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单中心肾移植术后带状疱疹的相关危险因素分析

贺腾辉 钱叶勇 范宇 李刚 解俊杰

贺腾辉, 钱叶勇, 范宇, 等. 单中心肾移植术后带状疱疹的相关危险因素分析[J]. 器官移植, 2017, 8(3): 215-219. doi: 10.3969/j.issn.1674-7445.2017.03.008
引用本文: 贺腾辉, 钱叶勇, 范宇, 等. 单中心肾移植术后带状疱疹的相关危险因素分析[J]. 器官移植, 2017, 8(3): 215-219. doi: 10.3969/j.issn.1674-7445.2017.03.008
He Tenghui, Qian Yeyong, Fan Yu, et al. Analysis of risk factors of herpes zoster after renal transplantation in a single center[J]. ORGAN TRANSPLANTATION, 2017, 8(3): 215-219. doi: 10.3969/j.issn.1674-7445.2017.03.008
Citation: He Tenghui, Qian Yeyong, Fan Yu, et al. Analysis of risk factors of herpes zoster after renal transplantation in a single center[J]. ORGAN TRANSPLANTATION, 2017, 8(3): 215-219. doi: 10.3969/j.issn.1674-7445.2017.03.008

单中心肾移植术后带状疱疹的相关危险因素分析

doi: 10.3969/j.issn.1674-7445.2017.03.008
基金项目: 

首都临床特色应用研究 Z131107002213139

详细信息
    通讯作者:

    钱叶勇,Email: qianyy@medmail.com.cn

  • 中图分类号: R617, R752.1+2

Analysis of risk factors of herpes zoster after renal transplantation in a single center

More Information
  • 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。

     

  • 图  1  高龄受者和中青年受者肾移植术后带状疱疹的累积发生率

    Figure  1.  Cumulative incidence of herpes zoster of elderly recipients and young and middle-aged recipients 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
    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)
      ATG107(14)3(7)
      ALG157(20)10(24)
    免疫维持方案
      FK506+MZR+Pred35(4)2(5)0.169
      CsA+MZR+Pred23(30)4(10)
      FK506+MMF+Pred433(55)18(43)
      CsA+MMF+Pred297(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
    下载: 导出CSV

