腎臟移植患者消化性潰瘍的危險因子----單一醫學中心十一年的經驗

背景 消化性潰瘍，是腎臟移植患者一種常見的併發症，且會引起顯著的罹病率及死亡率。 方法 從西元1990年至西元2000年，共有465位腎臟移植患者在我們醫院接受追蹤。大部份的腎臟移植患者，接受以類固醇及環孢靈為主的免疫抑制劑的治療。大約有三分之一的病患(156位患者)，接受mycophenolate mofetil的治療。經過內視鏡證實有消化性潰瘍的病患，我們仔細審閱他們的病歷記錄，並且記錄可能造成消化性潰瘍的危險因子。使用單變項分析及多變項回歸分析的方式，來分析這些可能造成消化性潰瘍的危險因子，是否引起顯著的差異。 結果 在465位腎臟移植患者中，有181位患者，曾遭受過至少一次的消化性潰瘍。盛行率為38.9 %。最常見的消化性潰瘍為胃炎、胃潰瘍、十二指腸潰瘍、食道炎、十二指腸炎、及食道潰瘍。以多變項回歸分析的方式可知，使用methylprednisolone脈衝治療(危險比為3.954, 95 %信賴區間為3.154至18.312, P值為0.03)及腎臟移植前有消化性潰瘍病史的患者(危險比為7.599, 95 %信賴區間為1.211至12.905, P值小於0.0001)，為腎臟移植後，得到消化性潰瘍的獨立危險因子。 結論 我們的發現顯示，有使用methylprednisolone脈衝治療來治療急性排斥，或是腎臟移植前有消化性潰瘍病史的腎臟移植患者，在腎臟移植後，得到消化性潰瘍的危險很高。這些患者，值得使用密集的抗消化性潰瘍的藥物治療。

Background Peptic ulcer disease is a common complication among renal transplant recipients and causes significant morbidity and mortality. Methods From 1990 through 2000, 465 renal transplant patients were followed up in our institute. Most patients received corticosteroids and cyclosporine-based immunosuppressive regimen. About one third (n= 156) of them received mycophenolate mofetil. Patients with endoscopy-proved peptic ulcer disease were identified by reviewing medical records. Possible risk factors were analyzed by univariate analysis and multiple logistic regression analysis. Results Among 465 kidney transplant patients, there were 181 (38.9 %) who suffered at least one episode of peptic ulcer disease. The most frequent types of peptic ulcer disease were gastritis, gastric ulcer, duodenal ulcer, esophagitis, duodenitis and esophageal ulcer. By multivariate analysis, the use of methylprednisolone pulse therapy (odds ratio= 3.954, 95 % confidence interval= 3.154-18.312, P= 0.03) and history of pre-transplant peptic ulcer disease (odds ratio= 7.599, 95 % CI= 1.211-12.905, P< 0.0001) were independent risk factors for post-transplant peptic ulcer disease. Conclusions Our findings demonstrated that renal transplant patients who undergo methylprednisolone pulse therapy for acute rejection or who have a history of pre-transplant peptic ulcer disease carry a high risk for the development of peptic ulcer disease and deserve intensive anti-ulcer treatment.