Longitudinal relations between obesity and hypertension following pediatric renal transplantation
Longitudinal relations between obesity and hypertension following pediatric renal transplantation
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DOI：
10.1007/s00467-010-1572-4
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发表时间：
2010-10-01
影响因子：
3
通讯作者：
Leonard, Mary B.
中科院分区：
文献类型：
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作者：
Denburg, Michelle R.;Pradhan, Madhura;Leonard, Mary B.
肥胖和高血压经常使肾移植（RTxp）复杂化。目的是评估儿科 RTxp 接受者的肥胖、高血压和糖皮质激素之间的关系。对 141 名 2-21 岁的 RTxp 接受者进行了一项回顾性队列研究，并进行了 12 个月的随访。记录体重指数 Z 评分 (BMI-Z)、收缩压和舒张压 Z 评分（SBP-Z 和 DBP-Z）以及第 1、3、6 和 12 个月以及此后每年的用药情况。使用拟最小二乘回归分析。肥胖率（BMI 千分之一欧元千分之九十五）从基线时的 13% 增加到 3 个月后的 30% 以上。糖皮质激素暴露量（mg/kg/天）越大，BMI-Z 的增加越大（p < 0.001）。这种关联在男性、年轻接受者和基线 BMI-Z 较低的人中更为明显（所有交互作用 p < 0.02）。 1 个月时收缩期高血压的患病率（SBP 千分之 95%）为 73%，所有随访时的患病率为 40%。随着时间的推移，糖皮质激素暴露量的增加（p < 0.001）和 BMI-Z 的增加（p = 0.005）是 SBP-Z 的独立决定因素。环孢素（与他克莫司相比）与较高的 SBP-Z 和 DBP-Z 独立相关 (p = 0.001)。持续肥胖和高血压经常使儿科 RTxp 复杂化。肥胖是收缩期高血压的独立决定因素。需要制定策略来预防肥胖及其对高血压、心血管疾病和同种异体移植物存活的影响。
Obesity and hypertension frequently complicate renal transplantation (RTxp). The objective was to assess relations among obesity, hypertension, and glucocorticoids in pediatric RTxp recipients. A retrospective cohort study was carried out in 141 RTxp recipients, 2-21 years of age, with a parts per thousand yen12 months of follow-up. Body mass index Z-score (BMI-Z), systolic and diastolic blood pressure Z-scores (SBP-Z and DBP-Z), and medications at 1, 3, 6, and 12 months and annually thereafter were recorded. Quasi-least squares regression analysis was used. The prevalence of obesity (BMI a parts per thousand yenaEuro parts per thousand 95th percentile) increased from 13% at baseline to > 30% from 3 months onward. Greater glucocorticoid exposure (mg/kg/day) was associated with greater increases in BMI-Z (p < 0.001). This association was greater in males, younger recipients, and those with lower baseline BMI-Z (all interactions p < 0.02). The prevalence of systolic hypertension (SBP a parts per thousand yenaEuro parts per thousand 95th percentile) was 73% at 1 month and a parts per thousand yenaEuro parts per thousand 40% at all follow-up visits. Greater glucocorticoid exposure (p < 0.001) and increases in BMI-Z (p = 0.005) were independent determinants of SBP-Z over time. Cyclosporine (versus tacrolimus) was independently associated with greater SBP-Z and DBP-Z (p = 0.001). Sustained obesity and hypertension frequently complicated pediatric RTxp. Obesity was an independent determinant of systolic hypertension. Strategies are needed to prevent obesity and its impact on hypertension, cardiovascular disease, and allograft survival.