~8000例次,其中活体肾移植约占20%左右,但与世界发达国家活体肾移植相比差距仍然较大。除受经济状况及传统观念等的影响外,严格的供体筛选标准,将患有肾脏或非肾脏良性疾病以及受年龄偏大等一系列问题影响的供体排除在外,从而造成供肾资源的浪费。因此如何合理安全地利用这类边缘供体,从而有效缓解活体供肾短缺的矛盾,越来越受到人们的关注。目的探讨边缘供肾在严格控制筛选标准后,在亲属活体肾移植中应用的临床效果,为临床工作者提供有利的选择依据。方法随机选择2012年1月1日至2014年3月1日郑州人民医院器官移植中心施行亲属活体肾移植手术的受者200例。根据供体情况,分为边缘供肾组与标准供肾组。将边缘供肾组设为研究组,共60例。将标准供肾组设为对照组,共140例。研究组中供体年龄≥60岁18例;肥胖供体(BMI≥28kg/m2)10例;高血压供体10例;糖尿病供体8例;供肾动脉轻中度狭窄10例,,病变部位均位于肾动脉起始部;供肾合并结石2例,结石直径分别为2mm、4mm;供肾合并囊肿2例,囊肿直径分别为10mm、15mm。规律随访36m,对两组受体临床资料进行回顾性分析。比较两组受体肾移植术后1周、1、3、6、12、24、36个月肾小球滤过率估计值(glomerular filtration rate estimates,e GFR),术后肝功能异常,急性排斥反应,移植肾功能恢复延迟(delayed graft function,DGF),肺部感染,外科并发症等术后并发症的发生率,以及1年、3年人/移植肾生存率情况。结果研究组中受体术后各个随访点e GFR水平均低于对照组。受体术后1周e GFR水平与对照组相比,差异具有统计学意义(t=1.762,P0.05)。研究组受体术后1、3、6、12、24、36个月e GFR水平与对照组受体相比,差异不具有统计学意义(t=1.143、P0.05,t=1.281、P0.05,t=1.681、P0.05,t=1.262、P0.05,t=1.131、P0.05,t=1.331、P0.05);研究组受体与对照组受体术后1年、3年生存率分别为98.3%/100%、94.9%/98.6%,两组相比差异均无统计学意义(χ2=2.311、P0.05,χ2=2.234、P0.05)。研究组受体与对照组受体术后移植肾1年、3年生存率分别为98.3%/99.3%、91.6%/96.4%,两组相比差异均无统计学意义(χ2=2.946、P0.05,χ2=2.017、P0.05);研究组受体与对照组受体术后肝功能损害、急性排斥反应、DGF、肺部感染、外科并发症发生率方面,两组相比差异均无统计学意义(χ2=1.159、P0.05,χ2=1.685、P0.05,χ2=2.681、P0.05,χ2=1.184、P0.05,χ2=1.492、P0.05)。结论边缘供肾受体术后早期临床效果是理想的,但应严格控制其纳入的标准。边缘供肾对于受体长期移植肾功能的影响,尚需要继续观察。在当前供肾需求紧张的情况下,边缘供肾可选择性的作为扩大活体供肾来源的有效途径之一。
[Abstract]:Background: with the improvement of surgical technique, the progress of basic research on transplantation immunity and novel immunosuppressive agents have been developed, kidney transplantation has become the end-stage renal disease (end-stage renal, disease, ESRD) the best alternative treatment for the patients with renal transplantation. Since 1954, the first in the human body successfully carried out so far, kidney transplantation has saved countless patients with ESRD life. With the contradiction between the shortage of donor kidney from renal transplant patients and wait for the increasing number of growing, living related kidney transplantation has become one of the important ways to solve the shortage of donor sources. According to incomplete statistics, China's annual number of 7000~8000 cases of renal transplantation, the living donor kidney transplantation accounted for about 20%, but with the world developed countries living kidney transplantation compared to the gap is still large. In addition to the economic situation and the traditional concept of the donor, the strict screening criteria, the kidney or kidney Benign disease and donor age affected by a series of problems such as excluded, resulting in kidney wasting. So how to reasonable and safe use of this type of marginal donor, so as to effectively alleviate the contradiction between the shortage of donor kidney, people pay more and more attention. To explore the edge of donor kidney in the strict control of the screening criteria after the clinical application effect in living related kidney transplantation in the selection provide advantageous basis for clinical workers. 200 cases of recipients of organ transplantation center of Zhengzhou people's Hospital from January 1, 2012 to March 1, 2014 the implementation methods of living relative kidney transplantation surgery. According to the donor, divided into marginal donor group and standard donor group. The edge donor group for the study group, a total of 60 cases. The standard donor group as control group, 140 cases in the study group. 18 cases of donor age more than 60 years old; obese donor (BMI = 28kg/m2) and 10 cases of high; Blood donor in 10 cases; 8 cases of diabetic donor; renal artery stenosis in 10 cases, mild to moderate, lesions were located in the renal artery; for 2 cases of renal calculi, stone diameter were 2mm and 4mm; for kidney with cyst in 2 cases, cyst diameter were 10mm, 15mm. rules for clinical follow-up of 36m. Data of two groups were retrospectively analyzed. 1 weeks between the two groups after renal transplantation, 1,3,6,12,24,36 months estimated glomerular filtration rate (glomerular, filtration rate estimates, e GFR), postoperative liver function abnormalities, acute rejection, graft function recovery delay (delayed graft function, DGF), pulmonary infection the incidence of surgical complications, postoperative complications, and 1 years, 3 years of patient / graft survival rate. The results of each follow-up point receptor in the study group after e GFR average water is lower than the control group. After 1 weeks of E receptor GFR levels compared with the control group, the difference has statistics Statistically significant (t=1.762, P0.05). The study group of recipients after 1,3,6,12,24,36 months e GFR receptor levels compared with control group, the difference was not statistically significant (t=1.143, P0.05, t=1.281, P0.05, t=1.681, P0.05, t=1.262, P0.05, t=1.131, P0.05, t=1.331, P0.05); the study group and the control group receptor receptor after 1 years, 3 years survival rate were 98.3%/100%, 94.9%/98.6%, the difference between the two groups were not statistically significant (x 2=2.311, P0.05 x 2=2.234, P0.05). The study group and the control group receptor of recipients after renal transplantation for 1 years, 3 years survival rate were 98.3%/99.3%, 91.6%/96.4%, the difference between the two groups were no statistically significant (x 2=2.946, P0.05 x 2=2.017, P0.05); the study group and the control group of liver function damage receptor receptor after acute rejection, DGF, pulmonary infection, surgical complications, the difference between the two groups were not statistically significant (x 2=1.159, P0.05 x 2=1.685, P0.05, X 2=2.681, P0.05 x 2=1.184, P0.05 x 2=1.492, P0.05). Conclusion the clinical effect of early renal marginal donor receptor after surgery is ideal, but should be strictly controlled into standard. Influence of edge donor for the receptor to long-term graft function, still need to continue to observe. In the current tense situation for renal demand under the edge of donor kidney can be selectively as one of the effective ways to enlarge the source of living donor kidney.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2

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