Analysis of risk factors for cerebral apoplexy in the recipients after renal transplantation
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摘要:
目的 分析肾移植受体发生脑卒中的危险因素。 方法 回顾性分析376例规律随访的肾移植受体的临床资料,按照是否发生脑卒中分为脑卒中组(39例)和非脑卒中组(337例)。采用单因素分析和COX比例风险回归模型分析脑卒中的危险因素。 结果 376例受体的中位随访时间55个月,共有39例发生脑卒中,其累积发生率为10.4%。单因素分析发现,脑卒中组与非脑卒中组之间移植时年龄≥ 40岁、移植前透析时间≥ 12个月、估算肾小球滤过率(eGFR) < 30 mL/(min·1.73 m2)、高血压、糖尿病、脂代谢异常的发生率比较,差异均有统计学意义(均为P < 0.05)。多因素分析发现,影响肾移植受体脑卒中发生的独立危险因素为年龄≥40岁[风险比(HR)=1.110,95%可信区间(CI)为1.067~1.154,P=0.000]、移植前透析时间≥ 12个月(HR=1.044,95%CI为1.021~1.067,P=0.000)、eGFR < 30 mL/(min·1.73 m2)(HR=2.448,95%CI为1.197~5.005,P=0.014)。 结论 肾移植受体发生脑卒中的独立危险因素包括年龄≥ 40岁、移植前透析时间长和肾功能减退。 Abstract:Objective To analyze the risk factors for cerebral apoplexy in the recipients after renal transplantation. Methods Clinical data of 376 renal transplant recipients who were followed up regularly were retrospectively analyzed. The recipients were divided into cerebral apoplexy group (39 cases) and non-cerebral apoplexy group (337 cases) according to the occurrence of cerebral apoplexy. The risk factors of cerebral apoplexy were analyzed using single factor analysis and COX proportional hazards regression model. Results The 376 recipients were followed up for a median duration of 55 months, among whom 39 recipients suffered from cerebral apoplexy, with a cumulative incidence of 10.4%. Single factor analysis indicated that there were significant differences in age ≥40 years old at transplantation, duration of dialysis ≥12 months before transplantation, estimated glomerular filtration rate (eGFR) < 30 mL/(min·1.73m2), incidence of hypertension, diabetes and dyslipidemia between cerebral apoplexy group and non-cerebral apoplexy group (all P < 0.05). Multivariate analysis indicated that the independent risk factors for cerebral apoplexy occurred in the recipients after renal transplantation were age ≥40 years old [hazard ratio (HR) =1.110, 95% confidence interval (CI)=1.067-1.154, P=0.000], duration of dialysis ≥12 months before transplantation (HR=1.044, 95%CI=1.021-1.067, P=0.000) and eGFR < 30 mL/(min·1.73m2) (HR=2.448, 95%CI=1.197-5.005, P=0.014). Conclusions The independent risk factors for cerebral apoplexy in the recipients after renal transplantation include age ≥ 40 years old, long duration of dialysis before transplantation and renal insufficiency. -
表 1 两组危险因素的单因素分析结果
Table 1. The results of univariate analysis of risk factors for two groups [n(%)]
变量 脑卒中组(n=39) 非脑卒中组(n=337) χ2值 P值 性别 男 23(59) 176(52) 0.639 0.499 女 16(41) 161(48) 年龄 < 40岁 12(31) 265(79) 41.287.. 0.000 ≥40岁 27(69) 072(21) 移植前透析时间 < 12个月 5(13) 198(59) 29.6890 0.000 ≥12个月 34(87) 139(41) DGF 14(36) 085(25) 2.053 0.152 eGFR < 30 mL/(min·1.73m2) 25(64) 098(29) 19.4780 0.000 糖尿病 24(62) 106(31) 13.986 0.000 高血压 31(79) 197(58) 6.477 0.011 高尿酸血症 21(54) 138(41) 2.382 0.123 脂代谢异常 23(59) 131(39) 5.841 0.024 服用FK506 27(69) 258(77) 1.023 0.312 服用CsA 26(67) 210(62) 0.283 0.595 表 2 肾移植术后发生脑卒中危险因素的多因素分析结果
Table 2. The results of multivariate analysis of risk factors for cerebral apoplexy after renal transplantation
危险因素 HR 95%CI P值 年龄≥40岁 1.110 1.067~1.154 0.000 移植前透析时间≥12个月 1.044 1.021~1.067 0.000 eGFR < 30 mL/(min·1.73m2) 2.448 1.197~5.005 0.014 脂代谢异常 1.583 0.762~3.291 0.218 糖尿病 1.701 0.843~3.434 0.138 高血压 1.622 0.370~3.703 0.251 高尿酸血症 1.254 0.644~2.441 0.505 DGF 1.432 0.694~2.954 0.331 -
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