老年肾移植受者肺部感染的危险因素分析

Analysis of risk factors for pulmonary infection in elderly kidney transplant recipients

目的:探讨老年(60周岁以上)肾移植受者发生肺部感染的危险因素。方法:回顾性分析解放军总医院第八医学中心自2010年1月至2019年1月行肾移植术的119例老年肾移植受者的临床资料。依据肾移植术后是否发生肺部感染将受者分为感染组(40例)和非感染组(79例)。分析两组的临床资料,包括受者的性别、年龄、供肾类型、体重指数、有无吸烟史、术前透析时间、术前透析方式、免疫诱导方案、免疫维持方案、有无移植肾功能延迟恢复、有无白细胞减少症、感染前血肌酐水平、是否接受过静脉激素冲击治疗、手术前后有无糖尿病史、有无冠心病史、有无乙型病毒性肝炎史、是否预防性应用复方磺胺甲恶唑、是否预防性应用缬更昔洛韦或更昔洛韦,进行单因素分析和多因素Logistic回归分析,分析老年肾移植受者肺部感染的危险因素。结果:老年肾移植受者肺部感染发生率为33.6%(40/119),感染组15例发生重症肺部感染而死亡,死亡率为37.5%(15/40);有吸烟史(OR=10.58,95%CI:1.98~56.40,P=0.006)、静脉激素冲击治疗(OR=25.06,95%CI:4.25~147.71,P<0.001)、术前透析时间长(OR=1.032,95%CI:1.003~1.062,P=0.033)是老年肾移植受者肺部感染的危险因素。结论:老年肾移植受者肺部感染发生率及死亡率均较高;吸烟史、静脉激素冲击治疗、术前透析时间长与老年肾移植受者发生肺部感染相关。

Objective To explore the risk factors of pulmonary infection in elderly(aged 60+years)kidney transplant recipients.Methods The clinical data were retrospectively analyzed for 119 elderly kidney transplant recipients from January 2010 to January 2019.According to whether or not pulmonary infection occurred after renal transplantation,the recipients were divided into infected group(n=40)and non-infected group(n=79).Clinical data was analyzed for two groups.The relevant risk factors of gender,age,donor type,body mass index,history of smoking,preoperative dialytic time,preoperative dialysis,immune induction,immune maintenance,presence or absence of delayed graft function,leucopenia,serum creatinine before infection,venous hormone shock therapy or not,diabetic history before or after surgery,history of coronary heart disease,history of hepatitis B virus,prophylactic dosing of compound sulfamethoxazole,prophylactic valganciclovir or ganciclovir,were examined by univariate analysis and multivariate logistic regression analysis.Results The incidence of pulmonary infection in elderly kidney transplant recipients was 33.6%(40/119).In infected group,15 patients died of severe pulmonary infection with a mortality rate of 37.5%(15/40).History of smoking(OR=10.58,95%CI:1.98-56.40,P=0.006),venous hormone shock therapy(OR=25.06,95%CI:4.25-147.71,P<0.001)and preoperative dialytic time(OR=1.032,95%CI:1.003-1.062,P=0.033)were the risk factors for pulmonary infection in elderly kidney transplant recipients.Conclusions The incidence and mortality of lung infection are higher in elderly kidney transplant recipients.Smoking history,venous hormone shock therapy and long preoperative dialytic are associated with pulmonary infection in elderly kidney transplant recipients.