肾移植受者对异种移植看法的问卷调查及影响因素分析

A questionnaire study of kidney transplant recipients'views on xenotransplantation and analysis of influencing factors

目的调查肾移植受者对异种肾移植的看法并探讨其相关影响因素,为后期我国异种肾移植的临床研究提供辅助参考依据。方法提取在华中科技大学同济医学院附属同济医院器官移植中心随访的194例肾移植受者对异种移植看法的问卷调查数据。非参数检验用于比较得分差异,χ^(2)检验用于比较具体问题回答情况。将非参数检验中具有统计学意义的变量纳入多因素线性回归分析以探究受者对异种移植态度的影响因素。结果肾移植受者对异种肾脏移植态度量表得分(百分制)较高(75分);"认知偏好"维度得分最高(85分);"风险担忧"维度得分最低(50分)。单因素分析结果显示:性别(P=0.020)、有无医学背景(P=0.006)和是否了解临床试验案例(P<0.001)是"认知偏好"维度得分的影响因素;学历(P=0.029)是"风险担忧"维度得分的影响因素;年龄(P=0.028)、是否了解临床试验案例(P=0.001)是"社会心理"维度得分的影响因素;有无医学背景(P=0.018)和是否了解临床试验案例(P=0.008)是"功效预期"维度得分的影响因素;性别(P=0.010)、有无医学背景(P=0.018)和是否了解临床试验案例(P=0.008)是总分的影响因素。多因素分析结果示:性别(B=-0.821,95%CI:-1.419~-0.223,P=0.007)、有无医学背景(B=0.938,95%CI:0.097~1.779,P=0.029)和是否了解美国异种移植临床试验案例(B=1.498,95%CI:0.887~2.110,P<0.001)是"认知偏好"维度得分的影响因素;学历(B=-0.693,95%CI:-1.353~-0.034,P=0.040)是"风险担忧"维度得分的影响因素;是否了解美国异种移植临床试验案例(B=1.075,95%CI:0.418~1.731,P=0.001)是"社会心理"维度得分影响因素;是否了解美国异种移植临床试验案例(B=0.710,95%CI:0.063~1.358,P=0.032)是"功效预期"维度得分的影响因素;性别(B=-2.259,95%CI:-4.094~-0.423,P=0.016)、是否有医学背景(B=2.799,95%CI:0.219~5.378,P=0.034)和是否了解美国异种移植临床试验案例(B=3.237,95%CI:1.360~5.114,P=0.001)是总分的影响因素。结论肾移植受者对异种移植的知晓率较高,对异种移植的接受度总体较好,其中男性、有医学背景、了解异种移植临床案例的肾移植受者对异种移植态度更好;肾移植受者更担心感染风险,同时肾移植受者期待异种猪肾脏能达到与同种异体肾脏一样的长期存活。

ObjectiveTo explore the attitude of kidney transplant(KT)recipients towards xenotransplantation and explore its related influencing factors to provide auxiliary references for the clinical research of xenotransplantation in China.MethodsThe questionnaire data of"Attitude survey of KT recipients towards xenotransplantation"were collected from 194 KT recipients followed up at Organ Transplant Center of Affiliated Tongji Hospital.Nonparametric tests were utilized for comparing score differences andχ2 tests for comparing responses to specific questions.Variables with statistical significance in non-parametric test were included into multifactor linear regression analysis for exploring the influencing factors of recipients'attitudes towards xenotransplantation.ResultsKT recipients had a higher score(75 points)on attitude scale of xenotransplantation."Cognitive preference"dimension scored the highest(85 points);"Fear of risk"dimension scored lowest(50 points).The results of univariate analysis indicated that gender(P=0.020),medical background(P=0.006)and knowledge of clinical trial cases(P<0.001)were the influencing factors of score of cognitive preference.Educational background(P=0.029)was the factor affecting the score of"risk concern"dimension.Age(P=0.028)and knowledge of clinical trial cases(P=0.001)were the factors influencing the score of"psychosocial"dimension.Whether medical background(P=0.018)and knowledge of clinical trial cases(P=0.008)were the factors influencing the score of"efficacy expectation"dimension;Gender(P=0.010),medical background(P=0.018)and knowledge of clinical trial cases(P=0.008)were the factors influencing total score.The results of multi-factor analysis revealed that gender(B=-0.821,95%CI:-1.419~0.223,P=0.007),medical background(B=0.938,95%CI:0.097~1.779,P=0.029)and knowledge of clinical trials of xenotransplantation in the United States(B=1.498,95%CI:0.887~2.110,P<0.001)was the influencing factor of cognitive preference.Educational background(B=-0.693,95%CI:-1.353~-0.034,P=0.040)was the influencing factor of score on"risk concern"dimension.Knowledge of clinical trials of xenotransplantation in the United States(B=1.075,95%CI:0.418~1.731,P=0.001)was an influencing factor of score on"social psychological"dimension;Knowledge of clinical trials of xenotransplantation in the United States(B=0.710,95%CI:0.063~1.358,P=0.032)was an influencing factor of score on"efficacy expectation"dimension;Gender(B=-2.259,95%CI:-4.094~-0.423,P=0.016),medical background(B=2.799,95%CI:0.219~5.378,P=0.034)and knowledge of clinical trials of xenotransplantation in the United States(B=3.237,95%CI:1.360~5.114,P=0.001)were the influencing factors of total score.ConclusionsKT recipients have a higher awareness rate of xenotransplantation and a better acceptance of xenotransplantation in general.Those males with medical background and knowing clinical cases of xenotransplantation demonstrate a better attitude towards xenotransplantation.More concerned about the risk of infection,respondents expect heterologous pig kidneys to achieve the same long-term survival as allogeneic kidneys.