肾移植后尿路感染危险因素荟萃分析  

Meta--analysis of the risk factors of nrinary tract infection after renal transplantation

作　　者：李明霞[1] 彭贵主[1] 曾宪鹏[1] 王彦峰[1] 李玲[1] 夏志平[1] 叶啓发[1,2] 

机构地区：[1]武汉大学中南医院武汉大学肝胆疾病研究院武汉大学移植医学中心移植医学技术湖北省重点实验室,430071 [2]中南大学湘雅三医院卫生部移植医学工程技术研究中心

出　　处：《中华器官移植杂志》2016年第3期159-164,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金重点项目（U1403222）;中央高校基本科研业务费专项资金（2042015kfl016）

摘　　要：目的探讨肾移植后导致尿路感染（UTI）的危险因素，为临床有效预防UTI提供依据。方法检索1995年1月至2015年12月间CNKI、VIP、万方等数据库以及Pubmed、Embase、Ovid、EBSCO等数据库文献。英文检索关键词为renal transplantation,kidney transplantation.urinarytract infection,risk factors和Metaanalysis，中文检索关键词为肾移植、尿路感染、泌尿系统感染、危险因素。收集所有公开发表的关于肾移植后UTI危险因素的研究文献，采用RevMan软件进行统计分析。结果共纳入15篇文献，UTI组累计1 236例，非UTI组2729例。荟萃分析结果提示，受者年龄，糖尿病史，术前腹膜透析，巨细胞病毒感染，急性排斥反应，使用吗替麦考酚酯、他克莫司和环孢素A，二次肾移植等，对术后发生UTI无明显影响（P〉0．05）；女性受者UTI发生率高于男性受者[比值比（oR）为2．69；95％可信区间（CI）为1．92～3．77；P〈0．000013；尸体供肾移植后UTI发生率高于活体供肾移植（oR为1．51；95％CI为1．71～1．95；P=0．002）；留置输尿管内支架管（D-J管）较不留置D-J管者术后更易发生UTI（OR为1．51；95％CI为1．07～2．13；P=0．02）；术前长时间透析导致UTI发病率增高（加权均数差为1．48；95％CI为0．22～2．74；P=0．02）。结论女性受者、尸体供肾移植、留置D-J管及术前长时间透析是肾移植后发生UTI的危险因素。Objective To determine the risk factors of urinary tract infection （UTI） after renal transplantation, so as to provide a theoretical basis of reducing the rate of postoperative UTI effectively. Method Such databases as CNKI, VIP, Wanfang, Pubmed, Embase, Ovid, andEBSCO） were searched from January 1995 to December 2015 for collecting the studies about UTI after renal transplantation. The search keywords were renal transplantation, kidney transplantation, urinary tract infection and risk factors. Meta-analysis was performed by using the RevMan 5.2 software. Result Fifteen studies were identified, including 1 236 patients in UTI group and 2 729 patients in the control group （non UTI group）. The two groups had no significant differences in recipient age, diabetes mellitus history, peritoneal dialysis, cytomegaovirus infection, acute rejection, usage of MMF, usage of Tacrolimus, usage of CsA and retransplantation. The incidence of UTI after renal transplantation was significantly higher in female patients than male patients （OR： 2. 69; 95% CI： 1.92 - 3. 77; P〈0. 000 01）. The incidence of UTI of cadaveric renal transplantation was higher than living donor renal transplantation （OR： 1.51; 95% CI： 1.71 - 1.95; P=0. 002）. Using D-J tube for urinary reconstruction significantly increased the incidence of UTI （OR： 1.51 ; 95% CI： 1.07 - 2. 13; P= 0. 02）. Patients in the UTI group had a significantly longer preoperative dialysis time （WMI）： 1.48; 95% CI： 0.22 - 2.74! P = 0.02）. Conclusion The female recipients, cadaveric renal transplantation, using D-J tube and prolonged preoperative dialysis time were factors affecting the riskof UTI. UTI after renal transplantation had no relationship with recipient age, diabetes mellitus history, peritoneal dialysis, cytomegaovirus infection, acute rejection, usage of MMF, Tacrolimus and CsA, and retransplantation.

关 键 词：肾移植 尿路感染 危险因素 荟萃分析 

分 类 号：R699.2[医药卫生—泌尿科学] R691.3[医药卫生—外科学]