肾移植术后一年体质量指数对慢性移植物肾病的影响

目的 研究肾移植患者术后1年体质量指数(BMI)对慢性移植物肾病(CAN)的影响.方法 肾移植术受者564例,依据BMI分3组:①I组:18.5≤BMI≤25(正常);②Ⅱ组:25＜BMI≤30(超重);③Ⅲ组,BMI＞30(肥胖).比较各组术后高血压、糖尿病、CAN等发生情况.结果 各组术后1年的BMI均较术前增加,其中Ⅱ、Ⅲ组与术前比较差异有统计学意义(P值分别＜0.05和0.01).3组CAN发生率分别为34.9%(128/367)、38.4%(48/125)、43.1%(31/72),术后1年随着BMI的升高而增加,Ⅲ组与Ⅰ组比较差异有统计学意义(P＜0.05);高血压、糖尿病和高脂血症的发病率随着BMI升高而增加,Ⅲ组与Ⅰ组高血压、糖尿病和高脂血症的发生率分别为30.6%(22/72)和21.0%(77/367)、26.4%(19/72)和15.8%(58/367)、29.2%(21/72)和18.1%(66/367),2组比较差异有统计学意义(P＜0.05);急性排斥反应发生率:Ⅰ组26.4%(97/367),Ⅱ组25.6%(32/125),Ⅲ组22.2%(16/72),3组之间急性排斥反应发生率比较差异无统计学意义(P＞0.05).结论 肾移植患者术后1年BMI和CAN的发生密切相关,通过饮食控制、适当体育锻炼、免疫抑制剂减量等措施可以控制移植后BMI,进而最大限度降低CAN的发生.

Effect of one-year post transplant body mass index on chronic allograft nephropathy in renal transplant recipients

Objective To evaluate the effect of body mass index(BMI)at 1 year after renal transplantation on chronic allograft nephropathy(CAN).Methods 564 patients received kidney transplants between June 1997 and March 2005 were grouped according to their body mass index (BMI)at 1 year after transplantation into three groups;group Ⅰ,BMI more than 18.5 and less than or equal to 25(normal weight);group Ⅱ,BMI greater than 25 and less than or equal to 30(overweight);and group Ⅲ,BMI greater than 30(obese).All selected patients were retrospectively studied.Results One year post transplant BMIs were more than that of preoperation in all groups.The BMIs in Group Ⅱ and Ⅲ were significantly increased than before operation(P＜0.05 and P＜0.01).The CAN incidence rates in 3 groups were 34.9%(128/367),38.4%(48/125)and 43.1%(31/72),respectively.There was a statistically significant difference in CAN between group Ⅰ andⅢ(P＜0.05).With the increase of one-year post transplant BMI,hypertension.diabetes mellitus and hyper-lipidemia rates increased in group Ⅲ and Ⅰ,30.6%(22/72)and 21.0%(77/367),26.4%(19/72)and 15.8%(58/367),29.2%(21/72)and 18.1%(66/367)respectively.There was a statistically sig-nificant difference in one-year post transplant BMI,hypertension,diabetes mellitus and hyperlipidemiarates between group Ⅲ and I(P＜O.05).Acute rejection rate was 26.4%(97/367),25.6%(3z/125),22.2%(16/72)respectively in these three groups.There was no difference in acute rejection rate among these three groups. Conclusions1 year BMI after kidney transplantation has a strong association with CAN.Controlling diet,proper exercises and decrease of immunosuppressiVe agent could help in control of BMI and then decreases the CAN incidence.