目的：本研究探討腎臟移植後一年之病人發生腹瀉而使移植腎功能惡化之危險因子。
方法：使用Hyperion 資料倉儲於南部某醫學中心進行回溯性觀察研究，搜尋自2009 年1 月1 日至2015 年8 月31 日之資料中，移植後一年而有腹瀉診斷、腹瀉持續三天以上、使用或未使用抗生素治療腹瀉者；收集腎臟移植接受者腹瀉前後包括血清肌酸酐值 (serum creatinine, Scr) 的變化、International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 腹瀉診斷、腹瀉持續時間等。類別變項以chi-square test 分析，以student t-test 或analysis of variance (ANOVA) 檢定Scr 變化與危險因子之相關性。
結果： 腎臟移植後因感染cytomegalovirus (CMV) 或Clostridium difficile 引起腹瀉者其血清肌酸酐值 (Scr) 的上升大於非感染性腹瀉 (0.31 ± 0.52 vs. 0.1 ± 0.27)；而當腹瀉持續 ≥ 10 天時其Scr 變化又較持續 < 10 天者顯著 (0.53 ± 0.55 vs. 0.05± 0.22; p = 0.0018)，因此推論感染性腹瀉及腹瀉持續時間為移植後腎功能惡化之危險因子。免疫抑制的使用與腹瀉之間雖無顯著的相關性，然而使用tacrolimus +mycophenolate + mammalian target of rapamycin inhibitor 組合的病人在非感染性腹瀉方面有相對較高的發生率。
結論：本研究結果發現移植後腹瀉影響移植後腎功能惡化之危險因子有感染性腹瀉、腹瀉持續大於10 天以上者；而免疫抑制的使用與腹瀉間之相關性則較不顯著。
Objective: This study was to investigate the risk factors of worsening graft renal function in patients with diarrhea after one year renal transplantation.
Methods: We conducted a retrospective observational study use Hyperion data warehouse as data source at a medical center in a Southern Taiwan from January 1, 2009 to August 31, 2015. Patients were collected according to ICD-9-CM diagnosis code of diarrhea, diarrhea period ≥ 3 days, use (or not) of antibiotic agents. Chisquare test was for category variables, student t-tests or analysis of variance (ANOVA) were used to verify the correlation among the serum creatinine changes and diarrhea causes, diarrhea periods (continuous variables).
Results: Patients with infectious diarrhea due to cytomegalovirus (CMV) or Clostridium difficile demonstrated a larger mean serum creatinine (Scr) change than those with non-infectious diarrhea (0.31 ± 0.52 vs. 0.1 ± 0.27), and when their diarrhea persisted for more than 10 days, a significant larger mean serum creatinine change would be observed (0.53 ± 0.55 vs. 0.05 ± 0.22; compared with those with diarrhea period of < 10 days, p = 0.0018), showing that the irreversible kidney allograft function change was associated with both persisted diarrhea and infectious diarrhea. The association between the immunosuppressive agent combination and diarrhea occurred was non-significant. However, combination use of tacrolimus (Tac), mycophenolate mofitil (MMF) and mammalian target of rapamycin inhibitor (mTOR) had a relatively high incidence rates in noninfectious diarrhea.
Conclusions: Our study brings new data in the direction showing that infectious diarrhea does more damages to renal function than non-infectious ones in kidney transplant recipients, especially when the diarrhea persists for more than 10 days.
