胰肾联合移植术后不明原因发热的临床分析  

Analysis of unknown-origin fever after simultaneous pancreas-kidney transplantation

作　　者：潘建勇 付迎欣[1] 曹玉 冯钢[1] 赵杰[1] 王辉[1] 史晓峰[1] 王振[1] 宋文利[1] 莫春柏[1] Pan Jianyong;Fu Yingxin;Cao Yu;Feng Gang;Zhao Jie;Wang Hui;Shi Xiaofeng;Wang Zhen;Song Wenli;Mo Chunbai(Department of Kidney Transplantation,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院肾移植科,天津300192

出　　处：《中华器官移植杂志》2022年第2期82-87,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81970654);天津市卫生健康委员会科技项目(ZC20167、ZC20227、RC20111、RC20090、RC20122、RC20128)。

摘　　要：目的:探讨胰肾联合移植(simultaneous pancreas-kidney transplantation,SPK)术后不明原因发热的临床特点、病因和转归。方法:回顾性分析2015年3月至2020年1月于天津市第一中心医院肾移植科接受胰肾联合移植的120例受者的临床资料。根据微生物培养、影像学表现或排斥反应等明确导致发热的证据,将受者分为无发热(free-fever,FF)组(41例)、原因明确发热(defined-fever,DF)组(47例)和不明原因发热(fever of unknown origin,FUO)组(32例),比较三组在一般临床特征、外科并发症、实验室检查及预后方面差异,定义不明原因发热的临床特征。采用Logistic回归分析不明原因发热的风险因素,采用Kapla-Meier进行生存分析,P<0.05为差异有统计学意义。结果:多因素分析提示,术前糖尿病性胃肠病可能是不明原因发热的独立危险因素。FUO组和DF组白细胞计数[6.50(5.13,7.36)×10^(9)/L比10.36(6.11,12.97)×10^(9)/L]、C反应蛋白[11.75(6.25,16.85)μg/ml比35.00(16.30,75.00)μg/ml]、降钙素原[0.13(0.06,0.18)ng/ml比0.19(0.11,1.05)ng/ml]等急性期标志物比较,差异均有统计学意义(P<0.001,P<0.001,P=0.025)。FUO组仅接受1~2种抗生素及较短疗程的受者为13例(40.6%),与DF组32例(68.1%)比较,差异有统计学意义(P=0.016)。FUO组另有6例(18.7%)受者在确诊为不明原因发热后,仅使用非甾体抗炎药实现临床转归。FUO组住院时间为(48.72±19.51)d与DF组(57.36±27.46)d比较,差异有统计学意义(P<0.001);两组住院费用分别为253463.25元和334605.96元,组间比较,差异亦有统计学意义(P=0.002)。结论:术前糖尿病性胃肠病是SPK术后早期不明原因发热的独立危险因素。不明原因发热者白细胞计数、C反应蛋白、降钙素原等炎性标记物均显著低于原因明确发热者,这一典型临床特征有助于不明原因发热的早期诊断。Objective To explore the clinical features,etiologies and outcomes of unknown origin fever after simultaneous pancreas-kidney transplantation(SPK).Methods From March 2015 to January 2020,clinical data were retrospectively reviewed for 120 SPK recipients.According to the definite evidence of fever,such as microbial culture,imaging findings or rejection,they were divided into three groups of free-fever(FF,n=41)and defined-fever(DF,n=47)and fever of unknown origin(FUO,n=32).The differences in general clinical features,surgical complications,laboratory tests and prognoses were compared.Logistic regression was employed for analyzing the risk factors of FUO and Kapla-Meier for survival analysis.And P<0.05 was deemed as statistically significant.Results Multivariate analysis revealed that preoperative diabetic gastroenteropathy was an independent risk factor for unexplained fever.Significant differences existed between FUO and DF groups in leucocyte count[6.50(5.13,7.36)vs.10.36(6.11,12.97)×10^(9)/L],C-reactive protein(CRP)[11.75(6.25,16.85)vs.35.00(16.30,75.00)μg/ml],procalcitonin[0.13(0.06,0.18)vs.0.19(0.11,1.05)ng/ml](P<0.001,P<0.001,P=0.025).As compared with DF group,19 recipients in FUO group only received 1-2 antibiotics and there was a shorter course of treatment[13(40.6%)vs.32(68.1%),P=0.016].For 6(18.7%)recipients after a diagnosis of FUO,clinical outcome was achieved with only NSAIDs.Length of stay was(48.72±19.51)days in FUO group versus(57.36±27.46)days in DF group and the difference was statistically significant(P<0.001).Hospitalization expenses of two groups were 253463.25 and 334605.96 yuan respectively and the difference was also statistically significant(P=0.002).Conclusions Diabetic gastroenteropathy is an independent risk factor for early FUO after SPK transplantation.Inflammatory markers of leukocytes,CRP and procalcitonin in FUO patients are significantly lower than DF group.And these clinical features can help diagnose FUO in an early stage.

关 键 词：胰肾联合移植 糖尿病 不明原因发热 排斥反应 

分 类 号：R699.2[医药卫生—泌尿科学] R657.5[医药卫生—外科学]