發(fā)布時(shí)間：2018-03-16 01:27

  本文選題：腎功能衰竭　切入點(diǎn)：腎移植　出處：《廣東醫(yī)學(xué)》2017年04期 　論文類型：期刊論文

【摘要】：目的探討腎功能衰竭腎移植治療患者腹膜形態(tài)的變化及其與術(shù)后急性排斥反應(yīng)和遠(yuǎn)期預(yù)后的關(guān)系。方法選取進(jìn)行腎移植治療的慢性腎功能衰竭患者68例為移植組,術(shù)前患者均采用腹膜透析1年以上,另選取同期行血液透析治療的慢性腎功能衰竭患者30例為對(duì)照組,同期進(jìn)行腹膜活檢的健康志愿者10例為健康組。觀察腹膜活檢標(biāo)本的形態(tài),以健康組腹膜形態(tài)為正常標(biāo)準(zhǔn),分析移植組腹膜形態(tài)正常率和異常率。采用Kaplan Meier生存曲線分析隨訪3年期間的人/腎生存率,并比較移植組不同腹膜形態(tài)患者的術(shù)后急性排斥反應(yīng)發(fā)生率和術(shù)后1、3年人/腎存活率。采用Spearman秩相關(guān)分析法和logistic多因素回歸分析法分析腎功能衰竭腎移植治療患者腹膜形態(tài)與其術(shù)后急性排斥反應(yīng)和遠(yuǎn)期預(yù)后的關(guān)系。結(jié)果對(duì)照組患者均無腹膜形態(tài)的明顯變化,移植組58例(85.29%)患者存在腹膜形態(tài)異常。移植組中,與術(shù)前腹膜形態(tài)正�；颊弑容^,術(shù)前腹膜形態(tài)異常患者急性排斥反應(yīng)的發(fā)生率升高,術(shù)后1、3年人/腎存活率則均降低(P0.05)。Spearman秩相關(guān)分析結(jié)果顯示腎功能衰竭腎移植治療患者腹膜形態(tài)異常與其術(shù)后急性排斥反應(yīng)發(fā)生率無明顯的相關(guān)性(r=0.342,P0.05),與其術(shù)后1、3年人/腎存活率則呈負(fù)相關(guān)(r=-0.752、-0.783,P0.05)。Logistic多因素分析結(jié)果顯示,腹膜形態(tài)為腎功能衰竭腎移植治療患者術(shù)后1年和術(shù)后3年人/腎存活率的獨(dú)立影響因素。結(jié)論腎功能衰竭腎移植治療前采用腹膜透析�？蓪�(dǎo)致腹膜形態(tài)的改變,而其腹膜形態(tài)可明顯影響患者的預(yù)后情況,這可能與腹膜透析破壞對(duì)腹腔內(nèi)環(huán)境維持具有重要作用的間皮細(xì)胞而移植腎的存活受腹腔內(nèi)環(huán)境影響較大有關(guān)。因此腎功能衰竭患者腎移植術(shù)前應(yīng)盡量減少腹膜透析,改用血液透析或其他維持治療方法,防止腹膜形態(tài)異常及不良預(yù)后的發(fā)生。
[Abstract]:Objective to investigate the changes of peritoneal morphology and its relationship with postoperative acute rejection and long-term prognosis in patients with renal failure after renal transplantation. Methods Sixty-eight patients with chronic renal failure undergoing renal transplantation were selected as transplantation group. All patients were treated with peritoneal dialysis for more than one year before operation. 30 patients with chronic renal failure who were treated with hemodialysis were selected as control group. Ten healthy volunteers who performed peritoneal biopsy at the same time were healthy group. The morphology of peritoneal biopsy specimen was observed, and the normal form of peritoneal biopsy was taken as normal standard. Kaplan Meier survival curve was used to analyze the survival rate of human / kidney during the follow-up period of 3 years. The incidence of postoperative acute rejection and 1,3-year survival rate were compared in patients with different peritoneal morphology in the transplantation group. Spearman rank correlation analysis and logistic multivariate regression analysis were used to analyze the renal transplantation patients with renal failure. Results there were no significant changes in peritoneal morphology in the control group. In the transplantation group, the incidence of acute rejection in the patients with abnormal peritoneal morphology was higher than that in the patients with normal peritoneal morphology before operation. The results of rank correlation analysis showed that there was no significant correlation between the abnormal peritoneal morphology and the incidence of postoperative acute rejection in patients with renal failure, and there was no significant correlation between the rate of postoperative acute rejection and that of 1, 3 years postoperatively. The results of logistic multivariate analysis showed that the renal survival rate was negatively correlated with r-0.752U -0.783U P0.05N. Peritoneal morphology is an independent factor influencing the human / renal survival rate in patients with renal failure 1 year and 3 years after renal transplantation. Conclusion Peritoneal dialysis before renal failure renal transplantation can lead to the change of peritoneal morphology. However, the peritoneal morphology could significantly affect the prognosis of the patients. This may be related to the destruction of mesothelial cells that play an important role in the maintenance of peritoneal environment and the survival of the transplanted kidney is greatly affected by the peritoneal environment. Therefore, peritoneal dialysis should be minimized before renal transplantation in patients with renal failure. Hemodialysis or other maintenance therapy was used to prevent abnormal peritoneal morphology and poor prognosis.
【作者單位】： 海南省農(nóng)墾總醫(yī)院泌尿外科;
【基金】：海南省重點(diǎn)科研課題(編號(hào):1421320.27A1004)
【分類號(hào)】：R699.2

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本文編號(hào)：1617737