Construction and validation of a prediction model for public acceptance of kidney xenotransplantation in China
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摘要:
目的 通过构建和验证基于异种移植调查问卷的预测模型,探讨中国公众对异种肾移植的态度。 方法 使用问卷星平台对中国公众进行方便抽样调查,分析公众对异种肾移植的接受度及影响因素。使用随机分配法将所有纳入的问卷(2 280份)按7∶3分为训练集和验证集,构建预测模型并进行验证。 结果 共纳入2 280份调查问卷,公众对于异种肾移植的接受度为71.3%。多因素分析结果显示性别、婚姻状况、居住地区、医保状况、宗教信仰、是否素食主义、异种肾移植知晓情况、是否肾移植等待者是公众能否接受异种肾移植的独立影响因素(均为P<0.05)。训练集预测模型的受试者工作特征(ROC)曲线下面积(AUC)为0.773,验证集预测模型的AUC为0.785,训练集和验证集校准曲线均提示预测模型有较好的预测价值,决策曲线分析(DCA)均提示模型预测效能较好。 结论 中国公众对于异种肾移植的接受度相对较高且存在较大提升空间。基于问卷调查所构建的预测模型预测效能较好,为今后的研究提供了参考依据。 Abstract:Objective To explore the public attitude towards kidney xenotransplantation in China by constructing and validating the prediction model based on xenotransplantation questionnaire. Methods A convenient sampling survey was conducted among the public in China with the platform of Wenjuanxing to analyze public acceptance of kidney xenotransplantation and influencing factors. Using random distribution method, all included questionnaires (n=2 280) were divided into the training and validation sets according to a ratio of 7:3. A prediction model was constructed and validated. Results A total of 2 280 questionnaires were included. The public acceptance rate of xenotransplantation was 71.3%. Multivariate analysis showed that gender, marital status, resident area, medical insurance coverage, religious belief, vegetarianism, awareness of kidney xenotransplantation and whether on the waiting list for kidney transplantation were the independent influencing factors for public acceptance of kidney xenotransplantation (all P<0.05). The area under the curve (AUC) of receiver operating characteristic (ROC) of the prediction model in the training set was 0.773, and 0.785 in the validation set. The calibration curves in the training and validation sets indicated that the prediction models yielded good prediction value. Decision curve analysis (DCA) suggested that the prediction efficiency of the model was high. Conclusions In China, public acceptance of kidney xenotransplantation is relatively high, whereas it remains to be significantly enhanced. The prediction model based on questionnaire survey has favorable prediction efficiency, which provides reference for subsequent research. -
表 1 异种肾移植问卷调查对象一般资料
Table 1. General information of survey subjects for kidney xenotransplantation questionnaire [n (%)]
变量 总数(N=2280) 训练集(n=1596) 验证集(n=684) 统计值 P值 性别 0.974 0.324 男 1 144(50.2) 790(49.5) 354(51.8) 女 1 136(49.8) 806(50.5) 330(48.2) 年龄 0.398 0.528 ≤30岁 607(26.6) 431(27.0) 176(25.7) >30岁 1 673(73.4) 1 165(73.0) 508(74.3) 文化程度 0.274 0.872 初中及以下 180(7.9) 128(8.0) 52(7.6) 高中或专科 771(33.8) 543(34.0) 228(33.3) 本科及以上 1 329(58.3) 925(58.0) 404(59.1) 婚姻状况 1.728 0.422 已婚 1 661(72.9) 1 150(72.1) 511(74.7) 未婚 502(22.0) 361(22.6) 141(20.6) 其他 117(5.1) 85(5.3) 32(4.7) 生育情况 1.136 0.567 未生育 615(27.0) 435(27.3) 180(26.3) 生育1个 1 025(45.0) 706(44.2) 319(46.6) 生育2个及以上 640(28.1) 455(28.5) 185(27.0) 个人月收入 0.020 0.990 <5 000元 995(43.6) 695(43.5) 300(43.9) 5 000~20 000元 1 068(46.8) 749(46.9) 319(46.6) >20 000元 217(9.5) 152(9.5) 65(9.5) 居住地区 3.060 0.801 东北 496(21.8) 343(21.5) 153(22.4) 华东 604(26.5) 432(27.1) 172(25.1) 华中 117(5.1) 87(5.5) 30(4.4) 华南 89(3.9) 63(3.9) 26(3.8) 西南 111(4.9) 76(4.8) 35(5.1) 西北 174(7.6) 124(7.8) 50(7.3) 华北 689(30.2) 471(29.5) 218(31.9) 当前居住地 <0.001 0.991 农村 497(21.8) 348(21.8) 149(21.8) 城市 1 783(78.2) 1 