Kokot F, Grzeszczak W, Zukowska-Szczechowska E, Wiecek A
Department of Nephrology, Silesian School of Medicine, Katowice, Poland.
Blood Purif. 1990;8(2):76-86. doi: 10.1159/000169928.
Several factors are involved in the persistence of endocrine alterations after renal transplantation, among which the following are to be mentioned: (1) duration of chronic uraemia before renal transplantation; (2) residual function of the patients' native kidneys; (3) quality of function of the renal graft; (4) modulation of secretion, transport, and degradation of hormones, and/or (5) altered target organ responsiveness to hormones induced by immunosuppressive drugs (glucocorticoids, azathioprine, cyclosporin A) or altered internal environment. In kidney transplant patients the following endocrine abnormalities are to be mentioned: dissociation of the physiological relationship between aldosterone synthesis and function of the renin-angiotensin system, abnormal volumetric regulation of arginine vasopressin secretion, suppressed responsiveness of cortisol secretion to stimulatory manoeuvres, persistent secondary hyperparathyroidism, relative deficiency of insulin (induced by glucocorticoid therapy), with consequent carbohydrate intolerance or even diabetes mellitus, suppressed response of gastrin and pancreatic hormone secretion to a test meal, and reduced responsiveness of atrial natriuretic peptide secretion to central hypervolaemia. Episodes of acute graft rejection are characterized by endocrine alterations similar to those seen in patients with acute or chronic renal failure.
肾移植后内分泌改变持续存在涉及多个因素，其中包括：（1）肾移植前慢性尿毒症的持续时间；（2）患者自身肾脏的残余功能；（3）肾移植的功能质量；（4）激素分泌、转运和降解的调节，和/或（5）免疫抑制药物（糖皮质激素、硫唑嘌呤、环孢素A）诱导的靶器官对激素的反应性改变或内环境改变。肾移植患者存在以下内分泌异常：醛固酮合成与肾素 - 血管紧张素系统功能之间的生理关系解离、精氨酸加压素分泌的容量调节异常、皮质醇分泌对刺激操作的反应性受抑制、持续性继发性甲状旁腺功能亢进、胰岛素相对缺乏（由糖皮质激素治疗引起），进而导致碳水化合物不耐受甚至糖尿病、胃泌素和胰腺激素分泌对试餐的反应受抑制、心房利钠肽分泌对中枢性血容量过多的反应性降低。急性移植排斥反应的发作以内分泌改变为特征，类似于急性或慢性肾衰竭患者所见的改变。
