超声在肾移植术后肾功能延迟恢复患者随访中的应用

目的分析常规超声在肾移植术后肾功能延迟恢复（DGF）患者随访中的应用。 方法选取2016年10月至2019年10月于苏州大学附属第一医院接受同种异体肾移植的患者158例。根据术后肾功能恢复情况及是否需要血液透析，分为DGF组和早期肾功能恢复（IGF）组，收集患者术后第6、12、18、24、30、36个月的超声检查资料及实验室检查结果。采用χ²检验比较2组患者性别、透析方式、供体死亡原因等计数资料的差异，采用独立样本t检验比较2组患者年龄、供肾冷缺血时间、淋巴细胞毒性实验、血肌酐值、估算肾小球滤过率（eGFR）、移植肾长径、肾动脉阻力指数的差异，采用Mann-Whitney U检验比较2组患者慢性肾病病史时间、透析时间、供肾热缺血时间、移植肾肾动脉峰值流速的差异。 结果DGF组患者48例（31.0%），IGF组患者110例（69.0%），2组患者在性别构成、年龄、慢性肾病病史时间、透析方式、透析时间、供体年龄、供体死亡原因、供肾热缺血时间、淋巴细胞毒性实验等临床特征以及移植肾长径、肾动脉峰值流速等超声特征方面比较，差异均无统计学意义（P均＞0.05）。但是，DGF组供肾的冷缺血时间明显长于IGF组［（15.47±4.90）h vs （13.43±4.43）h］，差异有统计学意义（t=2.534，P=0.012）。术后不同时间点，DGF组患者血肌酐始终高于IGF组，而IGF组的eGFR始终高于DGF组，差异均具有统计学意义（P均＜0.05）。且DGF组的肾动脉阻力指数始终高于IGF组，除了在术后36个月时间点2组之间比较，差异无统计学意义（t=1.932，P=0.063）外，其余时间点2组之间比较，差异均具有统计学意义（P均＜0.05）。 结论肾移植术后DGF的发生对移植肾不同时间点肾功能及肾动脉阻力指数均存在着不良影响，移植肾超声检查参数肾动脉阻力指数可以帮助更好地了解移植肾的状况。

Application of ultrasound in follow-up of kidney transplant patients with delayed graft function

ObjectiveTo evaluate the application value of ultrasound in the follow-up of kidney transplant recipients with delayed graft function (DGF). MethodsA total of 158 patients who received allograft renal transplantation at the First Affiliated Hospital of Soochow University from October 2016 to October 2019 were retrospectively analyzed. According to the postoperative recovery of renal function and the need for hemodialysis, these patients were divided into two groups: DGF group and immediate graft function (IGF) group. Their ultrasonic and laboratory data were collected semiannually. The chi-square test was used to compare the difference of count data such as gender, dialysis method, and cause of donor death between the two groups. The difference of measurement data including age, cold ischemia time of donor kidney, lymphocyte toxicity test, serum creatinine, estimated glomerular filtration rate (eGFR), graft length, and renal artery resistance index (RI) was compared by the independent t-test. Data with a non-normal distribution were compared by the Mann-Whitney U test, including history time of chronic kidney disease, dialysis time, warm ischemia time, and peak flow velocity of transplanted renal artery. ResultAmong the patients included, 48 (31.0%) had DGF and 110 (69.0%) had IGF. There were no differences in gender, age, history of chronic kidney disease, dialysis method and time, donor age, cause of donor death, warm ischemia time, lymphocyte toxicity test, and some ultrasonographic features (P＞0.05 for all). The cold ischemia time in the DGF group was significantly longer than that of the IGF group (15.47±4.90) h vs (13.43±4.43) h, t=2.534, P=0.012]. The level of serum creatinine in the DGF group was persistently higher than that of the IGF group. The eGFR in the IGF group was significantly higher than that of the DGF group at different time points (P＜0.05 for all). The RI in the DGF group was significantly higher than that of IGF group (P＜0.05 for all), except at 3 years after operation (t=1.932, P=0.063). ConclusionThe occurrence of DGF after transplantation leads to worse graft function and higher renal artery resistance index. Ultrasound (renal artery RI) can provide more information about the condition of the transplanted kidneys for clinical evaluation.