Analysis of risk factors of herpes zoster after renal transplantation in a single center
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摘要:
目的 探讨肾移植术后带状疱疹发生的临床特点及相关危险因素。 方法 回顾性分析2009年3月至2012年3月在解放军第309医院器官移植研究所接受首次肾移植术的830例受者的临床资料。采用单因素和多因素Logistic回归法分析肾移植术后发生带状疱疹的相关危险因素。 结果 830例患者中,42例(5.1%)患者术后发生带状疱疹。带状疱疹的临床表现以头面部、躯干、四肢的水痘状皮疹为主,未发生因带状疱疹感染导致的直接死亡,带状疱疹后遗神经痛(PHN)是最常见的并发症。单因素分析显示高龄、肾上腺皮质激素(激素)冲击治疗增加肾移植术后发生带状疱疹病毒感染的风险[比值比(OR)=2.414,P=0.016;OR=2.936,P=0.003]。多因素分析显示高龄和激素冲击治疗均为肾移植术后发生带状疱疹的独立危险因素(OR=2.238,P=0.030;OR=2.755,P=0.005)。 结论 肾移植术后带状疱疹的临床特点为水痘状皮疹。高龄和激素冲击治疗是肾移植术后发生带状疱疹的独立危险因素。 Abstract:Objective To investigate the clinical characteristics and risk factors of the incidence of herpes zoster after renal transplantation. Methods Clinical data of 830 recipients undergoing renal transplantation for the first time in the Organ Transplantation Research Institute of the 309th Hospital of Chinese People's Liberation Army from March 2009 to March 2012 were retrospectively analyzed. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors of the incidence of herpes zoster after renal transplantation. Results Among 830 patients, 42 (5.1%) suffered from herpes zoster postoperatively. Clinical manifestations of herpes zoster mainly included varicella-zoster rash in the head, face, trunk and limbs. No patient died from herpes zoster. Post-herpetic neuralgia (PHN) was the most common complication of herpes zoster. Univariate Logistic regression analysis revealed that advanced age and adrenal cortical hormone (hormone) shock therapy could increase the risk of herpes zoster viral infection after renal transplantation (OR=2.414, P=0.016; OR=2.936, P=0.003). Multivariate Logistic regression analysis demonstrated that advanced age and hormone shock therapy were the independent risk factor of the incidence of herpes zoster following renal transplantation (OR=2.238, P=0.030; OR=2.755, P=0.005). Conclusions Herpes zoster after renal transplantation is clinically manifested with varicella-zoster rash. Advanced age and hormone shock therapy are the independent risk factor of the incidence of herpes zoster after renal transplantation. -
表 1 发生与未发生带状疱疹患者的一般资料比较
Table 1. Comparison of general data between patients with herpes zoster and patients without herpes zoster
[n(%)] 指标 未发生带状疱疹的患者(n=788) 发生带状疱疹的患者(n=42) P值 年龄 ≥55岁 101(13) 11(26) 0.013 <55岁 687(87) 31(74) 性别 男 574(73) 25(60) 0.061 女 214(27) 17(41) 诱导方案 无诱导 74(9) 10(24) 0.031 巴利昔单抗 450(57) 19(45) ATG 107(14) 3(7) ALG 157(20) 10(24) 免疫维持方案 FK506+MZR+Pred 35(4) 2(5) 0.169 CsA+MZR+Pred 23(30) 4(10) FK506+MMF+Pred 433(55) 18(43) CsA+MMF+Pred 297(38) 18(43) 激素冲击治疗 是 94(12) 12(29) 0.001 否 694(88) 30(71) 捐献类型 活体供肾 116(15) 8(19) 0.466 DCD供肾 672(85) 34(81) DCD为心脏死亡器官捐献 表 2 单因素和多因素Logistic回归分析肾移植术后带状疱疹危险因素
Table 2. Univariate and multivariate Logistic analysis of risk factors for herpes zoster after renal transplantation
危险因素 OR值 95%可信区间 P值 单因素分析 年龄 <55岁 1.000 ≥55岁 2.414 1.176~4.953 0.016 性别 男 1.000 女 1.039 0.523~2.567 0.913 诱导方案 无诱导 1.000 巴利昔单抗 2.122 0.846~5.319 0.109 ATG 0.666 0.303~1.463 0.311 ALG 0.440 0.118~1.637 0.221 捐献类型 活体供肾 1.000 DCD供肾 0.734 0.331~1.625 0.445 激素冲击治疗 否 1.000 是 2.936 1.453~5.932 0.003 多因素分析 年龄 <55岁 1.000 ≥55岁 2.238 1.080~4.635 0.030 激素冲击治疗 否 1.000 是 2.755 1.355~5.604 0.005 -
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