本文選題：血小板功能 + 腎移植　； 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：腎移植是根治終末期腎功能衰竭最佳的治療手段,隨著腎移植成功率逐步提高使得越來越多的患者獲得新生。但是,腎移植術(shù)后早期移植腎功能延遲恢復(fù)(delay graft function, DGF)是導(dǎo)致移植物長期存活率下降的重要原因。臨床上觀察到,腎移植術(shù)后受者一旦發(fā)生DGF,會(huì)伴有不同程度的移植腎腎單位出血傾向,表現(xiàn)為血尿和炎癥反應(yīng),病理表現(xiàn)為移植物血管內(nèi)皮下炎性細(xì)胞浸潤。血小板不僅具有凝血功能,還參與炎癥反應(yīng)過程。我們?cè)谂R床工作中發(fā)現(xiàn)許多受者在腎移植術(shù)后早期外周血中血小板的數(shù)量變化非常明顯,DGF發(fā)病時(shí)外周血中普遍出現(xiàn)炎性細(xì)胞升高。低溫保存后供腎局部缺血和移植后開放血液循環(huán)出現(xiàn)缺血-再灌注損傷激活了一系列反應(yīng),使移植腎持續(xù)受損,在DGF發(fā)展中起主導(dǎo)作用。相關(guān)研究證實(shí),減輕脂質(zhì)過氧化反應(yīng)和減少氧自由基,進(jìn)行擴(kuò)張血管、抗氧化、抗炎治療可減輕DGF相關(guān)性腎損傷。這些現(xiàn)象表明血小板性炎癥反應(yīng)可能在DGF的發(fā)病中起一定作用。2012年1月,Park等最新報(bào)道在腎移植術(shù)后檢測(cè)血小板分泌的某些抗氧化劑水平在早期恢復(fù)順利的受者和出現(xiàn)DGF的受者體內(nèi)具有統(tǒng)計(jì)學(xué)差異。 移植腎早期不可避免存在缺血-再灌注損傷(Ischemia-reperfusion injury, IRI),它可引起移植腎原發(fā)性無功能、移植腎功能延遲恢復(fù),同時(shí)還與免疫因素協(xié)同作用引起急性排斥反應(yīng),嚴(yán)重者可導(dǎo)致移植腎功能喪失,對(duì)移植腎的早期恢復(fù)和遠(yuǎn)期預(yù)后都產(chǎn)生重要影響。IRI是指缺血組織或器官重新獲得血液灌注或氧供后損傷反而加重,甚至發(fā)生不可逆性損傷。缺血-再灌注不但損傷腎小管上皮細(xì)胞,還導(dǎo)致腎間質(zhì)炎癥和微血管病變,而微血管病變是缺血-再灌注損傷引起腎功能障礙的關(guān)鍵因素,缺血后微血管病變以內(nèi)皮細(xì)胞腫脹和隨之而來的微血管閉塞為特征,導(dǎo)致移植腎再灌注不能順利進(jìn)行。 腎移植術(shù)后早期移植腎功能延遲恢復(fù)(delayed graft function, DGF)和急性排斥反應(yīng)(acute rejection. AR),是導(dǎo)致移植腎長期存活率下降的重要原因。臨床上觀察到,腎移植術(shù)后無論是因先發(fā)生DGF引起急性排斥,還是因先發(fā)生急性排斥而誘發(fā)DGF,這兩種移植后不良反應(yīng)就像一對(duì)孿生并發(fā)癥,而且受者一旦發(fā)生DGF或急性排斥反應(yīng)時(shí),會(huì)伴有不同程度的移植腎腎單位出血傾向,臨床表現(xiàn)為血尿和炎癥反應(yīng),病理表現(xiàn)為移植腎血管內(nèi)皮下炎性細(xì)胞浸潤,嚴(yán)重影響腎移植術(shù)后人／腎成活時(shí)間,延長住院時(shí)間。移植腎功能延遲性恢復(fù)的診斷標(biāo)準(zhǔn)為腎移植術(shù)后少尿(24h1200ml)或無尿,血肌酐水平無明顯下降甚至升高或術(shù)后第7天血肌酐仍大于400umol/L,須行血液透析治療者。引起DGF的主要因素包括腎前性、腎性及腎后性3種,腎移植術(shù)中及移植后早期低血容量、低血壓、腎動(dòng)靜脈吻合口狹窄為腎前性因素。環(huán)孢素A腎毒性、腎小管壞死、排斥反應(yīng)及供腎原有疾病(如高血壓腎病、糖尿病腎病等)為腎性因素。移植腎尿路梗阻如外界血腫壓迫、結(jié)石或血塊梗死、吻合口狹窄、輸尿管過長導(dǎo)致扭曲為腎后性因素。目前盡管現(xiàn)在聯(lián)合應(yīng)用免疫抑制劑使移植腎存活率顯著升高,但急性排斥反應(yīng)仍然是腎移植后DGF最常見的原因之一。 血小板是一種重要的炎癥細(xì)胞。有研究表明,在潰瘍性結(jié)腸炎、克羅恩病、類風(fēng)濕性關(guān)節(jié)炎和強(qiáng)直性脊柱炎等疾病中血小板平均體積(MPV)參數(shù)降低；MPV升高是早期動(dòng)脈粥樣硬化的預(yù)測(cè)因子,平均血小板體積反映了血小板的大小,血小板活化時(shí),血小板體積增加,體積大的血小板含有更多的顆粒和更高的活性,活化的血小板分泌一系列的炎癥物質(zhì),如趨化因子、細(xì)胞因子等,以促進(jìn)血小板的聚集、粘附和血栓形成。此外血小板分泌的炎癥物質(zhì)還通過血小板的P-選擇素募集中性粒細(xì)胞、單核細(xì)胞、嗜酸性粒細(xì)胞等進(jìn)入炎癥部位,促進(jìn)炎癥反應(yīng)的發(fā)生。研究證實(shí),血小板對(duì)移植物的功能有重要影響。我們?cè)谂R床工作中發(fā)現(xiàn),腎移植后DGF發(fā)病時(shí)血小板數(shù)量發(fā)生明顯變化,由此推斷血小板可能是DGF發(fā)病的危險(xiǎn)因子之一。