【作者】 李智；

【导师】 袁洪；

【作者基本信息】 中南大学 ， 临床医学， 2013， 硕士

【摘要】 目的：1.了解肾移植后高血压(PTH)的临床特点；2.探讨不同免疫抑制剂对PTH发生的影响；3.分析不同免疫抑制剂治疗方案对氨氯地平降压疗效的影响。方法：1.收集2007年-2011年期间在中南大学湘雅三医院接受肾移植手术患者住院及门诊随访资料。记录患者的性别、年龄、身高、体重、基础疾病、移植前伴随疾病、移植后并发疾病、移植手术相关因素、供体情况以及患者的血压、心率、血常规、尿常规、血生化情况、服用药等情况。根据标准将研究人群分为：移植后高血压(PTH组)、移植后非高血压(非PTH组),统计PTH的发病率、了解PTH类型,并分析PTH相关影响因素。2.根据免疫抑制剂使用方案将患者分为FK506组和CsA组,对比分析不同免疫抑制剂剂量和浓度对肾移植后患者血压的影响。3.根据免疫抑制剂使用方案将PTH患者分为FK506组和CsA组,研究不同免疫抑制剂对PTH患者的降压疗效的影响,并比较其差异。结果：1.入选的406例肾移植受者的平均舒张压为93.7±5.0mmHg,平均收缩压为148.7±5.9mmHg,其中共292例患者出现PTH, PTH发生率为71.9%。其中,肾移植术后0-3,3-6,6-12,12-24及24个月后分别有205,20,22,19,26例患者被诊断为PTH,移植术后第0-3,3-6,6-12,12-24,24个月后的PTH累计发病率分别为50.5%(205/406),55.4%(225/406),60.8%(247/406),65.6%(266/406)和71.9%(292/406)。PTH患者血压主要以DBP、SBP同时升高为主(69.8%),单纯SBP升高比例为21.6%,单纯DBP升高的患者比较少见。PTH组男性比例、平均年龄、体重及BMI均显著高于非PTH组(P<0.05)；亲属供体PTH患病率显著高于同种异体(P<0.05)；不同基础疾病肾移植患者PTH患病率无显著性差异(P>0.05)。2.肾移植术后接受FK506治疗的257例患者有172例在术后并发PTH,其发病率为66.9%(172/257)；接受CsA治疗的149例患者有120例在术后并发PTH,其发病率为80.5%(120/149),CsA组PTH患病率显著高于FK506组(P<0.05)。移植术后第1,3,6,12,24个月中DBP、SBP水平CsA组均高于FK506组,其中第3,12个月组间血压具有显著差异(P<0.05)。3.氨氯地平在不同免疫抑制剂的治疗中均能够有效的降低PTH患者血压,FK506组降压达标率高于CsA组,但无显著性差异(P>0.05)。结论：1.移植后高血压的发病率较高,为71.9%；2.与FK506相比,CsA对肾移植患者血压的影响更加明显；3.不同免疫抑制剂对氨氯地平的降压疗效产生一定影响,FK506组降压达标率比CsA组要高,但是其差异不存在显著性意义。图5幅,表13个,参考文献65篇更多还原

【Abstract】 Objectives:1.Understand the clinical characteristics of hypertension after renal transplantation;2. Investigate the effect of different immunosuppressive on PTH occurred;3.Analyze the influence of different immunosuppressive regimens to anti-hypertensive effect of amlodipine.Method:1. We collected and studied the records of2007-2011kidney transplant patient accepted in the Third Xiangya Hospital inpatient and follow-up outpatient. Record the patient’s gender, age, height, weight, underlying diseases, concomitant diseases before transplantation, transplant comorbidities, transplant-related factors, as well as the donor patient’s blood pressure, heart rate, routine blood, routine urine, blood biochemistry situation, taking medicine, etc. According to the standard the study population was divided two groups:people with hypertension after transplantation as the PTH group and people without hypertension after transplantation as non-PTH group. Incidence of PTH、the type of PTH and PTH related factors were analyzed.2. According to the use of immunosuppressant, the patients were divided into FK506group and CsA group, compared and analyzed the effects of different antihypertensive dose and concentration on blood pressures of renal transplant patients.3. According to the use of immunosuppressant, the PTH patients were divided into FK506group and CsA group, studied the effects of different immunosuppressant on antihypertensive efficacy in patients with PTH and compared the differences.Results:1. Selected406cases of renal transplant recipients, the average diastolic blood pressure was93.7±5.0mmHg, mean systolic blood pressure was148.7±5.9mmHg, of which a total of292cases of patients with PTH, PTH rate was71.9%. Which, after renal transplantation0-3,3-6,6-12,12-24and24months there were205,20,22,19,26patients were diagnosed as PTH, respectively, after transplantation0-3,3-6,6-12, 12-24,24months the cumulative incidence rates were50.5%(205/406),55.4%(225/406),60.8%(247/406),65.6%(266/406), respectively. The character of hypertension was the elevating of systolic pressure as well as diastolic pressure (Occupy69.8%), and SBP alone or DBP alone is relatively rare in patients with elevated. In PTH group, the proportion of males, average age, body weight and BMI were significantly higher than non-PTH group (P<0.05); The prevalence of PTH that living related donor is significantly higher than that of allergenic (P<0.05); The prevalence of PTH have no significant difference on the kidney transplant patients with different underlying diseases (P>0.05).2. There were172patients who accepted FK506treatment occurred PTH after renal transplantation, the incidence rate was66.9%(172/257); and there were120patients who treated with CsA occurred PTH after renal transplantation, the incidence rate was80.5%(120/149), the prevalence rate of PTH in CsA-treated group was significant higher than that in FK506-treated group (P<0.05). The level of DBP and SBP in CsA-treated group were higher than FK506group after transplantation1,3,6,12,24months, even there is a significant difference between the groups of3and12months (P<0.05).3. During the treatment about hypertension of post-transplantation, amlodipine can effectively reduce the BP level of patients who with PTH and treat with different immunosuppressant, compliance rate of blood pressure in FK506group higher than CsA group, but no significant difference (P>0.05).Conclusions:1. The incidence of post-transplant hypertension was higher, at71.9%.2. Compared with FK506, the effect of CsA on blood pressure in patients with renal transplantation is more obvious.3. There were certain impacts that different immunosuppressant on antihypertensive efficacy of amlodipine, the buck compliance rate of FK506group is higher than CsA group, but the difference is not significant.Figure5, Table13, References65更多还原