供肾Remuzzi评分对肾移植受者预后的指导作用

目的分析不同Remuzzi评分供肾移植后受者/移植肾预后情况。 方法回顾性分析武汉大学人民医院2018年11月至2020年8月接受单肾移植的81例受者临床资料。根据供肾Remuzzi评分将81例受者分为低分组(Remuzzi评分0~3分，n＝38)及高分组(43例)(Remuzzi评分4~6分，n＝43)。正态分布计量资料采用两独立样本t检验比较；非正态分布计量资料采用Mann-Whitney U检验比较。计数资料采用χ²检验或Fisher确切概率法比较。采用Graphpad 8.0.2绘制受者/移植肾生存曲线，并采用log-rank检验比较。P<0.05为差异有统计学意义。 结果低分组38例受者供肾Remuzzi评分为(2.23±0.87)分，高分组43例受者供肾Remuzzi评分为(4.56±0.66)分，差异有统计学意义(t＝-13.449，P<0.05)。低分组术后1、3个月血清肌酐分别为(143±92)和(136±75) μmol/L，高分组分别为(138±80)和(123±39) μmol/L，差异均无统计学意义(t＝0.237和1.031，P均>0.05)。低分组术后6个月血清肌酐107.5(60，821) μmol/L]低于高分组113.0 (67，224) μmol/L]，差异有统计学意义(U＝-0.371，P<0.05)。低分组术后1、3和6个月估算肾小球滤过率分别为(60±24)、(59±26)和(61±27)mL/min，高分组分别为(64±25)、(64±21)和(66±20)mL/min，差异均无统计学意义(t＝-0.823、-0.903和-0.756，P均>0.05)。截至2022年2月14日，受者随访时间(29±6)个月(1~36个月)。低分组16例受者(42.1%)移植术后发生移植肾功能延迟恢复(DGF)，高分组12例受者(27.9%)移植术后发生DGF，差异无统计学意义(χ²＝0.180，P>0.05)。两组受者术后生存率差异无统计学意义(χ²＝0.668，P>0.05)。两组受者移植肾存活率差异有统计学意义(χ²＝4.078，P<0.05)。低分组发生DGF、低分组未发生DGF、高分组发生DGF和高分组未发生DGF受者术后生存率及移植肾存活率差异均无统计学意义(P均>0.05)。 结论Remuzzi评分作为供肾病理学评估的重要部分，为肾移植受者术后治疗提供一定指导，评分较高供肾移植后受者也能获得良好预后。

The guiding effect of donor kidney Remuzzi score on the prognosis of kidney transplant recipients

ObjectiveTo analyze the prognosis of kidney recipients and transplanted kidneys after donor kidney transplantation with different Remuzzi scores. MethodsThe clinical data of 81 recipients of single kidney transplantation in Renmin Hospital of Wuhan University from November 2018 to August 2020 were retrospectively analyzed. The recipients were divided into low-scoring group (38 cases, Remuzzi score 0-3 points) and high-scoring group (43 cases, Remuzzi score 4-6 points). Measurement data with normal distribution were compared using two independent samples t test. Measurement data with nonnormal distribution were compared using the Mann-Whitney U test. The counting data were compared using the chi-squared test or fisher′s exact probability method. Graphpad 8.0.2 was used to plot the recipient/transplant kidney survival curve, and the log-rank test was used to compare the survival rate. P<0.05 for the difference was considered statistically significant. ResultsThe donor kidney Remuzzi score of 38 recipients in the low-scoring group was (2.23±0.87) and the donor kidney Remuzzi score of 43 recipients in the high-scoring group was (4.56±0.66), and the difference was statistically significant (t=-13.449, P<0.05). Serum levels of creatinine of the low-scoring group at 1, 3 months postoperatively were (143±92) and (136±75) μmol/L, respectively, while the high-scoring group were (138±80) and (123±39) μmol/L, respectively, and the differences were not statistically significant (t=0.237 and 1.031, all P>0.05). Serum levels of creatinine of the low-scoring group at 6 months after transplantation was 107.5 (60, 821) μmol/L, which was lower than the high-scoring group 113.0 (67, 224) μmol/L], the difference was statistically significant (U=-0.371, P<0.05). The estimated glomerular filtration rates were (60±24), (59±26) and (61±27) mL/min at the 1, 3, and 6 months after surgery in the low-scoring group, and the high-scoring group were (64±25), (64±21) and (66±20) mL/min, respectively, and the differences were not statistically significant (t=-0.823, -0.903 and -0.756, all P>0.05). The recipients were followed up for (29±6) months (1-36 months) by February 14, 2022. Delayed graft function (DGF) occurred in 16 recipients in the low-scoring group (42.1%), and DGF occurred in 12 recipients in the high-scoring group (27.9%), and the difference was not statistically significant (χ²=0.180, P>0.05). There was no significant difference in postoperative survival rate of recipients between the 2 groups (χ²=0.668, P>0.05). The difference in transplant kidney survival rate between the 2 groups was statistically significant (χ²=4.078, P<0.05). There were no significant differences in postoperative survival rates and transplanted kidney survival rates among recipients with DGF or without DGF in low-scoring and high-scoring groups (all P>0.05). ConclusionsThe Remuzzi score, as an important part of the assessment of donor renal pathology, provides some guidance for kidney recipients′ later treatment, and donor kidneys with higher scores can also receive a good prognosis for recipients.