肾移植术后肺炎的临床特点及生存分析

发布时间：2018-11-11 01:28

【摘要】：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CRP40 mg/L组的OS下降(P0.001),降钙素原(PCT)≥1 ng/ml组较PCT1 ng/ml组的OS下降(P=0.002),血小板计数(Plt)≤100×10~9/L组较Plt100×10~9/L组的OS下降(P0.001),脑钠肽(BNP)100 pg/ml组较BNP≤100 pg/ml组的OS下降(P0.001),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≤100×10~9/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≤100×10~9/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。
[Abstract]:Objective to summarize the clinical features of patients with pneumonia after renal transplantation and to analyze the factors influencing their prognosis. Methods from January 1, 2014 to December 31, 2015, 89 renal transplant patients hospitalized for pneumonia in Sichuan Provincial people's Hospital were included. The clinical data were collected. The overall survival rate (OS) was calculated by Kaplan-Meier method and the survival curve was drawn. The influence of different factors on prognosis was analyzed by Cox regression model. Results the time of pneumonia after renal transplantation was mainly within 6 months after transplantation. The main manifestations included dry cough (95.5%), fever (56.1%) and dyspnea (12.3%). The mortality of pneumonia after renal transplantation was 11.2%, and the death rate was mainly within 5 months after transplantation. Kaplan-Meier analysis showed that the OS of C reactive protein (CRP) 鈮，

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