肾移植术后并发慢性移植肾失功影响因素分析  

Analysis of influencing factors of chronic renal allograft dysfunction after renal transplantation

作　　者：张胜男[1] 贾丹[1] 孙平辉[2] 滕昊林 Zhang Shengnan;Jia Dan;Sun Pinghui;Teng Haolin(The Second Department of Urology,the First Hospital of Jilin University,Changchun 130021,China;College of Public Hygiene,Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院泌尿外二科,长春130021 [2]吉林大学公共卫生学院,长春130021

出　　处：《中华移植杂志（电子版）》2021年第3期147-151,共5页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的探究肾移植术后并发慢性移植肾失功(CRAD)的影响因素。方法回顾性分析2008年1月至2018年12月于吉林大学第一医院行肾移植的1457例受者临床资料。根据肾移植受者术后是否发生CRAD将其分为CRAD组和对照组。收集受者性别、年龄、术前体质指数(BMI)、原发病、术前透析方式、供肾类型、免疫诱导方案和免疫抑制方案等临床资料作为观察指标。采用成组t检验比较CRAD组和对照组受者年龄和术前BMI。采用卡方检验或Fisher确切概率法比较两组受者性别、原发病、透析方式、供肾类型、免疫诱导方案和免疫抑制方案。将单因素分析中有统计学差异的变量纳入Logistic回归进行多因素分析。P<0.05为差异有统计学意义。结果1457例受者中61例发生CRAD,CRAD发生率为4.19%(61/1457),其中59例恢复透析,2例因“间质肺”分别于肾移植术后8个月及10个月死亡;其余1396例受者均带肾存活。CRAD组和对照组受者年龄、术前BMI、术前透析方式、供肾类型及免疫诱导方案差异均有统计学意义(t=-2.835和-2.722,χ^(2)=29.400、18.310和27.250,P均<0.05)。Logistic回归分析结果表明受者年龄、BMI、术前透析方式及免疫诱导方案均为影响CRAD的独立危险因素(P均<0.05)。结论严格控制肾移植受者年龄和BMI,在情况允许下应尽早进行肾移植,并予合理的免疫诱导方案,有利于减少CRAD的发生,延长移植肾存活时间。Objective To explore the influencing factors of chronic renal allograft dysfunction(CRAD)after renal transplantation.Methods The clinical data of 1457 renal transplant recipients who underwent renal transplantation between January 2008 and December 2018 in the First Hospital of Jilin University were retrospective analyzed.The recipients were divided into CRAD group and control group according to whether or not the recipient with CRAD after renal transplantation.The clinical data including sex,age,body mass index(BMI)before transplantation,protopathy,dialysis before transplantation,type of kidney donor,immunity induction and immunosuppressant regiments.Group t test was used to compare the age and BMI of recipients before transplantation between CRAD group and control group.Chi-square test or Fisher exact probability method were used to compare the sex,protopathy,preoperative dialysis form,type of kidney donor,immunity induction and immunosuppressant protocols between the two groups.The variables with statistical difference in univariate analysis were included in Logistic regression for multivariate analysis.A P<0.05 was considered statistically significant.Results The occurrence rate of CRAD was 4.19%(61/1457).Among 61 recipients with CRAD 59 recipients received dialysis again after transplantation,and 2 recipients died of interstitial lung disease at 8 and 10 months postoperatively,respectively.The rest recipients(n=1396)were all survived with transplant kidneys.The age,preoperative BMI,preoperative dialysis form,immune induction protocol between of recipients between the two groups had significant difference(t=-2.835 and-2.722,χ^(2)=29.400,18.310 and 27.250,all P<0.05).Logistic regression multivariate analysis showed that age,BMI,preoperative dialysis form and immune induction protocol of recipients were independent risk factors for CRAD(all P<0.05).Conclusions Stricter control of age and BMI of renal transplant recipients,early renal transplantation and immunity induction are beneficial to reduce the occurrenc

关 键 词：肾移植 慢性移植肾失功 体质指数 免疫诱导 

分 类 号：R699.2[医药卫生—泌尿科学]