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目的探讨肾移植术后发生下肢深静脉血栓(lower extremities deep venous thrombosis,LDVT)的危险因素。方法以肾移植术后坚持长期随访的972例患者为研究对象,并根据术后有否发生LDVT将患者分成LDVT组(37例)以及对照组(935例),对潜在的危险因素包括年龄、性别、体重指数、术前糖尿病、术前动脉粥样硬化、手术时间、移植肾动脉吻合方式(移植肾动脉与髂外动脉吻合)、术后应用他克莫司、术后红细胞增多症和高脂血症共10项指标进行单因素分析。再将单因素分析中P<0.20的变量纳入Logistic多因素回归分析。记录相对危险度(relative risk,RR)和95%可信区间(confidence interval,CI)。结果 972例中有37例(3.8%)患者诊断为LDVT,其中27例(73%)在术后6个月内发病,30例(81%)患者发生LDVT位置与移植肾所在位置同侧。经单因素分析后,将年龄、术前患糖尿病、术后红细胞增多症以及术后高脂血症共4项纳入Logistic多因素分析。Logistic多因素回归分析结果显示:年龄(RR=1.08,95%CI为1.02～1.17,P<0.01)、糖尿病(RR=26.9,95%CI为5.71～139.8,P<0.01)以及红细胞增多症(RR=7.54,95%CI为1.21～9.76,P<0.05)共3种因素是发生LDVT的独立危险因素,而高脂血症不是引起LDVT的独立危险因素。结论年龄偏大、术前患有糖尿病及术后发生红细胞增多症的患者发生LDVT的风险明显增大。
Objective To investigate the risk factors of lower extremities deep venous thrombosis (LDVT) after renal transplantation. Methods Nine hundred and ninety-seven patients who underwent long-term follow-up after renal transplantation were enrolled in this study. Patients were divided into LDVT group (n = 37) and control group (n = 935) according to whether LDVT occurred or not. Potential risk factors including age, Gender, body mass index, preoperative diabetes, preoperative atherosclerosis, operation time, graft anastomosis (anastomosis of renal artery and external iliac artery), postoperative application of tacrolimus, postoperative polycythemia and high A total of 10 indicators of lipidosis univariate analysis. Then univariate analysis of variables P <0.20 into Logistic multivariate regression analysis. Relative risk (RR) and 95% confidence interval (CI) were recorded. Results Thirty-seven (3.8%) of the 972 patients were diagnosed with LDVT, of which 27 (73%) developed disease within 6 months after surgery and 30 (81%) had ipsilateral LDVT and transplanted kidney. After univariate analysis, four factors including age, preoperative diabetes, postoperative polycythemia and postoperative hyperlipidemia were included in the Logistic multivariate analysis. Logistic multivariate regression analysis showed that age (RR = 1.08, 95% CI 1.02-1.17, P <0.01), diabetes mellitus (RR = 26.9, 95% CI 5.71-139.8, P <0.01) and polycythemia RR = 7.54, 95% CI 1.21-9.76, P <0.05). All three factors were independent risk factors of LDVT. However, hyperlipidemia was not an independent risk factor of LDVT. Conclusions The risk of LDVT is significantly increased in patients who are older, preoperative with diabetes mellitus and postoperative polycythemia.