血小板膜上有大量磷脂酶,在炎癥因子刺激下通過信號(hào)轉(zhuǎn)導(dǎo)機(jī)制可生成大量生物活性物質(zhì),如白三烯(leukotrienes, LT)、脂氧素(lipoxins, LXS)、血栓烷和前列腺素(prostaglandin, PG)等,這些生物活性物質(zhì)對(duì)血管內(nèi)皮細(xì)胞功能、白細(xì)胞功能和血小板激活等具有重要的調(diào)節(jié)作用。目前已經(jīng)有研究證實(shí),血小板引起的炎癥反應(yīng)在動(dòng)脈粥樣硬化、腦梗塞、心絞痛、缺血性腦病、缺血性心臟病以及由于免疫系統(tǒng)功能異常導(dǎo)致的自身免疫性疾病和各型腎病等疾病中起重要作用。關(guān)于血小板數(shù)量(platelet number, PLT)、血小板比容測(cè)定(platelet hematocrit,PCT)、平均血小板體積(average platelet volume,MPV)、血小板體積分布寬度(platelet volume distribution width, PDW)和大型血小板比值(large platelet ratio, P-LCR)五項(xiàng)參數(shù)是否與DGF相關(guān),目前尚無相關(guān)報(bào)道,本課題擬通過對(duì)腎移植術(shù)后2個(gè)月內(nèi)受者外周血血小板五項(xiàng)參數(shù)變化的統(tǒng)計(jì)學(xué)分析,探討血小板在DGF發(fā)生中的作用。 第一部分腎移植受者血小板相關(guān)指標(biāo)檢測(cè)結(jié)果的統(tǒng)計(jì)學(xué)分析 目的 檢測(cè)腎移植術(shù)后早期受者外周血血小板相關(guān)指標(biāo)變化規(guī)律,探討血小板相關(guān)指標(biāo)對(duì)腎移植術(shù)后受者的作用。 方法 對(duì)我院2009年1月至2013年9月的232例腎移植受者術(shù)前至術(shù)后2個(gè)月內(nèi)臨床資料進(jìn)行回顧性分析,其中男162例,女70例,年齡14～80歲,平均40.9歲。供受者ABO血型相符,淋巴毒實(shí)驗(yàn)均陰性,HLA配型檢測(cè)A、B、DR三個(gè)位點(diǎn),所有受者均采用口服他克莫司(FK506)或環(huán)孢素A (CsA)+霉酚酸酯(MMF)+醋酸潑尼松(Pred)三聯(lián)抗排斥藥物方案,取受試者術(shù)前及術(shù)后第1天、第2天、第3天、第4天、第5天、第6天、第7天、第8天、第9天、第10天、第15天、第30天、第45天、第60天外周靜脈血各2mL,乙二胺四乙酸二鉀抗凝,采用Sysmex XE2100型全自動(dòng)血液分析儀及配套進(jìn)口試劑對(duì)血小板參數(shù)進(jìn)行測(cè)定,所有檢測(cè)數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差(±s)表示,采用SPSS19.0統(tǒng)計(jì)軟件,兩組間比較采用獨(dú)立樣本t檢驗(yàn),以P0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果 通過對(duì)術(shù)后2個(gè)月內(nèi)232例腎移植受者血小板相關(guān)指標(biāo)檢驗(yàn)發(fā)現(xiàn),與術(shù)前相比,腎移植受者術(shù)后第1天PLT、PCT迅速降低,于術(shù)后第5天降至最低且明顯低于術(shù)前水平(p0.05),后又開始升高,于術(shù)后第15天升至最高并明顯高于術(shù)前水平(p0.05),然后又緩慢降低,術(shù)后第30-60天接近術(shù)前水平(p0.05)。PLT、PCT在術(shù)后第1至第15天與術(shù)前相比差異有統(tǒng)計(jì)學(xué)意義(p0.05),在術(shù)后第30天、45天、60天降至接近術(shù)前水平,與術(shù)前相比差異無統(tǒng)計(jì)學(xué)意義(p0.05)。術(shù)后第1天MPV、PDW、P-LCR均迅速升高,于術(shù)后第7天升至最高且明顯高于術(shù)前水平(p0.05),之后緩慢降低并于術(shù)后第15天降至接近術(shù)前水平(p0.05),后又緩慢升高,MPV、P-LCR至術(shù)后30-60天明顯高于術(shù)前水平(p0.05),PDW至術(shù)后45-60天明顯高于術(shù)前水平(p0.05)。 結(jié)論 所有232例腎移植受者血小板相關(guān)指標(biāo)呈規(guī)律性變化,提示臨床上血小板相關(guān)指標(biāo)作為腎移植術(shù)后骨髓功能恢復(fù)情況的監(jiān)測(cè)指標(biāo)有一定的臨床價(jià)值。 第二部分腎移植術(shù)后是否發(fā)生DGF的受者血小板相關(guān)指標(biāo)檢測(cè)結(jié)果的統(tǒng)計(jì)學(xué)分析 目的 探討血小板參數(shù)變化與腎移植術(shù)后早期移植腎功能延遲恢復(fù)(DGF)的關(guān)系。 方法 對(duì)我院2009年1月至2013年9月的232例腎移植受者進(jìn)行回顧性分析,以術(shù)后第1周內(nèi)需要行血液透析治療,或者雖未經(jīng)過血液透析治療,但在術(shù)后第7天血肌酐水平仍大于400umol/L作為DGF的診斷標(biāo)準(zhǔn),供受者ABO血型相符,淋巴毒實(shí)驗(yàn)均陰性,HLA配型檢測(cè)A、B、DR三個(gè)位點(diǎn),所有受者均采用口服他克莫司(FK506)或環(huán)孢素A (CsA)+霉酚酸酯(MMF)+醋酸潑尼松(Pred)三聯(lián)抗排斥藥物方案。