肾移植术后长期服用免疫抑制剂诱发恶性肿瘤的影响因素分析

Analysis of Influencing Factors of Malignant Tumor Induced by Long-term Use of Immunosuppressants After Kidney Transplantation

目的观察肾移植术后长期服用免疫抑制剂患者恶性肿瘤的发病情况,并分析患者继发恶性肿瘤的影响因素。方法回顾性分析197例在医院完成肾移植,且术后长期服用免疫抑制剂患者的资料,全部患者在用药治疗期间均获得随访,观察患者恶性肿瘤发病情况,通过单因素及多因素分析肾移植术后长期服用免疫抑制剂患者恶性肿瘤发病的影响因素。结果11例发生恶性肿瘤,恶性肿瘤发病率为5.58%(11/186),主要为肝癌和肾癌。经单项Logistic回归分析并建立多元回归模型行多因素分析检验结果显示,血药浓度高、乙型肝炎病毒(HBV)感染、Treg细胞高表达均可能是肾移植术后长期服用免疫抑制剂诱发恶性肿瘤的影响因素(OR>1,P<0.05)。结论肾移植术后,患者长期服用免疫抑制剂,会增加恶性肿瘤发病风险,可能受血药浓度、HBV感染、Treg细胞表达等因素影响。临床应重视对肾移植术后患者免疫抑制剂服用期间恶性肿瘤风险因素评估,并做到合理干预,对减少恶性肿瘤发生、改善预后结局可能有积极意义。

Objective To observe the occurrence of malignant tumors in patients taking immunosuppressive agents for a long time after kidney transplantation,and to analyze the influencing factors of patients with secondary malignant tumors.Methods197 patients who completed kidney transplantation and took long-term immunosuppressive agents after operation were retrospectively analyzed.All patients were followed up during the medication treatment,observed the occurrence of malignant tumors of patients.The influencing factors of the occurrence of malignant tumors in patients who took immunosuppressants for a long time after kidney transplantation were analyzed by single factor and multiple factors.Results 11 cases developed malignant tumors in this study,and the incidence rate of malignant tumors was 5.58%(11/186),mainly were liver cancer and kidney cancer;after a single Logistic regression analysis and a multiple regression model was established,the results of multivariate analysis showed that high plasma concentration,hepatitis B virus(HBV)infection,and high expression of Treg cells might all be influencing factors for malignant tumors induced by long-term immunosuppressants after kidney transplantation(OR>1,P<0.05).Conclusion After kidney transplantation,long-term use of immunosuppressive agents in patients may increase the risk of malignant tumors,which may be affected by factors such as plasma concentration,HBV infection,and Treg cell expression.The clinic should pay attention to the evaluation of malignant tumor risk factors during the period of immunosuppressive therapy in patients after kidney transplantation,and make reasonable interventions,which may have positive significance in reducing the occurrence of malignant tumors and improving the prognostic outcome.