    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OR95%可信区间P
    单因素分析
     年龄
      <55岁1.000
      ≥55岁2.4141.176~4.9530.016
     性别
      男1.000
      女1.0390.523~2.5670.913
    诱导方案
      无诱导1.000
      巴利昔单抗2.1220.846~5.3190.109
      ATG0.6660.303~1.4630.311
      ALG0.4400.118~1.6370.221
     捐献类型
      活体供肾1.000
      DCD供肾0.7340.331~1.6250.445
     激素冲击治疗
      否1.000
      是2.9361.453~5.9320.003
    多因素分析
     年龄
      <55岁1.000
      ≥55岁2.2381.080~4.6350.030
     激素冲击治疗
      否1.000
      是2.7551.355~5.6040.005
    下载: 导出CSV
  • [1] Kırnap M, Akdur A, Ayvazoğlu Soy HE, et al. Prevalence and outcome of herpes zoster infection in renal transplant recipients[J]. Exp Clin Transplant, 2015, 13(Suppl 1): 280-283. DOI: 10.6002/ect.mesot2014.P113.
    [2] Pergam SA, Forsberg CW, Boeckh MJ, et al. Herpes zoster incidence in a multicenter cohort of solid organ transplant recipients[J]. Transpl Infect Dis, 2011, 13(1): 15-23. DOI: 10.1111/j.1399-3062.2010.00547.x.
    [3] Koo S, Gagne LS, Lee P, et al. Incidence and risk factors for herpes zoster following heart transplantation[J]. Transpl Infect Dis, 2014, 16(1): 17-25. DOI: 10.1111/tid.12149.
    [4] Zuckerman RA, Limaye AP. Varicella zoster virus (VZV) and herpes simplex virus (HSV) in solid organ transplant patients[J]. Am J Transplant, 2013, 13(Suppl 3):55-66;quiz 66. DOI:10.1111/ajt.12003.
    [5] Johnson RW, Bouhassira D, Kassianos G, et al. The impact of herpes zoster and post-herpetic neuralgia on quality-of-life[J]. BMC Med, 2010, 8: 37. DOI: 10.1186/1741-7015-8-37.
    [6] Ko GB, Kim T, Kim SH, et al. Increased incidence of herpes zoster in the setting of cytomegalovirus preemptive therapy after kidney transplantation[J]. Transpl Infect Dis, 2013, 15(4): 416-423. DOI: 10.1111/tid.12091.
    [7] Martin-Gandul C, Stampf S, Héquet D, et al. Preventive strategies against cytomegalovirus and incidence of alpha-herpesvirus infections in solid organ transplant recipients: a nationwide cohort study[J]. Am J Transplant, 2016, DOI:10.1111/ajt.14192[Epubahead of print].
    [8] Gourishankar S, Mcdermid JC, Jhangri GS, et al. Herpes zoster infection following solid organ transplantation: incidence, risk factors and outcomes in the current immunosuppressive era[J]. Am J Transplant, 2004, 4(1): 108-115. doi: 10.1046/j.1600-6143.2003.00287.x
    [9] Piaserico S, Sandini E, Peserico A, et al. Cutaneous viral infections in organ transplant patients[J]. G Ital Dermatol Venereol, 2014, 149(4): 409-415. http://www.minervamedica.it/it/riviste/dermatologia-venereologia/articolo.php?cod=R23Y2014N04A0409
    [10] Rommelaere M, Maréchal C, Yombi JC, et al. Disseminated varicella zoster virus infection in adult renal transplant recipients: outcome and risk factors[J]. Transplant Proc, 2012, 44(9): 2814-2817. DOI: 10.1016/j.transproceed.2012.09.090.
    [11] Pavlopoulou ID, Poulopoulou S, Melexopoulou C, et al. Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis[J]. BMC Infect Dis, 2015, 15: 285. DOI: 10.1186/s12879-015-1038-1.
    [12] 周海林, 蒋法兴.197例带状疱疹患者外周血T淋巴细胞亚群的测定[J].安徽医学, 2014, (4):485-487.DOI: 10.3969/j.issn.1000-0399.2014.04.024.

    Zhou HL, Jiang FX. Detection of peripheral blood T lymphocyte subsets in 197 cases with herpes zoster[J]. Anhui Med J, 2014(4):485-487. DOI: 10.3969/j.issn.1000-0399.2014.04.024.
    [13] Mustapic Z, Basic-Jukic N, Kes P, et al. Varicella zoster infection in renal transplant recipients: prevalence, complications and outcome[J]. Kidney Blood Press Res, 2011, 34(6): 382-386. DOI: 10.1159/000328730.
    [14] Hamaguchi Y, Mori A, Uemura T, et al. Incidence and risk factors for herpes zoster in patients undergoing liver transplantation[J]. Transpl Infect Dis, 2015, 17(5): 671-678. DOI: 10.1111/tid.12425.
    [15] 蔡玲琴, 朱希聪, 张灵鹏, 等.急性期带状疱疹患者的临床特征与T细胞亚群的关系[J].中华全科医学, 2017, 15(1):39-41. DOI:10.16766 /j.cnki.issn.1674-4152.2017.01.012.

    Cai LQ, Zhou XC, Zhang LP, et al. Relationship of clinical features of acute herpes zoster with T cell subsets[J]. Chin J Gen Pract, 2017, 15(1):39-41. DOI:10.16766 /j.cnki.issn.1674-4152.2017.01.012.
    [16] Steain M, Sutherland JP, Rodriguez M, et al. Analysis of T cell responses during active varicella-zoster virus reactivation in human ganglia[J]. J Virol, 2014, 88(5): 2704-2716. DOI: 10.1128/JVI.03445-13.
    [17] Jantsch J, Schmidt B, Bardutzky J, et al. Lethal varicella-zoster virus reactivation without skin lesions following renal transplantation[J]. Nephrol Dial Transplant, 2011, 26(1):365-368. DOI: 10.1093/ndt/gfq542.
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出版历程
  • 收稿日期:  2017-03-30
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2017-05-15

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