其中腎移植術(shù)后發(fā)生DGF患者29例,發(fā)生率為12.5%(29/232),未發(fā)生DGF203例。同樣取受試者術(shù)前及術(shù)后第1天、第2天、第3天、第4天、第5天、第6天、第7天、第8天、第9天、第10天、第15天、第30天、第45天、第60天外周靜脈血各2mL,乙二胺四乙酸二鉀抗凝,采用Sysmex XE2100型全自動(dòng)血液分析儀及配套進(jìn)口試劑對(duì)血小板參數(shù)進(jìn)行測(cè)定,所有檢測(cè)數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差(±s)表示,采用SPSS19.0統(tǒng)計(jì)軟件,兩兩比較采用配對(duì)樣本t檢驗(yàn),以P0.05有統(tǒng)計(jì)學(xué)意義。 結(jié)果 腎移植術(shù)后29例DGF受者與203例非DGF受者血小板相關(guān)指標(biāo)檢測(cè)發(fā)現(xiàn),非DGF組受者PLT在術(shù)后第5天降至最低,后開始升高并于術(shù)后第15天升至最高且明顯高于術(shù)前水平,術(shù)后30-60天降至接近術(shù)前水平；DGF組受者PLT于術(shù)后第6天降至最低,術(shù)后第15天升至最高且明顯高于術(shù)前水平,術(shù)后30天又降至低于術(shù)前水平,術(shù)后45-60天恢復(fù)至接近術(shù)前水平。非DGF組受者M(jìn)PV、PDW、P-LCR在術(shù)后第7天升至最高,于術(shù)后第15天降至接近術(shù)前水平,后又緩慢升高；DGF組患者M(jìn)PV、PDW、P-LCR在術(shù)后第7天升至最高,于術(shù)后30天降至最低但仍高于術(shù)前水平,二組受者術(shù)后血小板數(shù)量變化有一定規(guī)律性,即移植早期血小板數(shù)明顯降低,之后逐漸升高且明顯高于術(shù)前水平,術(shù)后第2天起DGF組受者血小板數(shù)量始終低于非DGF組受者,其中第7-10天二組受者血小板計(jì)數(shù)差異有統(tǒng)計(jì)學(xué)意義(p0.05)；PCT二者無明顯統(tǒng)計(jì)學(xué)意義(p0.05);DGF組患者M(jìn)PV、PDW. P-LCR始終高于非DGF組患者,其中術(shù)后第7、10、15天二組MPV、PDW、P-LCR的差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。 結(jié)論 232例腎移植受者PLT、PCT在術(shù)后第5天降至最低,術(shù)后第15天升至最高且明顯高于術(shù)前水平(p0.05), MPV、PDW、P-LCR在腎移植術(shù)后均有所增高,其中第6天、第7天升至最高(p0.05),術(shù)后15天降至最低(p0.05),腎移植屬于有創(chuàng)手術(shù),早期PLT降低可能因血小板參與創(chuàng)傷的止血和凝血過程,防止創(chuàng)傷后的血液丟失,血小板破壞增多。接受腎移植患者M(jìn)PV增加的機(jī)理可能是腎移植術(shù)后能有效清除尿毒癥毒素,尿毒癥潴留產(chǎn)物對(duì)骨髓的抑制作用逐漸解除,骨髓造血微環(huán)境逐漸恢復(fù)正常,造血干細(xì)胞可正常分化成熟,巨核系細(xì)胞正常增值,血小板是由骨髓中成熟巨核細(xì)胞的胞漿脫落而成,使循環(huán)血中出現(xiàn)較多年輕的大血小板,同時(shí)也使PLT數(shù)量逐漸增多(5-15天)。PLT與MPV相關(guān),血小板生成減少時(shí),MPV降低；血小板破壞增多時(shí),MPV增大；血小板分布異常導(dǎo)致血小板減少時(shí),MPV變化不大,由此可見,MPV、PDW、P-LCR可作為腎移植術(shù)后骨髓功能恢復(fù)情況的動(dòng)態(tài)監(jiān)測(cè)指標(biāo)。本研究還發(fā)現(xiàn),腎移植術(shù)后發(fā)生DGF患者PLT始終低于未發(fā)生DGF患者,其中DGF組患者與非DGF組患者相比術(shù)后第7d-10d有統(tǒng)計(jì)學(xué)意義(p0.05)：同樣,發(fā)生DGF患者M(jìn)PV、PDW、P-LCR始終高于未發(fā)生DGF患者,其中DGF組患者與非DGF組患者相比術(shù)后第7d、10d、15d有統(tǒng)計(jì)學(xué)意義(p0.05),說明在骨髓造血干細(xì)胞分化成熟過程中,在DGF患者中出現(xiàn)血小板活化過程,血小板破壞增多,消耗增加,血小板參與移植腎炎癥反應(yīng)和損傷再修復(fù)過程。對(duì)腎移植術(shù)后早期受者外周血血小板計(jì)數(shù)(PLT)、血小板比容測(cè)定(PCT)、平均血小板體積(MPV)、血小板體積分布寬度(PDW)、大型血小板比值(P-LCR)五項(xiàng)參數(shù)變化的監(jiān)測(cè),可為腎移植術(shù)后DGF的發(fā)生和逆轉(zhuǎn)提供新的疾病監(jiān)測(cè)標(biāo)志物、藥物靶標(biāo)和新的治療方法,這將有利于減少DGF的發(fā)生率,并借此提高腎移植患者的長期存活率。
