CAJ | 학술논문

目的研究肾移植受者术后1年内发生反复性肺炎的主要危险因素.方法回顾性分析2004年至2012年间接受肾移植的1516例受者的临床资料,将术后发生肺炎的受者分为普通肺炎组(对照组)和反复性肺炎组(研究组).采用x2检验和t检验对相关资料进行单因素分析,将单因素分析中有显著性差异的变量进行Logistic回归分析.结果 1516例肾移植受者中,181例受者发生肺炎,其中9例为反复性肺炎(总体发生率为0.59％),病原体构成主要包括真菌和病毒.与对照组比较,研究组受者术前透析时间较长(P＜0.05),术后淋巴细胞水平低下(P＜0.05),急性排斥反应发生次数较多(P＜0.0)5),以及首次肺炎的发病时间较早(P＜0.05),依次为(13.7±3.5)个月、(0.56±0.29)×109/L、(1.1±0.9)次及(25.8±16.4)d;研究组中少数民族受者构成比较高(P＜0.05).研究组受者中使用免疫球蛋白的受者比例显著低于对照组(P＜0.05).多因素分析结果显示,受者种族为肾移植术后发生反复性肺炎的独立危险因素(P=0.039,比数比为93.744).对照组受者的治疗周期为(25.2±8.3)d,1例死于重症肺炎并发急性排斥反应,其余受者均痊愈;研究组受者的治疗周期分别为(22.8±9.7)d,(31.9±7.9)d及(34.6±6.6)d,其中1例受者死于败血症、感染性休克伴急性呼吸衰竭,其余8例痊愈后随访1～2年未再发病.结论肾移植后1年内反复性肺炎的发生率约为0.59％,其病原体以真菌和病毒为主,受者种族、术前透析时间及术后多种因素均可能影响反复性肺炎的发生.
목적 연구신이식수자술후1년내발생반복성폐염적주요위험인소.방법 회고성분석2004년지2012년간접수신이식적1516례수자적림상자료,장술후발생폐염적수자분위보통폐염조(대조조)화반복성폐염조(연구조).채용x2검험화t검험대상관자료진행단인소분석,장단인소분석중유현저성차이적변량진행Logistic회귀분석.결과 1516례신이식수자중,181례수자발생폐염,기중9례위반복성폐염(총체발생솔위0.59％),병원체구성주요포괄진균화병독.여대조조비교,연구조수자술전투석시간교장(P＜0.05),술후림파세포수평저하(P＜0.05),급성배척반응발생차수교다(P＜0.0)5),이급수차폐염적발병시간교조(P＜0.05),의차위(13.7±3.5)개월、(0.56±0.29)×109/L、(1.1±0.9)차급(25.8±16.4)d;연구조중소수민족수자구성비교고(P＜0.05).연구조수자중사용면역구단백적수자비례현저저우대조조(P＜0.05).다인소분석결과현시,수자충족위신이식술후발생반복성폐염적독립위험인소(P=0.039,비수비위93.744).대조조수자적치료주기위(25.2±8.3)d,1례사우중증폐염병발급성배척반응,기여수자균전유;연구조수자적치료주기분별위(22.8±9.7)d,(31.9±7.9)d급(34.6±6.6)d,기중1례수자사우패혈증、감염성휴극반급성호흡쇠갈,기여8례전유후수방1～2년미재발병.결론 신이식후1년내반복성폐염적발생솔약위0.59％,기병원체이진균화병독위주,수자충족、술전투석시간급술후다충인소균가능영향반복성폐염적발생.
Objective To investigate the risk factors of repeated pneumonia after renal transplantation in the first year.Method In a case-control study,we reviewed 1516 cases of kidney transplant recipients between January 2004 and January 2012.The pneumonia cases post-transplantation were divided into two groups,which involved repeated pneumonia patients (case group) and common pneumonia(control group).All of patients had a similar follow-up period with a comparable immunosuppressive drug regimen.The outcomes were compared between the two groups with t-tests for continuous variables and chi-square tests for nominal variables.And the independent risk factors affecting disease development were analyzed using logistic regression.Result There were 181 pneumonia patients in this study.Nine episodes of repeated pneumonia were documented among 1516 kidney transplant recipients (0.59％).The types of pathogen documented were mainly invasive fungal and virus.It was found that long period of pre-transplant dialysis (13.7 months;P =0.034),less post-transplant lymphocyte counts (0.56 × 109/L; P =0.029),repeated acute rejection (1.1 time; P =0.048) and shorter period of median days from transplantation to initial diagnosis (25.8 days; P=0.004) were significantly associated with repeated pneumonia in term of the single factor.Furthermore,the constituent ratio of minority in case group was higher than in control group (P＜0.05),while that of immunoglobin treatment intraoperatively in case group was lower than in control group (P＜0.05).Multiple factors logistic regression analysis revealed that the minority groups were independent risk factor (P＜ 0.05).Otherwise,the duration of treatment of common pneumonia subjects was 25.2 days on average.During this time,only one patient was died from severe pneumonia with acute rejection.In case group,the duration of treatment was 22.8,31.9,and 34.6 days respectively.In this group,one case was died from septic shock with acute respiratory failure.Conclusion In our experience,0.59％ of kidney transplant recipients developed repeated pneumonia in the first year post-transplantation,mainly virus followed by fungal.Minority groups,pretransplant hemodialysis and post-operative various factors may influence the development of repeated pneumonia.