肾移植患者发生移植肾功能延迟恢复的危险因素分析及预测  

Risk factors of delayed graft function in cadaveric kidney transplantations: a single center report from Tongji hospital

作　　者：陈杰[1] 曾凡军[1] 金昊[1] 明长生[1] 陈知水[1] 张伟杰[1] 林正斌[1] 刘敦贵[1] 陈忠华 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究院教育部,卫生部器官移植重点实验室,武汉430030

出　　处：《中华器官移植杂志》2006年第8期456-459,共4页Chinese Journal of Organ Transplantation

基　　金：中国博士后科学基金资助项目(2005038539);国家重点基础研究发展规划项目(2003CB515505)

摘　　要：目的研究肾移植患者发生移植肾功能延迟恢复(DGF)的相关危险因素及预测方法。方法回顾性分析212例具有完整人类白细胞抗原(HLA)配型资料的尸体肾移植患者的临床资料,对患者的性别、年龄、血型、乙型肝炎病毒感染情况、心功能分级、是否再次移植、透析时间长短、HLA配型情况、供肾热缺血时间、供肾冷缺血时间以及血管开放后泌尿时间进行严格的记录和评估。用一元logistic回归方法初步找出与DGF发生相关的因素,再用多元逐步logistic回归方法找出导致DGF发生的各项高危险因素,建立移植肾功能延迟恢复的logistic回归模型。结果本组患者DGF发生率为16.51%。由一元logistic回归方法分析发现在α=0.05的水准上,DGF与心功能分级、透析时间、HLA-Ⅰ类错配、HLA总错配及移植肾冷缺血时间有关,但与是否再次移植、性别、年龄、血型、乙型肝炎病毒感染情况、肾脏热缺血时间、血管开放后泌尿时间等均无明显的相关性。用多元逐步lo-gistic回归分析方法发现患者心功能分级、HLA-Ⅰ类抗原错配和移植肾冷缺血时间是影响DGF的重要因素。结论DGF的发生不是移植肾冷保存时间过长或其它任何单一因素导致的,而是由供肾质量、免疫学因素和受者功能状况等多种因素决定的。应用DGF的多元回归预测模型,可以计算出患者发生DGF的概率,从而进行必要的临床干预,预防DGF的发生。Objective To define clinical parameters associated with delayed graft function （DGF）, and develop a multivariable logistic regression formula which can predict the occurrence of DGF. Methods Risk factors for DGF in 212 cadaveric renal transplant recipients, from Tongji hospital, were studied by a multivariable logistic regression analysis. All recipients underwent kidney transplantations from 2003 to 2004. Major clinical variables included recipient age, gender, primary indication for kidney transplantation, status of hepatitis B infection, functional classification of heart failure, previous kidney transplantation or first transplantation, titer of serum panel-reactive antibody, extent of HLA matching, warm and cold ischemia time, time from kidney reperfusion to urine excretion and the duration of hemodialysis before transplantation. Results In this cohort, the incidence of DGF was 16. 51%. It was found that cold ischemia time, recipients functional classification of heart failure and HLA mismatches on A and B loci were significantly associated with DGF （P〈0. 01）, and a multivariable logistic regression formula was created to predict the occurrence of DGF. Conclusions These resuits strongly suggested that not only cold ischemia time and extent of HLA mismatch, but also the cardiovascular status of recipient played important roles in the etiology of DGF. With the use of multivariable logistic regression formula, the risk of DGF for a recipient could be calculated. Therefore, relevant clinical intervention and optimal allocation decision can be conducted.

关 键 词：肾移植 危险因素 LOGISTIC模型 

分 类 号：R699.2[医药卫生—泌尿科学] R195.1[医药卫生—外科学]