[Abstract]:Renal transplantation is the best cure for end-stage renal failure. With the gradual improvement of renal transplantation success rate, more and more patients get new life. However, early renal transplantation after renal transplantation (delay graft function, DGF) is an important cause of the decrease of the long term graft survival rate. Once the recipients have DGF, they will be accompanied by a different degree of renal allograft bleeding tendency, characterized by hematuria and inflammatory reaction, and the pathological manifestation is infiltration of inflammatory cells under the graft vascular endothelium. Platelet not only has coagulation function, but also participates in the process of inflammatory reaction. In clinical work, we found that many recipients were transplanted in kidney transplantation. The changes in the number of platelets in the early peripheral blood are very obvious, and inflammatory cells are generally elevated in the peripheral blood of DGF. After cryopreservation, a series of reactions are activated by ischemia and reperfusion injury in the donor kidney and the open blood circulation after transplantation, which leads to the continued damage of the transplanted kidney and plays a leading role in the development of DGF. It is confirmed that the reduction of lipid peroxidation and oxygen free radicals, dilated blood vessels, antioxidation, and anti-inflammatory treatment can reduce DGF related renal damage. These phenomena suggest that the platelet inflammatory response may play a role in the pathogenesis of DGF in January, Park and other recent reports on the detection of some antioxidation of platelet secretions after renal transplantation. There was a significant difference in the level of the drug in the early recovery of the successful recipients and those with DGF.
The inevitable existence of ischemia-reperfusion injury (Ischemia-reperfusion injury, IRI) early in the transplant kidney, which can cause the primary transplantation of renal function, the delayed restoration of renal function, and the synergistic effect of the immune factors to the acute rejection, which can lead to the loss of transplanted kidney function, the early recovery of the transplanted kidney and the long term preconditioning. The subsequent important effect of.IRI is that the ischemic tissue or organ is re obtained after blood perfusion or oxygen