肾移植术后排斥反应患者肠道菌群、血小板参数的变化及其危险因素分析

目的:探讨肾移植术后排斥反应(AR)患者肠道菌群、血小板参数的变化及术后AR的危险因素。方法:选择接受肾移植的患者150例,术后发生AR 26例作为研究组,未发生AR 124例作为对照组,比较两组术前、术后肠道菌群变化及血小板参数变化,分析肾移植术后AR的危险因素。结果:术后研究组肠道乳酸杆菌、双歧杆菌的数量、双歧杆菌/肠杆菌较对照组减少,肠杆菌、肠球菌的数量较对照组增多(P0.05)。研究组术后5 d、7 d血小板比容(PCT)低于对照组,平均血小板容积(MPV)、血小板分布宽度(PDW)、血小板比率(P-LCR)高于对照组(P0.05)。多因素Logistic回归分析显示:术后乳酸杆菌数量减少、双歧杆菌数量减少、双歧杆菌/肠杆菌减少,肠杆菌数量增多、肠球菌数量增多,PCT降低、PDW升高、P-LCR升高为肾移植术后AR的危险因素(P0.05)。结论:肾移植术后AR患者肠道菌群失调,术后PCT降低,MPV、P-LCR升高。患者术后肠道菌群失调、PCT降低、PDW升高、P-LCR升高为AR的危险因素。

Changes of Intestinal Flora and Platelet Parameters and Risk Factors in Patients with Acut Rejection after Renal Transplantation

ABSTRACT Objective: To analyze the changes of intestinal flora and platelet parameters in patients with acut rejection (AR) after renal transplantation and the risk factors of postoperative AR. Methods: 150 cases of renal transplantation were selected, 26 cases of postoperative AR occurred patients were taken as study group, 124 cases of no AR occurred patients were taken as control group. The changes of intestinal flora, platelet parameters before and after operation were compared between the two groups, and analyzed the risk factors of AR after renal transplantation. Results: The number of intestinal Lactobacillus, Bifidobacterium and Bifidobacterium/ Enterobacter in the study group were less than those in the control group, while the number of Enterobacter and Enterococcus in the study group were more than those in the control group (P<0.05). The platelet specific volume (PCT) of study group at 5 d after operation and 7 d after operation was lower than that of control group, and the mean platelet volume (MPV), platelet distribution width (PDW) and platelet ratio (P-LCR) were higher than those of the control group (P<0.05). Multivariate logistic regression analysis showed that the number of Lactobacillus, Bifidobacterium and Bifidobacterium / Enterobacter decreased, the number of Enterobacter and Enterococcus increased, PCT reduction, PDW elevation and P-LCR elevation were risk factors for AR after renal transplantation (P<0.05). Conclusion: The intestinal flora of AR patients after renal transplantation is disordered, PCT is decreased, MPV and P-LCR are increased. Postoperative intestinal flora disorder, PCT reduction, PDW elevation and P-LCR elevation are risk factors for AR.