肾移植长期受者贫血的特征及相关因素分析

目的 分析肾移植长期受者贫血的特征及其影响因素。 方法 以肾移植长期受者258例为研究对象，总结贫血的性质和发生率，分析贫血与红细胞生成素（EPO）、肾小管功能、肾功能、排斥反应、免疫抑制药物及心脑血管并发症的关系。 结果 258例均为首次肾移植受者，贫血的总发生率为41.1％。受者大部分为正细胞正色素性贫血，少部分为小细胞低色素性贫血，极少部分为溶血性贫血。贫血受者中，大部分为EPO缺乏，少部分为EPO抵抗。受者的血红蛋白（Hb）与估算肾小球滤过率（eGFR）、肌酐清除率（Ccr）呈正相关（r = 0.348， P ＜ 0.01；r = 0.351，P ＜ 0.01）；与N-乙酰氨基葡萄糖苷酶（NAG）呈负相关（r = -0.327，P ＜ 0.01）。在Scr正常的情况下，贫血组肾小管病变比非贫血组严重。贫血受者急、慢性排斥反应的发生率显著高于非贫血受者（P ＜ 0.01)。环孢素+硫唑嘌呤+泼尼松方案（CsA+Aza+Pred ）贫血的发生率为69.0％；环孢素+霉酚酸酯+泼尼松方案（CsA+MMF+Pred）贫血的发生率为35.8％；他可莫司+霉酚酸酯+泼尼松方案（FK506+MMF+Pred)贫血的发生率为34.8％；西罗莫司（雷帕霉素）+霉酚酸酯+泼尼松方案 （SRL+MMF+Pred）贫血的发生率为41.7％。骨髓抑制是硫唑嘌呤最常见的不良反应。Hb与硫唑嘌呤的使用时间呈负相关（r = -0.354，P ＜ 0.01)；Hb与霉酚酸酯的剂量（2~3 g/d）及使用时间呈负相关（r = -0.285，P ＜ 0.05；r = -0.372，P ＜ 0.01）；Hb与雷帕霉素的剂量（2~5 mg/d）及使用时间呈负相关（r = -0.278，P ＜ 0.05； r = -0.359，P ＜ 0.01）。贫血受者心脑血管病变发生率显著高于非贫血受者（P ＜ 0.01）。 结论 肾移植长期受者贫血的发生率相当高。贫血不仅与肾功能、肾小管间质病变相关，而且也与EPO、排斥反应、免疫抑制药物相关。贫血是肾移植受者出现心脑血管并发症的高危因素。

Characteristics and correlation analysis of anemia in long-term renal transplant recipients

Objective To analyze the characteristics and relevant factors of anemia in long-term renal transplant recipients.Methods Two hundred and fifty eight long-term renal transplant recipients were enrolled in the study.The incidence and character of anemia was investigated.The correlation of anemia with EPO,tubular function,renal function,reject reaction,immunosuppressive drugs and cardiocerebrovascular complications was also analyzed.Results In above 258 recipients,the incidence of anemia was 41.1%.Most cases were normocyte and normochromic,some cases were microcytic hypochromic,and some cases were hemolytic anemia.In these anemic recipients,most cases were short of EPO,and some were EPO-resistance.The hemoglobin(Hb)level in anemic recipients was positively correlated with eGFR(r=0.348,P<0.01)and Ccr(r=0.351,P<0.01),while was negatively correlated with NAG(r=-0.327,P<0.01).When renal function was normal,tubulointerstitial damage was more severe in recipients with anemia as compared to those without anemia.The incidences of acute and chronic rejection were higher in recipients with anemia as compared to those without anemia(P<0.01).The incidence of anemia in CsA+Aza+Pred treatment was 69.0%; in CsA+MMF+Pred treatment was 35.8%; in FK506+MMF+Pred treatment was 34.8%; in SRL+MMF+Pred treatment was 41.7%,respectively.Marrow suppression was the commom adverse reaction of Aza.The Hb level in anemic recipients was negatively correlated with using time of Aza(r=-0.354,P<0.01); was negatively correlated with dose and using time of MMF(MMF 2-3 g/d,r=-0.285,P<0.05; r=-0.372,P<0.01); was negatively correlated with dose and using time of SRL(SRL 2-5 mg/d,r=-0.278,P<0.05;r=-0.359,P<0.01).The incidence of cardiocerebrovascular complication was higher in recipients with anemia as compared to those without anemia(P<0.01).Conclusions The incidence of anemia in long-term renal transplant recipients is quite high,which is not only correlated with tubular function and renal function,but also with EPO,reject reaction and immunosuppressive drugs.Anemia is a risk factor of cardiocerebrovascular complications in renal transplant recipients.