【摘要】：目的：研究活體腎移植術(shù)后腎功能及礦物質(zhì)代謝指標變化趨勢；對腎移植術(shù)后血清礦物質(zhì)進行相關(guān)因素分析；探討術(shù)前甲狀旁腺激素對術(shù)后血清礦物質(zhì)的影響。 方法：回顧性分析了活體腎移植術(shù)后3年內(nèi)血清總鈣、校正鈣和無機磷的水平。記錄共297人移植前和移植后1天、7天、1月、3月、6月、12月、24月、36月的血清總鈣、校正鈣和血清無機磷的水平,ALP,白蛋白,尿素氮和肌酐,eGFR。其中有術(shù)前PTH檢測數(shù)據(jù)者219人,以600pg/ml為界分為高PTH組34人和非高PTH組185人。比較兩組受者移植后不同時間點血清鈣磷水平的差異,并對腎移植術(shù)后血清礦物質(zhì)進行相關(guān)因素分析。 結(jié)果：腎功能在腎移植術(shù)后1周內(nèi)基本上即達到平臺期。血清總鈣、校正鈣在腎移植術(shù)后呈現(xiàn)雙相：術(shù)后迅速下降后,又緊接著上升,后總體上為緩慢下降趨勢。術(shù)后高鈣血癥在一年內(nèi)和一年后的發(fā)生率分別為8%和3%。腎移植后無機磷水平在圍手術(shù)期急劇下降,后逐漸上升,在術(shù)后3月達到一穩(wěn)定水平。在術(shù)后早期低磷血癥發(fā)生率為37%,后逐漸下降至16%左右�？傮w上而言,術(shù)后血鈣水平與術(shù)前透析時間、術(shù)前PTH水平、術(shù)前血鈣水平正相關(guān),與術(shù)后肌酐負相關(guān)；術(shù)后血磷水平與術(shù)前透析時間、術(shù)前PTH水平負相關(guān)。高PTH組和非高PTH組一般信息中的各指標和腎移植前后各時間點兩組血清肌酐、尿素、eGFR均無統(tǒng)計學差異,兩組術(shù)前血清總鈣、校正鈣、無機磷、高鈣血癥發(fā)生率和低磷血癥發(fā)生率也無統(tǒng)計學差異。腎移植后,總體上高PTH組血清總鈣、校正鈣水平大于非高PTH組,高PTH組血清無機磷水平低于非高PTH組,高PTH組高鈣血癥發(fā)生率、低磷血癥發(fā)生率大于非高PTH組。 結(jié)論：鈣磷代謝異常在腎移植術(shù)后會長期存在,常見為高鈣血癥和低磷血癥。其發(fā)生率在術(shù)后早期較高,后逐漸降低。術(shù)后鈣磷水平與術(shù)前透析時間、術(shù)前PTH、術(shù)前鈣磷水平、同期腎功能情況有關(guān)。術(shù)前中重度甲狀旁腺功能亢進會增加術(shù)后長期血鈣、血清堿性磷酸酶水平,降低血磷水平,增加術(shù)后長期高鈣血癥和低磷血癥的發(fā)生率。
[Abstract]:Objective: to study the change trend of renal function and mineral metabolism after renal transplantation, to analyze the related factors of serum mineral matter after renal transplantation, and to explore the effect of parathyroid hormone on serum mineral after renal transplantation. Methods: the levels of serum total calcium, corrected calcium and inorganic phosphorus in 3 years after live kidney transplantation were analyzed retrospectively. Serum total calcium, adjusted calcium and serum inorganic phosphorus levels, ALP, albumin, urea nitrogen and creatinine, eGFR. were recorded in 297 patients before and 1 day, 7 days, 1 day, 3 months, 6 months, 12 months, 24 months and 36 months after transplantation. Among them, 219 cases were detected by PTH before operation. According to 600pg/ml, 34 patients were in high PTH group and 185 in non-high PTH group. To compare the difference of serum calcium and phosphorus levels between the two groups at different time points after transplantation, and to analyze the related factors of serum mineral matter after renal transplantation. Results: the renal function reached the plateau stage within 1 week after renal transplantation. Serum total calcium and corrected calcium showed biphasic changes after renal transplantation. The incidence of hypercalcemia in one year and one year after operation was 8% and 3%, respectively. After renal transplantation, the level of inorganic phosphorus decreased sharply during perioperative period, then increased gradually, and reached a stable level at 3 months after renal transplantation. The incidence of hypophosphatemia was 37% at the early postoperative stage, and then decreased to about 16%. Generally speaking, postoperative serum calcium level was positively correlated with preoperative dialysis time, preoperative PTH level, preoperative serum calcium level, and negatively correlated with postoperative creatinine. Postoperative serum phosphorus level was negatively correlated with preoperative dialysis time and preoperative PTH level. There was no significant difference in serum creatinine, urea and eGFR between the two groups before and after renal transplantation. The serum total calcium, corrected calcium, inorganic phosphorus were not significantly different between the two groups before and after renal transplantation. There was no significant difference in the incidence of hypercalcemia and hypophosphatemia. After renal transplantation, the total serum calcium and corrected calcium levels in the high PTH group were higher than those in the non-high PTH group, the level of serum inorganic phosphorus in the high PTH group was lower than that in the non-high PTH group, and the incidence of hypercalcemia and hypophosphatemia in the high PTH group was higher than that in the non-high PTH group. Conclusion: abnormal calcium and phosphorus metabolism may exist for a long time after renal transplantation, and hypercalcemia and hypophosphatemia are common. The incidence rate was higher at the early postoperative stage, and then decreased gradually. Postoperative calcium and phosphorus levels were correlated with preoperative dialysis time, preoperative calcium and phosphorus levels before PTH, and renal function at the same time. Preoperative moderate and severe hyperparathyroidism could increase long-term serum calcium, serum alkaline phosphatase level, decrease serum phosphorus level, and increase the incidence of long-term hypercalcemia and hypophosphatemia.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.2

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