肾移植术后高钙血症的发生率及危险因素

摘要

目的:探讨肾移植术后1年内高钙血症的发生率及危险因素,并观察血清钙的演变特点. 方法:选取从2013年11月至2015年3月在南京军区南京总医院肾脏科行肾移植手术的受者115例,分别于肾移植术前、术后1个月、3个月、6个月、12个月检测血清钙、全段甲状旁腺激素(iPTH)等矿物质和骨代谢指标. 结果:肾移植术后受者血清钙逐步升高,高钙血症的发生率在术后3个月时达到最高值42.6％,随后逐步下降,至术后12个月时为39.1％.患者所有随访时间点的血清钙均＜3.0 mmol/L.多因素线性回归分析显示术前高iPTH、术后6个月时低磷血症和高碱性磷酸酶是术后6个月时高钙血症的危险因素,术前透析时间长和术前高iPTH是术后12个月时发生高钙血症的危险因素. 结论:肾移植术后1年内30％～ 40％的受者可出现高钙血症.术前高iPTH是术后6个月和12个月时高钙血症的危险因素.监控术前iPTH有助于术后高钙血症的预防和治疗.%Objective:To investigate the prevalence and risk factors of hypercalcemia 6 and 12 months after kidney transplantation,and to reveal the natural history of serum calcium in recipients after kidney transplantation.Methodology:From November 2013 to March 2015,a total of one hundred fifteen patients with kidney transplant were prospectively and consecutively recruited from National Clinical Research Center of Kidney Diseases,Jinling Hospital and enrolled in this study.The follow-up period was 12 months.The prevalence and risk factors of hypercalcemia 6 and 12 months after kidney transplantation were analyzed.Results:Serum calcium levels were increased,and the prevalence of hypercalcemia (corrected serum calcium ＞ 2.5 mmol/L) was 42.6％,33.9％,and 39.1％ in our kidney transplant recipients at 3,6,12 months respectively.Serum calcium levels were lower than 3.0 mmol/L in all the 115 patients after kidney transplantation.Multivariate linear regression analysis revealed that pre-operative intact parathyroid hormone (iPTH) was the best correlating factor with hypercalcemia 6 and 12 months after kidney transplantation.Conclusion:Hypercalcemia could happen in 30％ ～ 40％ patients within 12 months after kidney transplantation.The pre-operative treatment of hyperparathyroidism may help to offer better management of hypercalcemia after kidney transplantation.