【摘要】 背景：肥胖在中国人群中占比逐年递增，但其对肾移植术后早期肾功能恢复的影响尚未系统阐明，亟待本土化研究提供循证依据。目的：探讨不同体质量指数对肾移植受者术后早期肾功能恢复的影响，分析体质量指数与移植后肌酐、尿量及住院时间的关联，并提出个体化管理的临床建议。方法：回顾性分析2019-2020年中南大学湘雅二医院收治的495例肾移植受者的临床资料，依据中国肥胖标准分为偏瘦组(体质量指数<18.5 kg/m2,n=78)、正常组(18.5 kg/m2≤体质量指数<24 kg/m2,n=273)、超重组(24 kg/m2≤体质量指数<28 kg/m2,n=119)及肥胖组(体质量指数≥28 kg/m2,n=25)。比较各组患者的基线特征、术后肌酐、尿量及住院天数差异，采用多因素回归分析体质量指数对术后恢复的独立影响。结果与结论：(1)肥胖组患者年龄显著高于其他组(P<0.001)，活体供体比例(0%)最低(P=0.015)，术后第1天肌酐水平及住院天数均最高(P<0.001)，尿量最低(P<0.001)；(2)多因素回归显示，体质量指数每增加1 kg/m2，术后第1天肌酐升高38μmol/L(β=0.38,P<0.001)，尿量减少32 mL(β=-0.41,P<0.001)；(3)提示体质量指数升高是肾移植后早期肾功能恢复缓慢及住院时间延长的独立危险因素；基于中国肥胖标准(体质量指数≥28 kg/m2)，建议对肥胖受者加强围术期监测，优化免疫抑制方案，并制定个体化液体管理策略，以改善预后，此次研究可为本土化体质量指数分层管理提供循证依据。更多还原

【Abstract】 BACKGROUND:The proportion of obesity in the Chinese population has increased year by year,but its impact on early renal function recovery after kidney transplantation has not been systematically elucidated,and localized research is urgently needed to provide evidence-based basis.OBJECTIVE:To investigate the effect of different body mass indexes on early renal function recovery in renal transplant recipients after surgery,to analyze the association between body mass index and postoperative creatinine,urine volume and hospital stay,and to propose clinical recommendations for individualized management.METHODS:The clinical data of 495 renal transplant recipients in the Second Xiangya Hospital of Central South University from 2019 to 2020 were retrospectively analyzed.According to the Chinese obesity standard,they were divided into a lean group(body mass index <18.5 kg/m~2,n=78),a normal group(18.5≤body mass index <24 kg/m~2,n=273),an overweight group(24 kg/m~2≤body mass index <28 kg/m~2,n=119),and an obese group(body mass index≥28kg/m~2,n=25).The baseline characteristics,postoperative creatinine,urine volume,and hospital stay were compared among the groups.Multivariate regression analysis was used to analyze the independent effect of body mass index on postoperative recovery.RESULTS AND CONCLUSION:(1) The age of the obese group was significantly higher than that of the other groups(P <0.001),and the proportion of living donors was the lowest(0%,P=0.015).The creatinine level on the 1st day after surge ry and hos pitalization days were the highest(P <0.001),and the urine volume was the lowest(P<0.001).(2) Multivariate regression showed that for every 1 kg/m~2 increase in body mass index,the creatinine level on the 1st day after surgery increased by 38 μmol/L(β=0.38,P <0.001) and the urine volume decreased by 32 mL(β=-0.41,P <0.001).These findings suggest that increased body mass index is an independent risk factor for slow early renal function recove ry and prolonged hospital stay after kidney transplantation.Based on the Chinese obesity standard(body mass index≥28 kg/m~2),it is recommended to strengthen perioperative monitoring,optimize immunosuppression regimens,and develop individualized fluid management strategies for obese recipients to improve prognosis.This study provides evidence-based basis for the stratified management of body mass index tailored to local populations.更多还原