肾移植围手术期醛固酮的变化与肾功能的关系研究

摘要

目的：分析肾移植患者围手术期醛固酮与肾功能变化的关系，从而初步探讨醛固酮在慢性移植肾肾病中的作用。方法选取2010年1月1日到2013年12月31日，在沈阳军区总医院泌尿外科行同种异体肾移植患者共100例作为实验组，根据肾移植术后30 d 时 Scr 水平将实验组再分为 A 组（Scr≥133μmol／L，13例）和 B 组（Scr ＜133μmol／L，87例）。另选取年龄在25～35岁之间身体健康的志愿者10名，作为对照组。实验组在肾移植的当日（0 d）、移植术后1、7、15、30 d 清晨抽血，对照组在相应时段抽血，测定血清醛固酮和 Scr 水平。结果肾移植当日，实验组和对照组的 Scr 水平分别为（598±37）μmol／L 和（75±5）μmol／L，醛固酮水平分别为（0.26±0.06）ng／dl 和（0.13±0.03）ng／dl，两组比较差异均有统计学意义（P ＜0.05）。与0 d 同组比较，术后30 d A 组受者 Scr 水平降低，差异有统计学意义（P ＜0.05），醛固酮水平变化不大，差异无统计学意义（P ＞0.05）；术后30 d B 组受者 Scr 和醛固酮水平均明显降低，差异均有统计学意义（均为 P ＜0.05）。相关分析结果显示，实验组的血清醛固酮与 Scr 的变化均呈正相关（r ＝0.85，P ＜0.05）。结论肾移植术后 Scr 及醛固酮的变化趋势呈正相关，初步认为醛固酮在介导移植肾损伤过程中发挥着一定的作用。%Objective To investigate the relationship between changes of aldosterone level and renal function during perioperative period of renal transplantation and preliminarily discuss the role of aldosterone in chronic allograft nephropathy.Methods One hundred patients undergoing allogeneic renal transplantation in the Department of Urology of the General Hospital of Shenyang Military from January 1 ,201 0 to December 31 ,201 3 were assigned into the experimental group.According to the Scr levels measured at 30 d after renal transplantation,1 00 patients were divided into groups A (Scr≥1 33 μmol/L,n =1 3)and B (Scr <1 33 μmol/L,n =87).Ten healthy individuals aged 25-35 years were recruited into the control group.In the experimental group,blood sample was collected in the morning upon the day of renal transplantation (0 d),1 ,7,1 5 and 30 d after renal transplantation.In the control group,blood sample was obtained at the same time points for measurement of aldosterone and Scr levels.Results On the day of renal transplantation,the Scr level in the experimental group was (598 ±37)μmol/L,significantly higher compared with (75 ±5)μmol/L in the control group (P <0.05).The aldosterone level in the experimental group was (0.26 ±0.06)ng/dl,considerably higher than (0.1 3 ±0.03) ng/dl in the control group (P <0.05).Compared with 0 d,the Scr levels of group A significantly decreased at postoperative 30 d (P <0.05),whereas no statistical significance was noted in aldosterone levels between two time points (P >0.05).In group B,both Scr and aldosterone levels were significantly decreased at postoperative 30 d (both in P <0.05).Correlation analysis revealed that the serum level of aldosterone was positively correlated with Scr level changes (r =0.85,P <0.05).Conclusions After renal transplantation,change of Scr level is positively correlated with aldosterone level alterations, probably suggesting that aldosterone plays a partial role in mediating injury of transplant kidney during renal transplantation.