摘要
目的探讨肾移植术后患者应用含他克莫司(TAC)免疫抑制方案治疗早期发生泌尿系感染的危险因素及其预警价值。方法收集2015年1月1日至2021年10月30日在山东第一医科大学附属省立医院行同种异体肾移植术且术后应用TAC+吗替麦考酚酯+甲泼尼龙三联免疫抑制方案治疗患者的病历资料进行回顾性分析。通过医院信息系统提取患者相关临床资料,根据服用TAC 1个月内是否发生泌尿系感染将患者分为感染组和无感染组,比较2组患者临床特征,采用二元logistic回归法分析泌尿系感染的危险因素,计算比值比(OR)及其95%置信区间(CI)。应用受试者工作特征(ROC)曲线分析危险因素对泌尿系感染发生风险的预警价值。结果纳入分析的患者共256例,男性208例,女性48例;年龄34(29,42)岁,范围18~66岁;体重指数22.9(20.4,25.4)kg/m2,范围13.9~34.4 kg/m2;肾供体来源于亲属者163例,心脏死亡器官捐献(DCD)者93例。256例患者中发生泌尿系感染者56例(无症状菌尿32例,有症状的泌尿系感染24例),发生率为21.9%。2组患者在性别、年龄、体重、体重指数、原发疾病、合并疾病、肾供体来源、术后住院时间、留置导尿管及输尿管支架时间、术后并发症、术后合并其他感染、实验室检查等方面的差异无统计学意义(均P>0.05)。感染组患者服用TAC第7、14、21天血药谷浓度均高于无感染组[9.7(8.4,13.5)μg/L比8.0(6.3,9.8)μg/L,P<0.001;9.4(7.6,11.0)μg/L比8.0(6.3,9.8)μg/L,P=0.002;9.2(7.6,11.1)μg/L比8.2(6.3,9.8)μg/L,P=0.002]。二元logistic回归分析结果显示,服用TAC第7天血药谷浓度高(OR=1.815,95%CI:1.332~2.474,P<0.001)是肾移植术后患者早期发生泌尿系感染的独立危险因素。ROC曲线分析结果显示,服药第7天TAC血药谷浓度ROC曲线下面积为0.704(95%CI:0.626~0.782),截断值为8.35μg/L(敏感度76.8%,特异度53.5%)。按截断值将患者分为2组,>8.35μg/L组和≤8.35μg/L组泌尿系感�
Objective To explore the risk factors and the predicting value of early urinary tract infection in patients treated with tacrolimus(TAC)containing immunosuppressive regimen after kidney transplantation.Methods The medical records of patients who underwent allogeneic kidney transplantation in the Provincial Hospital Affiliated to Shandong First Medical University from January 1,2015 to October 30,2021 and received triple immunosuppressive regimen with TAC+mycophenolate mofetil+methylprednisolone were collected and analyzed retrospectively.Relevant clinical data of patients were extracted from the hospital information system.Patients were divided into infection group and noninfection group according to whether urinary tract infection occurred within 1 month after taking TAC and the clinical characteristics in patients between the 2 groups were compared.The risk factors of urinary tract infection were analyzed by binary logistic regression method,and the odds ratio(OR)and its 95%confidence interval(CI)were calculated.The receiver operating characteristic(ROC)curve was used to analyze the predicting value of risk factors on the risk of urinary tract infection.Results A total of 256 patients were entered in the analysis,including 208 males and 48 females,aged 34(29,42)years with an range from 18 to 66 years,and the body mass index of these patients was 22.9(20.4,25.4)kg/m2,ranging from 13.9 to 34.4 kg/m2.There were 163 living donors from relatives and 93 cardiac dead organ donors(DCD).Among the 256 patients,56 had urinary tract infection(asymptomatic bacteriuria in 32 patients and symptomatic urinary tract infection in 24 patients)after kidney transplantation with an incidence of 21.9%.The differences in gender,age,body weight,body mass index,primary disease,comorbidity disease,donor source,length of hospital stay after surgery,time of indwelling urinary tube and ureteral stent,postoperative complications,complicated infection in other parts of the body after surgery,laboratory test results and so on in patients betwe
作者
苗苗
王倩
王霞
张媛
关芳
王钰琪
张美霞
Miao Miao;Wang Qian;Wang Xia;Zhang Yuan;Guan Fang;Wang Yuqi;Zhang Meixia(Department of Kidney Transplantation,Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)
出处
《药物不良反应杂志》
CSCD
2022年第8期417-423,共7页
Adverse Drug Reactions Journal
关键词
肾移植
移植物排斥
泌尿道感染
免疫抑制剂
他克莫司
Kidney transplantation
Graft rejection
Urinary tract infections
Immunosuppressive agents
Tacrolimus
