El Haggan Wael, Vendrely Benoît, Chauveau Philippe, Barthe Nicole, Castaing Françoise, Berger Franck, de Précigout Valérie, Potaux Luc, Aparicio Michel
Department of Nephrology and Renal Transplantation, and Laboratory of Nuclear Medicine, Pellegrin University Hospital, Bordeaux, France.
Am J Kidney Dis. 2002 Sep;40(3):629-37. doi: 10.1053/ajkd.2002.34926.
Previous series have dealt with nutritional status after kidney transplantation. However, few studies have described the outcome of body composition after kidney transplantation.
A total of 44 cadaver kidney transplant recipients (28 men and 16 women) were followed prospectively during the first post-transplant year. Biochemical nutritional markers, dietary records, anthropometric measurements, and body composition were assessed at kidney transplantation and 3, 6, and 12 months later.
By the end of the first year, serum albumin level was not significantly different from initial values. Prealbumin and retinol binding protein decreased from 42.3 +/- 10.2 mg/dL to 30.4 +/- 6.3 mg/dL and from 1.96 +/- 0.61 g/dL to 0.65 +/- 0.2 g/dL (P < 0.0001). Separating patients by gender showed that dietary caloric and protein intake increased in women only. At the end of the follow-up period, mean weight change was +5.4 kg in women (P = 0.009) and -0.9 kg in men (not significant). Body composition analyses showed that in women total fat and lean masses increased (+2.1 kg, P = 0.05, and +2.4 kg, P = 0.006), whereas in men total fat mass decreased (-1.4 kg, P = 0.04), and total lean mass tended to increase (+0.5 kg, not significant). Percentage change in total bone mass was +1.4% in women (not significant) and -2.1% in men (P = 0.05). In multivariate analyses, an independent impact of female gender on weight gain was observed, although increased fat mass was related only to energy intake. Increased total lean mass was related to low steroid doses and the absence of acute rejection and delayed graft function. Bone loss was related to male gender and high steroid doses.
Changes in body composition during the first year after kidney transplantation are modulated by gender, energy intake, steroid doses, the occurrence of acute rejection, and delayed graft function.
既往系列研究探讨了肾移植后的营养状况。然而，很少有研究描述肾移植后身体成分的变化情况。
对44例尸体肾移植受者（28例男性和16例女性）在移植后的第一年进行前瞻性随访。在肾移植时以及术后3、6和12个月时评估生化营养指标、饮食记录、人体测量数据和身体成分。
到第一年末，血清白蛋白水平与初始值无显著差异。前白蛋白和视黄醇结合蛋白分别从42.3±10.2mg/dL降至30.4±6.3mg/dL，以及从1.96±0.61g/dL降至0.65±0.2g/dL（P<0.0001）。按性别对患者进行分组分析显示，仅女性的饮食热量和蛋白质摄入量增加。随访期末，女性的平均体重增加5.4kg（P=0.009），男性的平均体重减少0.9kg（无统计学意义）。身体成分分析表明，女性的总脂肪量和去脂体重均增加（分别增加2.1kg，P=0.05；增加2.4kg，P=0.006），而男性的总脂肪量减少（减少1.4kg，P=0.04），总去脂体重有增加趋势（增加0.5kg，无统计学意义）。女性的总骨量百分比变化为+1.4%（无统计学意义），男性为-2.1%（P=0.05）。多因素分析显示，尽管脂肪量增加仅与能量摄入有关，但观察到女性性别对体重增加有独立影响。总去脂体重增加与低剂量类固醇、无急性排斥反应和移植肾功能延迟有关。骨质流失与男性性别和高剂量类固醇有关。
肾移植后第一年身体成分的变化受性别、能量摄入、类固醇剂量、急性排斥反应的发生以及移植肾功能延迟的影响。
