肾移植术后人肾存活患儿生长发育的队列研究

目的探讨儿童肾移植后生长发育的临床特征及影响移植后追赶性生长的因素。方法收集2017年7月至2019年11月由广州市妇女儿童医疗中心和中山大学附属第一医院合作进行肾移植手术的受者术后随访的病历资料，生长发育指标：身高生长速率（ΔHtSDS）、末次身高标准差（HtSDS），生存指标：血肌酐、血清白蛋白、Hb、血钙、血磷、尿蛋白/肌酐、尿RBC计数、血压，并发症，用药情况（糖皮质激素、免疫抑制剂、降压药和骨化三醇等）。结果接受移植术受者18例，中位随访时间17.5（11，24.5）月，肾移植后第1年ΔHtSDS为0.8（0.1，1.2），追赶率为61%，第2年ΔHtSDS为-0.1（-03，0.4），末次随访HtSDS为-1.94±0.99，达标率50%。HtSDS移植前与末次随访呈正相关（r=0.64，P=0.005），与随访12个月时的ΔHtSDS呈负相关（r=-0.61，P=0.008）。随访期人肾存活率均100%，8例出现并发症，其中3例重症感染、4例抗体介导性排异反应、1例原发肾病复发。糖皮质激素（GC）累积量（143.6±86.6）mg·kg-1，每天剂量为（0.30±0.15）mg·kg-1，使用降压药10例，骨化三醇9例。多因素分析显示，移植前HtSDS、移植年龄和血压是肾移植后身高追赶性生长的危险因素，降压药的使用是身高追赶性生长的独立保护因素。结论肾移植受者术后随访终点身高低于同年龄同性别正常儿童身高2个标准差，移植前较低的HtSDS、较小的移植年龄及正常低限的平均动脉压是儿童肾移植后提高ΔHtSDS的有利因素，降压药的使用是肾移植后身高追赶性生长的保护因素。

Growth and development of children with graft survival after kidney transplantation: A cohort study

ObjectiveTo explore the clinical characteristics of growth and development, and the factors influencing the catch-up growth of pediatric recipients after kidney transplantation. MethodsFrom July 2017 to November 2019, Guangzhou Women and Children's Medical Center and the First Affiliated Hospital of Sun Yat-sen University cooperated to carry out children's kidney transplantation. A retrospective analysis of the children's follow-up medical records who had received the transplantation operation included growth indexes of height growth rate (Δ HtSDS) and last height standard deviation (HtSDS), survival indicators of serum creatinine, serum albumin, Hemoglobin, serium calcium, serium phosphorus, urine protein/creatinine, urine RBC and blood pressure, complications and medication conditions such as glucocorticoids, immunosuppressants, antihypertensive drugs and calcitriol, etc. ResultsEighteen cases were involved in the study with the median follow-up time of 17.5（11, 24.5） months. Data showed that Δ HtSDS was 0.8 (0.1, 1.2) with the catch-up rate of 61% during the 1st post-transplant year, and at the 2nd year Δ HtSDS was -0.1 (0.3, 0.4) and the last HtSDS during the follow-up was -1.94±0.99 with 50% of control rate. The baseline HtSDS correlated positively with the terminal HtSDS during the follow-up （r=0.64,P=0.005） and correlated negatively with Δ HtSDS at the 12th month of follow-up (r=-0.61，P=0.008). The patient and allograft survival rates were 100% during the follow-up, and there were 8 cases of complications, including 3 cases of severe infection, 4 cases of antibody mediated rejection and 1 case of primary nephropathy recurrence. The cumulative amount of glucocorticoid (GC) was (143.6±86.6) mg·kg-1, and the daily dose was (0.30±0.15) mg·kg-1. Ten cases were treated with antihypertensive drugs and 9 cases were treated with calcitriol. Multiple factor analysis showed that for catch-up growth, HtSDS of baseline, transplantation age and blood pressure were risk factors, while the use of antihypertensive drugs was an independent protective factor. ConclusionThe height at the end of follow-up after kidney transplantation was significantly improved compared with that before transplantation. The lower HtSDS of the pre-transplantation，the younger transplantation age and the lower normal blood pressure were the favorable factors for promoting Δ HtSDS of children after transplantation. The use of antihypertensive drugs was an independent protective factor for post-transplantation catch-up growth .