关于活体肾移植术前后矿物质代谢的单中心研究

发布时间：2018-10-22 15:08

【摘要】：目的：研究活体肾移植术后肾功能及矿物质代谢指标变化趋势；对肾移植术后血清矿物质进行相关因素分析；探讨术前甲状旁腺激素对术后血清矿物质的影响。方法：回顾性分析了活体肾移植术后3年内血清总钙、校正钙和无机磷的水平。记录共297人移植前和移植后1天、7天、1月、3月、6月、12月、24月、36月的血清总钙、校正钙和血清无机磷的水平,ALP,白蛋白,尿素氮和肌酐,eGFR。其中有术前PTH检测数据者219人,以600pg/ml为界分为高PTH组34人和非高PTH组185人。比较两组受者移植后不同时间点血清钙磷水平的差异,并对肾移植术后血清矿物质进行相关因素分析。结果：肾功能在肾移植术后1周内基本上即达到平台期。血清总钙、校正钙在肾移植术后呈现双相：术后迅速下降后,又紧接着上升,后总体上为缓慢下降趋势。术后高钙血症在一年内和一年后的发生率分别为8%和3%。肾移植后无机磷水平在围手术期急剧下降,后逐渐上升,在术后3月达到一稳定水平。在术后早期低磷血症发生率为37%,后逐渐下降至16%左右。总体上而言,术后血钙水平与术前透析时间、术前PTH水平、术前血钙水平正相关,与术后肌酐负相关；术后血磷水平与术前透析时间、术前PTH水平负相关。高PTH组和非高PTH组一般信息中的各指标和肾移植前后各时间点两组血清肌酐、尿素、eGFR均无统计学差异,两组术前血清总钙、校正钙、无机磷、高钙血症发生率和低磷血症发生率也无统计学差异。肾移植后,总体上高PTH组血清总钙、校正钙水平大于非高PTH组,高PTH组血清无机磷水平低于非高PTH组,高PTH组高钙血症发生率、低磷血症发生率大于非高PTH组。结论：钙磷代谢异常在肾移植术后会长期存在,常见为高钙血症和低磷血症。其发生率在术后早期较高,后逐渐降低。术后钙磷水平与术前透析时间、术前PTH、术前钙磷水平、同期肾功能情况有关。术前中重度甲状旁腺功能亢进会增加术后长期血钙、血清碱性磷酸酶水平,降低血磷水平,增加术后长期高钙血症和低磷血症的发生率。
[Abstract]:Objective: to study the change trend of renal function and mineral metabolism after renal transplantation, to analyze the related factors of serum mineral matter after renal transplantation, and to explore the effect of parathyroid hormone on serum mineral after renal transplantation. Methods: the levels of serum total calcium, corrected calcium and inorganic phosphorus in 3 years after live kidney transplantation were analyzed retrospectively. Serum total calcium, adjusted calcium and serum inorganic phosphorus levels, ALP, albumin, urea nitrogen and creatinine, eGFR. were recorded in 297 patients before and 1 day, 7 days, 1 day, 3 months, 6 months, 12 months, 24 months and 36 months after transplantation. Among them, 219 cases were detected by PTH before operation. According to 600pg/ml, 34 patients were in high PTH group and 185 in non-high PTH group. To compare the difference of serum calcium and phosphorus levels between the two groups at different time points after transplantation, and to analyze the related factors of serum mineral matter after renal transplantation. Results: the renal function reached the plateau stage within 1 week after renal transplantation. Serum total calcium and corrected calcium showed biphasic changes after renal transplantation. The incidence of hypercalcemia in one year and one year after operation was 8% and 3%, respectively. After renal transplantation, the level of inorganic phosphorus decreased sharply during perioperative period, then increased gradually, and reached a stable level at 3 months after renal transplantation. The incidence of hypophosphatemia was 37% at the early postoperative stage, and then decreased to about 16%. Generally speaking, postoperative serum calcium level was positively correlated with preoperative dialysis time, preoperative PTH level, preoperative serum calcium level, and negatively correlated with postoperative creatinine. Postoperative serum phosphorus level was negatively correlated with preoperative dialysis time and preoperative PTH level. There was no significant difference in serum creatinine, urea and eGFR between the two groups before and after renal transplantation. The serum total calcium, corrected calcium, inorganic phosphorus were not significantly different between the two groups before and after renal transplantation. There was no significant difference in the incidence of hypercalcemia and hypophosphatemia. After renal transplantation, the total serum calcium and corrected calcium levels in the high PTH group were higher than those in the non-high PTH group, the level of serum inorganic phosphorus in the high PTH group was lower than that in the non-high PTH group, and the incidence of hypercalcemia and hypophosphatemia in the high PTH group was higher than that in the non-high PTH group. Conclusion: abnormal calcium and phosphorus metabolism may exist for a long time after renal transplantation, and hypercalcemia and hypophosphatemia are common. The incidence rate was higher at the early postoperative stage, and then decreased gradually. Postoperative calcium and phosphorus levels were correlated with preoperative dialysis time, preoperative calcium and phosphorus levels before PTH, and renal function at the same time. Preoperative moderate and severe hyperparathyroidism could increase long-term serum calcium, serum alkaline phosphatase level, decrease serum phosphorus level, and increase the incidence of long-term hypercalcemia and hypophosphatemia.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

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