肾移植术后早期移植肾失功的危险因素分析

目的探讨肾移植术后发生早期移植肾失功的危险因素。方法回顾性分析35例肾移植术后2个月内发生移植肾失功患者（失功组）和同期70例未发生移植肾失功患者（对照组）的临床资料,应用单因素分析和多因素逐步Logistic回归分析找出导致早期移植肾失功的危险因素和独立危险因素,得出回归方程,并计算该模型判断有危险因素病例的早期移植肾失功的准确率。结果单因素分析表明,两组间供肾的热缺血时间、冷缺血时间、供肾血管异常、受者术前群体反应性抗体（panel reactive antibody,PRA）水平、供受者之间人类白细胞抗原（human leucocyte antigen,HLA）位点错配数是影响肾移植术后早期移植肾失功的危险因素（P〈0.05-0.01）。多因素逐步Logistic回归结果提示供受者之间HLA位点错配数、受者术前PRA水平、供肾冷缺血时间是早期移植肾失功的独立危险因素,其优势比分别为7.823、5.389和1.259（P〈0.05-0.01）。由此得出回归方程为：Y=-8.544＋2.057X1＋1.684X2＋0.230X3,该模型对具有危险因素的病例发生早期移植肾失功的预测准确率为80%。结论供受者之间HLA位点错配数、受者术前PRA水平、供肾冷缺血时间是肾移植术后早期移植肾失功的高危因素。

Risk factors of early non-functioning renal allograft after renal transplantation

Objective To explore the risk factors of early non-functioning renal allograft within 2 months after renal transplantation.Methods The clinical data of 35 cases of early non-functioning renal allograft and 70 cases of comparing group with normal graft function were retrospectively analyzed.χ2 and t test were used to analyze the single factor of early non-functioning renal allograft.The relationship between multifactor and early non-functioning renal allograft were analyzed by multiple factors stepwise logistic regression,establishing logistic equation and evaluating the discrimination accuracy rate predicted early non-functioning renal allograft for patients based on the risk factors.Results Hot and cold ischemia time,abnormal blood vessel of renal,titer of serum panel reactive antibody（PRA）and extent of human leucocyte antigen（HLA）mismatching were significantly associated with early non-functioning renal allograft in term of the single factor（P〈0.05~0.01）.Multiple factors stepwise logistic regression analysis showed that the cold ischemia time,HLA mismatching and titer of serum PRA were the risk factors of early non-functioning renal allograft.Their dominance ratios were 7.823,5.389 and 1.259（P〈0.05～0.01）.And regression equation was Y=-8.544＋2.057 X1＋1.684 X2＋0.230 X3.The discrimination accuracy rate predicted early non-functioning renal allograft for patients based on the risk factors was 80%.Conclusion Extent of HLA mismatching,titer of serum PRA and cold ischemia time are the risk factors of early non-functioning renal allograft.