Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
BJU Int. 2014 Dec;114(6):837-43. doi: 10.1111/bju.12744. Epub 2014 Jul 15.
To examine the incidence of and risk factors for development of hyperlipidaemia in patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) for renal cortical neoplasms, as hyperlipidaemia is a major source of morbidity in chronic kidney disease (CKD).
We conducted a two-centre retrospective analysis of 905 patients (mean age 57.5 years, mean follow-up 78 months), who underwent RN (n = 610) or PN (n = 295) between July 1987 and June 2007. Demographics, preoperative and postoperative hyperlipidaemia were recorded. De novo hyperlipidaemia was defined as that ocurring ≥6 months after surgery in cases where laboratory values met National Cholesterol Education Program Adult Treatment Panel III definitions. The Kaplan-Meier method was used to assess freedom from de novo hyperlipidaemia. Multivariable analysis was conducted to determine the risk factors for de novo hyperlipidaemia.
There were no significant differences with respect to demographics, preoperative glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) (P = 0.123) and hyperlipidaemia (P = 0.144). Tumour size (cm) was significantly larger in the RN group vs the PN group (7.0 vs 3.7; P < 0.001). Significantly greater postoperative GFR <60 mL/min/1.73 m(2) was noted in the RN group (45.7 vs 18%, P < 0.001). Significantly, more de novo hyperlipidaemia developed in the RN group than in the PN group (23 vs 6.4%; P < 0.001). The mean time to development of hyperlipidaemia was longer for PN than for RN (54 vs 44 months; P = 0.03). Five-year freedom from de novo hyperlipidaemia probability was 76% for RN vs 96% for PN (P < 0.001). Multivariable analysis showed that RN (odds ratio [OR] 2.93; P = 0.0107), preoperative GFR <60 mL/min/1.73 m(2) (OR 1.98; P = 0.037) and postoperative GFR <60 mL/min/1.73 m(2) (OR 7.89; P < 0.001) were factors associated with hyperlipidaemia development.
Patients who underwent RN had a significantly higher incidence of and shorter time to development of de novo hyperlipidaemia. RN and pre- and postoperative eGFR <60 mL/min/1.73 m(2) were associated with development of hyperlipidaemia. Further follow-up and prospective investigation are necessary to confirm these findings.
研究接受根治性肾切除术（RN）或部分肾切除术（PN）治疗肾皮质肿瘤的患者发生高脂血症的发生率和危险因素，因为高脂血症是慢性肾脏病（CKD）的主要发病源之一。
我们对 1987 年 7 月至 2007 年 6 月期间在两个中心接受 RN（n=610）或 PN（n=295）的 905 例患者（平均年龄 57.5 岁，平均随访 78 个月）进行了回顾性分析。记录了患者的人口统计学资料、术前和术后高脂血症情况。新发高脂血症定义为手术后≥6 个月实验室值符合国家胆固醇教育计划成人治疗小组 III 定义的情况。采用 Kaplan-Meier 方法评估新发高脂血症的无病生存率。采用多变量分析确定新发高脂血症的危险因素。
两组患者在人口统计学资料、术前肾小球滤过率（GFR）<60ml/min/1.73m2（P=0.123）和高脂血症（P=0.144）方面无显著差异。RN 组肿瘤直径（cm）明显大于 PN 组（7.0 比 3.7；P<0.001）。RN 组术后 GFR<60ml/min/1.73m2 显著更大（45.7 比 18%，P<0.001）。RN 组新发高脂血症的发生率明显高于 PN 组（23 比 6.4%；P<0.001）。PN 组发生高脂血症的平均时间长于 RN 组（54 比 44 个月；P=0.03）。5 年无新发高脂血症的概率为 RN 组 76%，PN 组 96%（P<0.001）。多变量分析显示，RN（比值比[OR]2.93；P=0.0107）、术前 GFR<60ml/min/1.73m2（OR 1.98；P=0.037）和术后 GFR<60ml/min/1.73m2（OR 7.89；P<0.001）是与高脂血症发生相关的因素。
接受 RN 的患者新发高脂血症的发生率显著更高，且发病时间更早。RN 和术前及术后 GFR<60ml/min/1.73m2 与高脂血症的发生有关。需要进一步的随访和前瞻性研究来证实这些发现。
