肾移植术后代谢综合征发病率及其危险因素临床研究

目的 调查肾移植术后代谢综合征(MS)发病率,初步探讨肾移植术后代谢综合征发病机制.方法 前瞻性观察292例肾移植受者,纳入的观察对象在移植术后6个月内未曾发生急性排斥、钙调蛋白抑制剂(CNI)毒性反应和严重感染,术后6个月尿常规及肾功能正常,移植前终末期肾衰竭(ESRF)原发病为慢性肾小球肾炎,无糖尿病史.1年后进行血、尿生化及体格检查,并计算体重身高指数(BMI).随机抽取普通社区居民200例作为对照.结果 肾移植受者术后Ms发病率为25.7%,显著高于普通社区人群的15%.男性肾移植受者MS发病率高于女性受者.环孢素+骁悉+强的松治疗组MS发病率高于普乐可复+骁悉+强的松治疗组,但差异无显著意义.环孢素维持剂量>200mg/d的肾移植受者MS发病率显著高于环孢素剂量≤200mg/d的肾移植受者.普乐可复维持剂量>2mg/d的肾移植受者MS发病率显著高于普乐可复剂量≤2mg.d的肾移植受者.肾移植受者中超重和肥胖的发病率与普通社区居民无显著差异,超重和肥胖的肾移植受者与超重和肥胖的普通社区居民比较,其MS发病率也无显著差异.结论 本研究结果表明肾移植术后MS发病率显著增加,提示MS系慢性移植肾肾病(CAN)非免疫性危险因素;本研究结果还提示男性、环孢素维持剂量>200mg.d-1、普乐可复维持剂量>2mg.d-1是肾移植术后MS发病的危险因素,而超重和肥胖不是本研究中肾移植受者术后MS发病率增加的主要因素.

Clinical Study of the Incidence and Pathogenesis of Metabolic Syndrome after Kidney Transplantation

Objectives To investigate the incidence and risk factors of metabolic syndrome(MS) in patients after renal transplantation.Methods 292 renal transplant recipients who had not undergone acute rejection,calcinurine intoxication and severe infection.and had normal renal function and no proteinuria at the 6th month post -transplantation,were involved in the study.They had a history of chronic glomerulonephritis as the primary diseaseof ESRF but no diabetes mellitus.One year after,blood and urine biochemical determinations and physical examination were performed in the recipients,and BMI calculated.200 community residents were randomized selected as controls.Results The incidence of MS in the recipients Was 25.7%,significantly higher than controls(15%).There Was no difference between the incidence of MS in recipients treated with cyclosporine+MMF+prednisone and recipients treated with tacrolimus+MMF+prednisone.The incidence in recipients respectively treated with cyclospo rine at a maintain dosage＞200mg/d or tacrolimus al a maintain dosage＞2mg/d Was markedly higher,compared to cyclosperine at a maintain dosage≤200mg/d or tacrolimus at a maintain dosage≤2mg/d.There was no significant difference between the incidence of obesity or overweight in the recipients and community residents.ConclusionsIt is suggested by the significantly increased incidence of MS that MS might increase the non-immune risk factorsof CAN.It is indicated that,after renal transplantation.male sex and maintain dosage of cyelosporine＞200mg.d1 or a maintain dosage of tacrolimus＞2mg.d-1 are the risk factors of MS after renal transplantation,while obesity and overweiight are not the main factors related to the increased incidence of MS in the sutdy.