不同评分模型预测肾移植术后移植物功能延迟恢复的效能研究  

The efficiency study on different scoring models in predicting delayed graft function after renal transplantation

作　　者：乔予希 丁晨光[1] 田普训[1] 丁小明[1] 潘晓鸣[1] 燕航[1] 项和立[1] 冯新顺[1] 侯军[1] 田晓辉[1] 李杨[1] 郑瑾[1] 薛武军[1] Qiao Yuxi;Ding Chenguang;Tian Puxun;Ding Xiaoming;Pan Xiaoming;Yan Hang;Xiang Heli;Feng Xinshun;Hou Jun;Tian Xiaohui;Li Yang;Zheng Jin;Xue Wujun(Department of Renal Transplantation,Kidney Disease Hospital,the First Affiliated Hospital of Xi’an Jiaotong University,Organ Transplantation Institute of Xi'an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾脏病医院肾移植科,西安交通大学器官移植研究所,710061

出　　处：《器官移植》2020年第3期379-383,共5页Organ Transplantation

基　　金：国家自然科学基金(81670681,81760137,81870514);中央高校基本科研业务费(xjj2018091);中国器官移植发展基金会“菁英计划”(2019JYJH04);西安交通大学第一附属医院重大临床研究项目(XJTU1AF-CRF-2015-005)。

摘　　要：目的分析国内外评分模型对我国肾移植术后移植物功能延迟恢复(DGF)的预测效能。方法前瞻性分析112例肾移植供者、220例受者的临床资料。将KDRI模型、Jeldres模型以及本中心模型预测的DGF与肾移植受者实际DGF发生率进行对比,分析各模型的预测效能,利用受试者工作特征(ROC)曲线的曲线下面积(AUC)比较预测的准确性。结果220例肾移植受者中,DGF发生率为14.1%(31/220)。KDRI模型预测DGF高危供者41例,AUC为0.57,灵敏度为0.37,特异度为0.66,阳性预测值为22%。Jedres模型预测DGF高危受者22例,AUC为0.56,灵敏度为0.13,特异度为0.92,阳性预测值为20%。本中心模型预测DGF高危供者25例,AUC为0.80,灵敏度为0.53,特异度为0.84,阳性预测值为40%。结论与KDRI和Jedres模型比较,本中心预测模型具有较高的AUC及灵敏度,对DGF有较好的预测效能,是目前适合我国公民逝世后器官捐献供者的评估体系。Objective To analyze the prediction efficiency of scoring models at home and abroad on delayed graft function(DGF)after renal transplantation in China.Methods The clinical data of 112 donors and 220 recipients undergoing renal transplantation were prospectively analyzed.The DGF predicted by KDRI model,Jeldres model,and model of our center was compared with actual DGF incidence of renal transplant recipients.The prediction efficiency of each model was analyzed.The predictive accuracy was compared by the area under curve(AUC)of receiver operating characteristic(ROC)curve.Results The DGF incidence of 220 renal transplant recipients was 14.1%(31/220).DGF prediction using KDRI model showed that 41 cases were high risk donors,the AUC was 0.57,the sensitivity was 0.37,the specificity was 0.66,and the positive predictive value was 22%.DGF prediction using Jedres model showed that 22 cases were high risk recipients,the AUC was 0.56,the sensitivity was 0.13,the specificity was 0.92 and the positive predictive value was 20%.DGF prediction using the model of our center showed that 25 cases were high risk donors,the AUC was 0.80,the sensitivity was 0.53,the specificity was 0.84,the positive predictive value was 40%.Conclusions Compared with the KDRI and Jedres models,the prediction model of our center has higher AUC and sensitivity with a better prediction efficiency on DGF.Therefore,it is a suitable evaluation system of donors from donation after citizen s death in Chinese.

关 键 词：肾移植 移植肾功能延迟恢复 原发性移植物无功能 评分模型 风险预测 受试者工作特征曲线 曲线下面积 

分 类 号：R617[医药卫生—外科学]