中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2008年
48期
3407-3410
,共4页
张磊%马麟麟%马斌荣%田野
張磊%馬麟麟%馬斌榮%田野
장뢰%마린린%마빈영%전야
肾移植%移植物排斥%急性排斥反应%供者年龄%供者性别
腎移植%移植物排斥%急性排斥反應%供者年齡%供者性彆
신이식%이식물배척%급성배척반응%공자년령%공자성별
Kidney transplantation%Graft rejection%Acute rejection episode%Donor age%Donor sex
目的 探讨供肾因素导致活体肾脏移植受者早期发生急性排斥反应的危险因素.方法 采用前瞻性定群研究对2004年4月至2007年11月的117例首次活体肾脏移植受者进行随访,记录急性排斥反应.按供者年龄分为两组,应用Kaplan-Meier乘积极限法计算急性排斥反应累积发病率;并以对数秩检验比较两组差异.应用COX比例风险模型分析受者术后早期发生急性排斥反应的独立危险因素.结果 随访中位数时间为16个月(术后3～44个月).供者年龄≥50岁组的受者在移植术后2周、6周急性排斥反应发生率分别为13.0%和19.5%;高于供者年龄<50岁组(2.8%和8.5%),差异有统计学意义(P=0.010).COX比例风险模型分析显示,女性供者(RR=2.731,95%CI:1.018～7.326)、老年供肾(RR:1.054,95%CI:1.004～1.107)是受者术后早期急性排斥反应发生率的独立危险因素(均P＜0.05).结论 活体肾脏移植中,老年供者选择应更加严格;在老年供肾摘取和移植过程中应尽最避免肾脏损伤;接受老年或女性供肾的受者,术后早期免疫抑制药物应足量应用.
目的 探討供腎因素導緻活體腎髒移植受者早期髮生急性排斥反應的危險因素.方法 採用前瞻性定群研究對2004年4月至2007年11月的117例首次活體腎髒移植受者進行隨訪,記錄急性排斥反應.按供者年齡分為兩組,應用Kaplan-Meier乘積極限法計算急性排斥反應纍積髮病率;併以對數秩檢驗比較兩組差異.應用COX比例風險模型分析受者術後早期髮生急性排斥反應的獨立危險因素.結果 隨訪中位數時間為16箇月(術後3～44箇月).供者年齡≥50歲組的受者在移植術後2週、6週急性排斥反應髮生率分彆為13.0%和19.5%;高于供者年齡<50歲組(2.8%和8.5%),差異有統計學意義(P=0.010).COX比例風險模型分析顯示,女性供者(RR=2.731,95%CI:1.018～7.326)、老年供腎(RR:1.054,95%CI:1.004～1.107)是受者術後早期急性排斥反應髮生率的獨立危險因素(均P＜0.05).結論 活體腎髒移植中,老年供者選擇應更加嚴格;在老年供腎摘取和移植過程中應儘最避免腎髒損傷;接受老年或女性供腎的受者,術後早期免疫抑製藥物應足量應用.
목적 탐토공신인소도치활체신장이식수자조기발생급성배척반응적위험인소.방법 채용전첨성정군연구대2004년4월지2007년11월적117례수차활체신장이식수자진행수방,기록급성배척반응.안공자년령분위량조,응용Kaplan-Meier승적겁한법계산급성배척반응루적발병솔;병이대수질검험비교량조차이.응용COX비례풍험모형분석수자술후조기발생급성배척반응적독립위험인소.결과 수방중위수시간위16개월(술후3～44개월).공자년령≥50세조적수자재이식술후2주、6주급성배척반응발생솔분별위13.0%화19.5%;고우공자년령<50세조(2.8%화8.5%),차이유통계학의의(P=0.010).COX비례풍험모형분석현시,녀성공자(RR=2.731,95%CI:1.018～7.326)、노년공신(RR:1.054,95%CI:1.004～1.107)시수자술후조기급성배척반응발생솔적독립위험인소(균P＜0.05).결론 활체신장이식중,노년공자선택응경가엄격;재노년공신적취화이식과정중응진최피면신장손상;접수노년혹녀성공신적수자,술후조기면역억제약물응족량응용.
Objective To identify the risk factors of acute rejection events after living related donor renal transplant.Methods Renal transplantation was performed on 117 patients, 85 males and 32 females, aged 9-57, with the kidneys from 117 donors, 63 males and 54 females, aged(47±6) (20-65).The cumulative incidence of acute rejection events was respectively evaluated by Kaplan-Meier product-limit method and log-rank test.Cox's proportional hazards model was used to determine the risk factors for acute rejection events.Results Follow-up was conducted for 16 (3 -44) months.The acute rejection rotes 2 and 6 weeks after transplantation of the group with the donor aged ≥50 were 13.0% and 19.5% respectively, both significantly higher than those of the group with the donor aged <50 (2.8% and 8.5% respectively, P =0.010).The risk of being female for acute rejection was 2.731 times as that of being male (95% CI:1.018 -7.326 ,P =0.046), and the risk of donor aged ≥50 for acute rejection was 1.054 times as that of the donors aged <50 (95%(CI:1.004 - 1.107,P =0.020).Conclusion The requirement for selecting elder living kidney donor should be stiff.Injury to the kidney should be avoided when the kidney of an eider donor is removed and transplanted.Early administration of sufficient immunosuppressive agents is necessary to the recipients of the kidney from an old or female living donor.