supply and even aggravated, even irreversible damage. Ischemia-reperfusion not only damage the renal tubular epithelial cells, but also lead to renal interstitial inflammation and microvascular lesions, and microvascular disease is ischemia reperfusion injury causing renal dysfunction. The key factor is microvascular lesion after ischemia. It is characterized by swelling of endothelial cells and consequent microvascular occlusion, leading to the failure of renal graft reperfusion.
Early renal transplantation (delayed graft function, DGF) and acute rejection (acute rejection. AR) after renal transplantation is an important cause of the decline in the long-term survival rate of renal allograft. It is clinically observed that after renal transplantation, acute rejection is caused by first DGF, and DGF is induced by acute rejection. The two kinds of adverse reactions are like a pair of twin complications, and when the recipients have DGF or acute rejection, they will be accompanied by different degrees of renal allograft bleeding tendency. The clinical manifestation is hematuria and inflammatory reaction. The pathological manifestation is inflammatory cell infiltration under the vascular endothelium of the transplanted kidney, which seriously affects human and renal survival after renal transplantation. The diagnostic criteria for delayed restoration of renal function were oliguria (24h1200ml) or no urine after renal transplantation, no significant decrease in serum creatinine level or even higher serum creatinine or more than 400umol/L after seventh days of operation. Hemodialysis patients must be treated with hemodialysis. The main factors that cause DGF include 3 types of pre renal, renal and postrenal, renal migration. Early low blood volume, hypotension, and narrowing of renal arteriovenous anastomosis are the prerenal factors during and after transplantation. Cyclosporine A nephrotoxicity, renal tubular necrosis, rejection and kidney disease (such as hypertensive nephropathy, diabetic nephropathy, etc.) are renal factors. Renal allograft obstruction such as external hematoma oppression, stone or clot infarction, anastomotic narrow Narrow ureteral distortion is a factor of post renal disease. Although immunosuppressive agents are now associated with a significant increase in renal graft survival, acute rejection is still one of the most common causes of DGF after renal transplantation.
