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目的探讨活体肾移植供肾肾小球滤过率(GFR)对受体中远期肾功能的影响。方法 2005年至2010年在中山大学附属第一医院移植中心接受活体肾移植治疗的无急性排斥反应、无移植肾功能延迟恢复的167例供受体为研究对象,其中亲属关系161例(97.0%)、夫妻关系5例(2.4%),帮扶关系1例(0.6%)。术前应用放射性核素99m TC-DTPA肾动态显像测定供体左右肾GFR。供体的双肾GFR为60.5~147.6 ml/min,将对象分为供肾GFR<46ml/min 82例和供肾GFR≥46 ml/min 85例。两组受体的术前透析情况、HLA错配率,移植肾冷、热缺血时间、抗体诱导及免疫抑制方案等基本资料相似,评价患者术后中远期肾功能变化情况。结果与供肾GFR<46 ml/min组比较,供肾GFR≥46 ml/min组的血肌酐(Scr)在术后3年,4年较低,5年较高,术后3年、4年、5年的差异均无统计学意义(P>0.05)。重复测量的方差分析显示术后3~5年两组受体Scr变化差异无统计学意义(P>0.05)。相关分析法显示供者术前肾小球滤过率与受者术后3年、4年、5年Scr之间无相关关系。(r值分别为-0.023,-0.042,0.005,P>0.05)。结论活体肾移植供肾GFR高低对受体术后中远期(3~5年)的Scr整体水平及变化趋势无显著影响。
Objective To investigate the effect of donor renal glomerular filtration rate (GFR) on the long-term renal function of recipients. Methods A total of 167 recipients with delayed graft function without graft rejection were enrolled in the First Affiliated Hospital of Sun Yat-sen Affiliated Affiliated Hospital of Sun Yat-sen University from 2005 to 2010. There were 161 relatives (97.0% ), 5 cases of marital relationship (2.4%) and 1 case of supporting relationship (0.6%). Preoperative application of radionuclide 99m TC-DTPA renal dynamic imaging of donor kidney GFR. The donor’s kidney GFR was 60.5 ~ 147.6 ml / min, and the subjects were divided into donor GFR <46ml / min 82 cases and donor kidney GFR≥46 ml / min 85 cases. Preoperative dialysis, HLA mismatch rate, renal transplant cold, warm ischemia time, antibody induction and immunosuppressive regimen were similar between the two groups. The changes of renal function in the long-term after operation were evaluated. Results The serum creatinine (Scr) of the kidneys with GFR ≥ 46 ml / min was significantly lower at 3 years, 4 years, 5 years, 3 years, 4 years There was no significant difference between years and five years (P> 0.05). Repeated measures analysis of variance showed that postoperative 3 to 5 years there was no significant difference in Scr between two groups (P> 0.05). Correlation analysis showed no correlation between the preoperative glomerular filtration rate of donor and the 3, 4, 5 years postoperative Scr. (r values were -0.023, -0.042,0.005, P> 0.05). Conclusion The GFR level of living donor kidney transplantation has no significant effect on the overall level of Scr and its changing trend in the long-term (3-5 years) postoperative recipients.