彩色多普勒超声检测肾移植术后早期动脉阻力指数及其对远期预后的影响

摘要

目的 应用彩色多普勒超声检测肾移植术后早期肾内动脉阻力指数(RI)并探讨其对远期预后的影响.方法 对2004年1月至2006 年12月 317例肾移植术后1个月行彩色多普勒超声检测肾血流且血清肾功能指标正常患者的临床资料进行回顾性分析,以肾叶间动脉RI中位数为分界,入选病例分为A组(RI <中位数)和B组(RI ≥中位数).应用Logistic多元线性回归分析对供者年龄、供肾冷缺血时间、HLA错配位点、受者年龄、性别、收缩压、舒张压、脉压差、空腹血糖、血清肌酐、甘油三酯、总胆固醇、FK506浓度、CsA浓度、24 h尿蛋白含量均考虑为可能影响RI的指标,纳入分析RI的影响因素,用Cox比例风险分析A组与B组术后肾移植物的生存率.结果 以中位数RI (0.64)为分界,A组144例, B组173例.影响RI的因素有受者年龄、24 h尿蛋白量,其他变量均非RI的影响因素.以血清肌酐提高＞50%以上为终点事件,A组、B组分别有12例、42例到达终点事件.经Cox比例风险分析,B组肾移植物术后存活率显著低于A组(P<0.01).结论 肾移植术后早期监测肾内动脉RI有助于术后早期预测肾移植物术后肾功能的改变及术后生存率、患者的病死率.%Objective To investigate whether the renal arterial resistance index ( RI) measured early by color Doppler ultrasound after kidney transplantation has any influence on renal allograft survival. Methods We retrospectively analyzed 317 cadaver kidney transplant patients who underwent RI evaluation within the first month with stable renal function during January 2004 to December 2006. All the patients were subdivided into two groups according to the RI median value, namely group A with RI ＜ median value and group B with RI ≥ median value. Then Logistic regression analysis was used to assess and rank the relative risk of potential variables on RI, such as donor age, cold ischemia time, human leukocyte antigen ( HLA ) mismatch, recipient age, gender, systolic blood pressure, diastolic blood pressure, pulse pressure , serum creatinine, serum cholesterol, ciclosporin or tacrolimus trough level, arterial blood pressure, number of HLA mismatches and anti-hypertensive medications and proteinuria. Cox proportional hazard analysis was employed to assess the renal allograft survival between two group. Results Group A and B included 144 and 173 patients, respectively, according to median RI value of 0. 64. The relative risk factors on RI value were both recipient age and proteinuria with the other variances excluded. Considering a serum creatinine increase ＞50％ as the endpoint of this study, there are 12 and 42 patients reached the endpoint in group A and group B respectively by the end of the 2008. Group B showed a statistically lower graft survival compared with group A by Cox proportional hazard analysis. Conclusion Early determination of RI can help predict long-term graft survival in kidney transplant recipients.