Platelets are an important inflammatory cell. Studies have shown that the mean platelet volume (MPV) parameters in ulcerative colitis, Crohn's disease, rheumatoid arthritis and ankylosing spondylitis are reduced, and the increase of MPV is a predictor of early atherosclerosis, and the flat average platelet volume reflects the size of platelets and platelet activity. Platelet volume increases and large platelets contain more particles and higher activity. Activated platelets secrete a series of inflammatory substances, such as chemokines, cytokines, etc., to promote platelet aggregation, adhesion and thrombosis. In addition, the inflammatory substances secreted by platelets are also collected through the P- selectin of platelets. Granulocytes, monocytes and eosinophils enter the site of inflammation and promote the occurrence of inflammatory reactions. Studies have shown that platelets have an important impact on the function of the graft. We found in clinical work that the number of platelets in DGF after renal transplantation is significantly altered, and it is concluded that platelets may be a risk factor for the pathogenesis of DGF. 1. There are a large number of phospholipases on the membrane of the platelets, which can produce a large number of bioactive substances, such as leukotrienes (LT), lipoxins (LXS), thromboxane and prostaglandin (prostaglandin, PG), through the signal transduction mechanism under the stimulation of inflammatory factors. These bioactive substances have the function of vascular endothelial cells, leukocyte function and blood. Platelets have been shown to play an important regulatory role. Studies have shown that the inflammatory reactions caused by platelets play an important role in atherosclerosis, cerebral infarction, angina, ischemic encephalopathy, ischemic heart disease, and autoimmune diseases and various types of kidney disease caused by abnormal immune system function. Number (platelet number, PLT), platelet specific volume assay (platelet hematocrit, PCT), average platelet volume (average platelet volume, MPV), platelet volume distribution width (platelet volume) and large platelet ratio are related to the five, there is no correlation at present. The purpose of this study is to explore the role of platelets in the occurrence of DGF by statistical analysis of the changes in the five parameters of the peripheral blood platelets within 2 months after renal transplantation.
Part one statistical analysis of platelet related indicators in renal transplant recipients
objective
Objective to detect the changes of platelet related indexes in the peripheral blood of recipients in early stage after renal transplantation, and to explore the effects of platelet related indexes on recipients after renal transplantation.
Method
The clinical data of 232 renal transplant recipients from January 2009 to September 2013 were retrospectively analyzed, including 162 men, 70 women, 14~80 years old and 40.9 years old. The donor ABO blood group was matched, the lymphatic test was negative, and the HLA matching was used to detect A, B, DR, and all the recipients were taken oral tacrolimus (FK). 506) or cyclosporin A (CsA) + mycophenolate mofetil (MMF) + prednisone acetate (Pred) triple anti rejection drug regimen, taking first days, second days, fourth days, fifth days, sixth days, seventh days, eighth days, Ninth days, Ninth days, Ninth days, Ninth days, tenth days, fifteenth, thirtieth days, and forty-fifth days, and Sysmex, potassium anticoagulant of ethylene diamine tetra acetic acid, using Sysmex. Platelet parameters were measured by XE2100 automatic hematology analyzer and matching imported reagents. All the measured data were expressed with mean standard deviation (+ s), and SPSS19.0 statistical software was used. The two groups were compared with independent sample t test, and P0.05 had statistical significance.
Result
By examining the platelet related indexes of 232 renal transplant recipients within 2 months after the operation, it was found that compared with the preoperative PLT, PCT decreased rapidly at first days after the operation, and decreased to the lowest and significantly lower than the preoperative level (P0.05) at fifth days after the operation, and then began to rise again at the highest level at the fifteenth day after the operation and significantly higher than the preoperative level (P0.05), and then again Slow down, 30-60 days after operation was close to preoperative level (P0.05).PLT, and PCT was statistically significant (P0.05) compared with preoperative (P0.05), thirtieth days, 45 days, 60 days after operation, and there was no statistical difference between preoperative and preoperative (P0.05). MPV, PDW, P-LCR increased rapidly on the first day after operation, and reached seventh days after the operation. The highest and significantly higher than preoperative level (P0.05), then slow down and fifteenth days after the operation to close to preoperative level (P0.05), and then slowly increase, MPV, P-LCR to 30-60 days after the operation was significantly higher than the preoperative level (P0.05), PDW to 45-60 days after the operation was significantly higher than the preoperative level (P0.05).
conclusion
The platelet related indexes of all 232 renal transplant recipients showed regular changes, suggesting that the clinical platelet related indexes were of certain clinical value as the monitoring index of the recovery of bone marrow function after renal transplantation.
