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-  2017 

肾移植术后肺炎的临床特点及生存分析

DOI: doi:10.7507/1671-6205.201609006

Keywords: 肾移植, 肺炎, 感染, 生存分析

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Abstract:

目的总结肾移植术后肺炎患者的临床特点,对影响其预后的相关因素进行生存分析。方法纳入 2014 年 1 月 1 日至 2015 年 12 月 31 日期间在四川省人民医院因肺炎住院的肾移植术后患者 89 例,采集患者的临床资料,通过 Kaplan-Meier 法计算总体生存率(OS)并绘制生存曲线,比较不同因素对预后的影响,采用 Cox 回归模型分析多种因素对生存的影响。结果肾移植术后肺炎发生时间集中在移植术后 6 个月内,主要表现包括干咳(95.5%)、发热(56.1%)和呼吸困难(12.3%)。肾移植术后肺炎病死率 11.2%,死亡集中在移植术后 5 个月内。Kaplan-Meier 分析显示 C 反应蛋白(CRP)≥40 mg/L 组较 CRP<40 mg/L 组的 OS 下降(P<0.001),降钙素原(PCT)≥1 ng/ml 组较 PCT<1 ng/ml 组的 OS 下降(P=0.002),血小板计数(Plt)≤100×109/L 组较 Plt>100×109/L 组的 OS 下降(P<0 001="" bnp="">100 pg/ml 组较 BNP≤100 pg/ml 组的 OS 下降(P<0.001),肺炎发生时间<移植术后 180 d 组较≥移植术后 180 d 组的 OS 下降(P=0.013)。Cox 回归模型分析显示 Plt≤100×109/L时死亡风险增加 66.6 倍(RR=0.015,P=0.006);CRP≥40 mg/L时死亡风险增加 20 倍(RR=0.05,P=0.029)。结论肾移植术后肺炎的发生发展、症状、体征、病原学、影像具有突出的临床特点。当 Plt≤100×109/L 或 CRP≥40 mg/L 时,肾移植术后肺炎患者的死亡风险明显增加,可作为评估病情严重程度的独立危险因素

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