肾移植术后远期贫血的发病及其相关危险因素

Study on the prevalence and risk factors of posttransplantation anemia after renal transplantation

目的探讨肾移植术后贫血（PTA）的发病率及可能的相关危险因素。方法回顾性分析2007-12~2015-12在本院规律随访的189例肾移植术后患者资料,根据PTA诊断标准将患者分成PTA组（n=51）及非PTA组（n=138）。记录可能引起PTA的各项参数,将可能引起PTA的危险因素进行统计学分析,对P〈0.05的参数进行Logistic多因素分析。结果189例肾移植术后患者,共有51例诊断为PTA,发病率为26.98%。统计学分析显示：患者年龄、免疫抑制剂类型、降压药物、移植术后糖尿病（PTMD）、血清铁蛋白、乙型病毒性肝炎与PTA的发生无相关性（P〉0.05）;性别、血清肌酐水平、急性排斥反应、肺部感染、更昔洛韦、伏立康唑、复方新诺明、血促红素（EPO）水平与PTA的发生呈明显相关性（P〈0.05）。将各变量再纳入多因素非条件Logistic回归分析表明：女性（OR=1.104,95%CI 1.019-2.635,P=0.041）,血清肌酐水平（OR=3.942,95%CI 2.011-5.722,P=0.001）,急性排斥（OR=6.305,95%CI 3.897-9.243,P=0.004）,更昔洛韦（OR=2.115,95%CI1.652-7.346,P=0.042）,血清EPO（OR=3.207,95%CI 0.410-6.051,P=0.001）5项因素与PTA的发生密切相关。结论PTA是肾移植术后一项常见的并发症,女性、移植肾功能降低、急性排斥反应、使用更昔洛韦以及血清EPO减少是发生PTA的危险因素。

Objective To investigate the incidence of posttransplantation anemia（PTA） and its associated risk factors in patients with kidney transplantation. Methods The clinical data of 189 patients who received renal transplant from December 2007 to December 2015 were retrospectively analyzed. The patients were divided into PTA group（n = 51 ） and non-PTA group（ n = 138）. All possible risk factors for PTA were recorded. Outcomes among the patients with PTA were compared with those without PTA using t-test and chi- square analysis method. Univariate and Logistic regression analysis were used to rank the relative risk of potential variables. Results The 56 of 189 patients with renal posttransplantation were diagnosed as PTA, and the incidence was 26.98%. There was no statistical difference between the two groups in age,immunosuppressive drugs, antihypertensive drugs, posttransplantation diabetes mellitus （PT- MD）, serum ferritin and hepatitis B virus （P 〉 0.05 ）. Logistic regression analysis of single factor showed that the sex, serum creati- nine, acute rejection,pneumonia,ganciclovir,voriconazole,compound sulfamethoxazole tablets,and serum erythropoietin were correlated with PTA （P 〈 0.05 ）. Multi-factors unconditional Logistic stepwise regression analysis showed that the risk factors for PTA were female （ OR = 1. 104, 95 % CI 1.019 - 2.635, P = 0.041 ）, serum creatinine level （ OR = 3. 942,95 % C I 2.011 - 5. 722, P = 0. 001 ）, acute rejection （ OR = 6. 305,95 % C I 3. 897 - 9. 243, P = 0.004 ）, ganciclovir （ OR = 2.115,95 % CI 1. 652 - 7. 346, P = 0. 042 ）, and serum erythropoietin（ OR = 3. 207,95% CI 0.410 - 6.051 ,P = 0.001 ）. Conclusion PTA is a frequent complication after kidney transplan- tation. Female ,impaired renal function, acute rejection, ganciclovir and serum erythropoietin decrease are risk factors of anemia in kidney transplantation recipients.