【摘要】：目的總結(jié)腎移植術(shù)后肺炎患者的臨床特點(diǎn),對影響其預(yù)后的相關(guān)因素進(jìn)行生存分析。方法納入2014年1月1日至2015年12月31日期間在四川省人民醫(yī)院因肺炎住院的腎移植術(shù)后患者89例,采集患者的臨床資料,通過Kaplan-Meier法計(jì)算總體生存率(OS)并繪制生存曲線,比較不同因素對預(yù)后的影響,采用Cox回歸模型分析多種因素對生存的影響。結(jié)果腎移植術(shù)后肺炎發(fā)生時(shí)間集中在移植術(shù)后6個(gè)月內(nèi),主要表現(xiàn)包括干咳(95.5%)、發(fā)熱(56.1%)和呼吸困難(12.3%)。腎移植術(shù)后肺炎病死率11.2%,死亡集中在移植術(shù)后5個(gè)月內(nèi)。Kaplan-Meier分析顯示C反應(yīng)蛋白(CRP)≥40 mg/L組較CRP40 mg/L組的OS下降(P0.001),降鈣素原(PCT)≥1 ng/ml組較PCT1 ng/ml組的OS下降(P=0.002),血小板計(jì)數(shù)(Plt)≤100×10~9/L組較Plt100×10~9/L組的OS下降(P0.001),腦鈉肽(BNP)100 pg/ml組較BNP≤100 pg/ml組的OS下降(P0.001),肺炎發(fā)生時(shí)間移植術(shù)后180 d組較≥移植術(shù)后180 d組的OS下降(P=0.013)。Cox回歸模型分析顯示Plt≤100×10~9/L時(shí)死亡風(fēng)險(xiǎn)增加66.6倍(RR=0.015,P=0.006);CRP≥40 mg/L時(shí)死亡風(fēng)險(xiǎn)增加20倍(RR=0.05,P=0.029)。結(jié)論腎移植術(shù)后肺炎的發(fā)生發(fā)展、癥狀、體征、病原學(xué)、影像具有突出的臨床特點(diǎn)。當(dāng)Plt≤100×10~9/L或CRP≥40 mg/L時(shí),腎移植術(shù)后肺炎患者的死亡風(fēng)險(xiǎn)明顯增加,可作為評估病情嚴(yán)重程度的獨(dú)立危險(xiǎn)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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