目的 探讨活体肾移植受者术后早期感染的临床特征及危险因素,为围手术期感染防控提供依据。方法 回顾性分析2019-01至2024-10在首都医科大学附属北京友谊医院接受活体肾移植手术患者的基本信息和临床资料,采用单因素分析和探索性多因素logistic回归分析归纳术后早期感染的危险因素。结果 共纳入119例活体肾移植受者,其中22例在术前采用血浆置换、利妥昔单抗和(或)依库珠单抗进行预处理。24例(20.17%)发生术后早期感染,最常见的感染类型为泌尿系统感染(18/24,75.00%),感染病原体主要为肠球菌和肠杆菌。单因素分析结果表明手术时长是术后早期感染的影响因素(OR=1.010,95％CI:1.002~1.018,P<0.05)。探索性多因素logistic回归分析结果表明,手术时长(OR=1.013,95％CI:1.003~1.023,P<0.05)、糖尿病(OR=19.040,95％CI:1.640~221.010,P<0.05)和诱导免疫中甲泼尼龙剂量(OR=1.172,95％CI:1.023~1.342,P<0.05)与术后早期感染存在相关性。结论 活体肾移植术后早期存在感染风险,手术时长较长、既往有糖尿病病史和诱导免疫中甲泼尼龙剂量较高与术后早期感染风险增加相关。
Abstract
Objective To analyze the clinical features and risk factors of early postoperative infection in living kidney transplant recipients, and to provide basis for the prevention and control of perioperative infection. Methods A retrospective study was conducted on the baseline information and clinical data of the patients who underwent living kidney transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2019 to October 2024. Univariate analysis and exploratory multivariate logistic regression analysis were used to identify risk factors of early postoperative infection. Results A total of 119 living kidney transplant recipients were included, among whom 22 received preoperative treatment with plasma exchange, rituximab, and/or eculizumab. Early postoperative infection occurred in 24 cases(20.17%), with urinary tract infection being the most common type(18/24, 75.00%). The predominant pathogens identified were enterococcus and enterobacter. Univariate analysis showed that the operation time was an influencing factor for early postoperative infection (OR=1.010, 95% CI: 1.002-1.018,P<0.05). Exploratory multivariate logistic regression analysis revealed that the operation time (OR=1.013, 95% CI: 1.003-1.023,P<0.05), diabetes mellitus (OR=19.040, 95% CI: 1.640-221.010,P<0.05), and methylprednisolone dose during induction immunotherapy (OR=1.172, 95% CI: 1.023-1.342,P<0.05) were related to early postoperative infection. Conclusions There is an infection risk after living kidney transplantation. Longer operation time, pre-existing diabetes mellitus, and a higher methylprednisolone dose during induction immunotherapy are associated with an increased risk of early postoperative infection.
关键词
活体供肾 /
肾移植 /
早期感染 /
病原体 /
危险因素
Key words
living kidney donation /
kidney transplantation /
early infection /
pathogen /
risk factors
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