The second part is a statistical analysis of the results of platelet related indexes in recipients of DGF after renal transplantation.
objective
Objective to investigate the relationship between platelet parameter changes and delayed graft function (DGF) in early stage after renal transplantation.
Method
A retrospective analysis of 232 renal transplant recipients from January 2009 to September 2013 was conducted in our hospital. Hemodialysis was required within first weeks after the operation, or although it was not treated by hemodialysis, but the serum creatinine level was still greater than 400umol/L as a diagnostic criterion for DGF at seventh days after the operation. The donor ABO blood group was matched, the lymphatic experiment was negative, and the HLA was matched. The three loci of A, B, and DR were detected. All the recipients were taken oral administration of tacrolimus (FK506) or cyclosporin A (CsA) + mycophenolate (MMF) and prednisone acetate (Pred). Among them, 29 cases of patients with DGF after renal transplantation were 12.5% (29/232), and no DGF203 cases. The subjects were also taken before and first days, second days after the operation. Third days, fourth days, fifth days, sixth days, eighth days, Ninth days, tenth days, fifteenth days, thirtieth days, thirtieth days, forty-fifth days, every 2mL of peripheral venous blood, ethylene diamine tetra acetic acid two potassium anticoagulant, Sysmex XE2100 automatic blood analyzer and matching import reagent to measure the parameters of the blood small plate, all the test data were measured with mean standard deviation standard deviation (+ s) table SPSS19.0 statistical software was used. 22 paired sample t test was used to compare P0.05 with statistical significance.
Result
After renal transplantation, 29 DGF recipients and 203 non DGF recipient platelet related indexes found that the PLT in non DGF group fell to the lowest fifth days after the operation, and then began to rise to the highest and higher than the preoperative level at fifteenth days after the operation, and to the level close to the preoperative level 30-60 days after the operation; the DGF group received PLT to the lowest postoperative day after the operation, after the operation. Fifteenth days to the highest and significantly higher than the preoperative level, 30 days after the operation to lower than the preoperative level, 45-60 days after the 45-60 day to close to the preoperative level. Non DGF group MPV, PDW, P-LCR reached the highest seventh days after the operation, fifteenth days after the operation to close to the preoperative level, then slowly rise; MPV, PDW, P-LCR in the group of DGF, the seventh day after the operation to the highest level to the most. The number of platelets in the two groups had a certain regularity after 30 days of operation. The number of platelets in the two groups had a certain regularity, that is, the number of platelets in the early stage of transplantation decreased obviously, and then gradually increased and significantly higher than that before the operation. The number of platelets in the DGF group was lower than that of the non DGF group on the second day of the operation, and the two group in the 7-10 day was the two group. The difference of platelet count was statistically significant (P0.05), and there was no significant statistical significance in PCT two (P0.05), and in group DGF, MPV and PDW. P-LCR were always higher than those in non DGF group, and the difference of MPV, PDW and P-LCR was statistically significant in group two after operation.
conclusion
232 cases of renal transplant recipients PLT, PCT to the lowest fifth days after operation, fifteenth days to the highest and significantly higher than preoperative level (P0.05), MPV, PDW, P-LCR increased after renal transplantation, sixth days, seventh days to the highest (P0.05), 15 days to the lowest (P0.05), kidney transplantation is a invasive operation, early PLT reduction may be due to platelets Participate in the process of hemostasis and coagulation, prevent blood loss and platelet damage after trauma.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.2

【參考文獻(xiàn)】

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1 潘曉鳴;薛武軍;田普訓(xùn);丁小明;燕航;馮新順;侯軍;項(xiàng)和立;;移植腎功能延遲恢復(fù)的臨床診治體會(huì)[J];現(xiàn)代泌尿外科雜志;2006年05期

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本文編號(hào)：1978837