腰围对肾移植术后早期切口相关并发症的预测价值

Predictive value of waist circumference in early incision related complications after kidney transplantation

目的:探讨腰围对肾移植术后早期切口相关并发症的预测价值。方法:选取2020年1月至2021年3月于联勤保障部队第九〇〇医院行肾移植手术患者127例,其中24例术后早期发生切口相关并发症(切口并发症组),103例术后早期未发生切口相关并发症(无切口并发症组)。对比两组患者在性别、年龄、吸烟史、糖尿病、腰围、体重指数(body mass index,BMI)、器官捐献类型、手术时间、关腹方式、筋膜关闭缝线、术后血清白蛋白低下、抗人类白细胞抗原(human leukocyte antigen,HLA)抗体方面的差异。多因素logistic回归分析肾移植术后早期切口相关并发症的预测因子,使用受试者工作特征(receiver operating character istic,ROC)曲线评价相关变量对切口相关并发症的预测价值。结果:切口并发症组患者较长腰围(男≥85 cm、女≥80 cm)、较高BMI(≥28 kg/m^(2))、较长手术时间(≥4 h)患者所占比例显著高于无切口并发症组,术后血清白蛋白低下和抗HLA抗体阳性患者所占比例显著高于无切口并发症组(P<0.05);两组患者在性别、年龄、吸烟史、糖尿病、器官捐献类型、关腹方式、筋膜关闭缝线方面差异无统计学意义(P>0.05)。多因素logistic回归分析发现:腰围(男≥85 cm、女≥80 cm)、术后血清白蛋白低下和抗HLA抗体阳性是肾移植术后早期发生切口相关并发症的独立预测因子(P<0.05)。ROC曲线分析显示:腰围(男≥85 cm、女≥80 cm)预测肾移植术后早期切口相关并发症的敏感度83.3%、特异度88.3%,曲线下面积(area under the curve,AUC)为0.858(95%CI:0.765~0.952)。结论:腰围对肾移植术后早期切口相关并发症具有预测价值,术前测量腰围可能有助于筛选高危患者使临床医师及时采取干预措施。

Objective:To investigate the predictive value of waist circumference in early incision-related complications after kidney transplantation.Methods:From January 2020 to March 2021,127 patients underwent kidney transplantation in our hospital were selected,including 24 patients with incision-related complications in the early postoperative period(an incision-related complications group)and 103 patients without incision-related complications in the early postoperative period(a no incision-related complications group).Differences in gender,age,smoking history,diabetes,waist circumference,body mass index(BMI),type of organ donation,operation time,abdominal closure,fascial closure suture,low serum albumin after operation,and anti-human leukocyte antigen(HLA)antibody were compared between the two groups.Multivariate Logistic regression was used to analyze the predictors of incision-related complications in the early stage after renal transplantation,and the subject operating characteristic(ROC)curve was used to evaluate the predictive value of related variables for incision-related complications.Results:The proportion of patients in the incision complication group with longer waist circumference(male≥85 cm,female≥80 cm),higher BMI(≥28 kg/m^(2))and longer operation time(≥4 h)was significantly higher than that in the non-incision complication group,and the proportion of patients with low serum albumin after operation and anti HLA antibody positive was significantly higher than that in the non-incision complication group(P<0.05).There was no significant difference between the two groups in gender,age,smoking history,diabetes mellitus,organ donation type,abdominal closure and fascial suture closure(P>0.05).Multivariate logistic regression analysis found that waist circumference(≥85 cm for men and≥80 cm for women),low serum albumin after operation and anti-HLA antibody positive were independent predictors of incisional complications in the early stages of renal transplantation(P<0.05).ROC curve analysis showed that waist circumference(≥85 cm for men and≥80 cm for women)had a sensitivity of 83.3%and specificity of 88.3%,and the area under the curve(AUC)was 0.858(95%CI:0.765-0.952)for predicting incisions related complications after renal transplantation.Conclusion:Waist circumference has predictive value in early incision-related complications after renal transplantation,and preoperative waist circumference measurement can help accurately screen out high-risk patients and make doctors take intervention measures as soon as possible.