248(78.2) 535(78.2) 职业 2.061 0.724 医疗 851(37.3) 600(37.6) 251(36.7) 法律 78(3.4) 58(3.6) 20(2.9) 科学 52(2.3) 37(2.3) 15(2.2) 新闻、文化 162(7.1) 107(6.7) 55(8.0) 其他或无职业 1 137(49.9) 794(49.7) 343(50.1) 医保 0.762 0.383 有 1 975(86.6) 1 389(87.0) 586(85.7) 无 305(13.4) 207(13.0) 98(14.3) 宗教信仰 10.158 0.118 无或无神论 1 814(79.6) 1 271(79.6) 543(79.4) 佛教 192(8.4) 133(8.3) 59(8.6) 道教 75(3.3) 45(2.8) 30(4.4) 伊斯兰教 33(1.4) 25(1.6) 8(1.2) 天主教 16(0.7) 9(0.6) 7(1.0) 基督教 45(2.0) 38(2.4) 7(1.0) 其他 105(4.6) 75(4.7) 30(4.4) 素食主义 0.008 0.928 是 155(6.8) 109(6.8) 46(6.7) 否 2 125(93.2) 1 487(93.2) 638(93.3) 器官捐献意愿 0.878 0.645 愿意 742(32.5) 529(33.1) 213(31.1) 不愿意 505(22.1) 350(21.9) 155(22.7) 不确定 1 033(45.3) 717(44.9) 316(46.2) 异种肾移植知晓情况 1.164 0.281 是 1 104(48.4) 761(47.7) 343(50.1) 否 1 176(51.6) 835(52.3) 341(49.9) 肾移植等待者 1.219 0.270 是 487(21.4) 331(20.7) 156(22.8) 否 1 793(78.6) 1 265(79.3) 528(77.2) 表 2 异种肾移植接受度的单因素和多因素分析
Table 2. Univariate and multivariate analysis of the acceptance of kidney xenotransplantation
变量 单因素分析 多因素分析 OR① 95%可信区间 P值 OR 95%可信区间 P值 性别 男 参照值 参照值 女 1.93 1.55~2.41 <0.001 1.64 1.27~2.12 <0.001 年龄 ≤30岁 参照值 参照值 >30岁 0.71 0.54~0.86 0.001 0.59 0.48~1.05 0.089 文化程度 初中及以下 参照值 高中或专科 0.96 0.64~1.46 0.842 本科及以上 0.80 0.54~1.20 0.269 婚姻状况 已婚 参照值 参照值 未婚 1.24 0.96~1.60 0.101 1.07 0.71~1.61 0.733 其他 2.07 1.32~3.23 0.001 1.87 1.05~3.29 0.031 生育情况 未生育 参照值 生育1个 0.88 0.68~1.15 0.354 生育2个及以上 1.04 0.78~1.39 0.774 个人月收入 <5 000元 参照值 参照值 5 000~20 000元 0.66 0.52~0.82 <0.001 0.84 0.63~1.12 0.229 >20 000元 0.60 0.40~0.89 0.013 0.95 0.57~1.56 0.845 居住地区 东北 参照值 参照值 华东 0.77 0.58~1.04 0.091 1.03 0.69~1.54 0.872 华中 0.42 0.23~0.72 0.002 0.60 0.30~1.16 0.142 华南 0.23 0.10~0.48 <0.001 0.41 0.16~0.92 0.041 西南 0.61 0.35~1.04 0.077 1.16 0.60~2.18 0.652 西北 0.53 0.33~0.84 0.007 0.78 0.46~1.29 0.340 华北 0.50 0.37~0.68 <0.001 0.71 0.50~1.02 0.061 当前居住地 农村 参照值 参照值 城市 0.56 0.44~0.72 <0.001 0.77 0.57~1.05 0.094 职业 医疗 参照值 参照值 法律 1.42 0.80~2.48 0.220 0.91 0.45~1.77 0.775 科学 0.59 0.23~1.28 0.212 0.39 0.13~1.04 0.078 新闻、文化 1.69 1.10~2.57 0.016 1.57 0.94~2.63 0.084 其他或无职业 0.97 0.76~1.23 0.784 0.83 0.62~1.11 0.212 医保 有 参照值 参照值 无 5.49 4.04~7.50 <0.001 4.10 2.82~5.99 <0.001 宗教信仰 无或无神论 参照值 参照值 佛教 1.45 0.99~2.10 0.053 1.58 1.00~2.47 0.047 道教 2.77 1.52~5.07 <0.001 1.94 0.88~4.27 0.099 伊斯兰教 1.25 0.51~2.83 0.609 0.70 0.22~2.04 0.524 天主教 2.12 0.52~8.06 0.264 1.60 0.30~8.40 0.575 基督教 0.82 0.36~1.69 0.615 0.92 0.38~2.04 0.840 其他 1.25 0.74~2.04 0.385 1.40 0.79~2.42 0.234 素食主义 是 参照值 参照值 否 0.37 0.25~0.55 <0.001 0.55 0.34~0.90 0.018 器官捐献意愿 愿意 参照值 参照值 不愿意 1.58 1.17~2.12 0.002 1.07 0.75~1.52 0.709 不确定 1.20 0.93~1.54 0.166 0.92 0.68~1.24 0.571 异种肾移植知晓情况 是 参照值 参照值 否 4.33 3.41~5.55 <0.001 3.50 2.65~4.65 <0.001 肾移植等待者 是 参照值 参照值 否 3.54 2.53~5.07 <0.001 3.07 2.03~4.74 <0.001 注:①OR为比值比。 -
[1] JAWONIYI O, GORMLEY K, MCGLEENAN E, et al. Organ donation and transplantation: awareness and roles of healthcare professionals-a systematic literature review[J]. J Clin Nurs, 2018, 27(5/6): e726-e738. DOI: 10.1111/jocn.14154. [2] Keeping kidneys[J]. Bull World Health Organ, 2012, 90(10): 718-719. DOI: 10.2471/BLT.12.021012. [3] MCCULLOUGH KP, MORGENSTERN H, SARAN R, et al. Projecting ESRD incidence and prevalence in the United States through 2030[J]. J Am Soc Nephrol, 2019, 30(1): 127-135. DOI: 10.1681/ASN.2018050531. [4] DOS SANTOS RMN. Kidney xenotransplantation: are we ready for prime time?[J]. Curr Urol Rep, 2023, 24(6): 287-297. DOI: 10.1007/s11934-023-01156-7. [5] WANG L, XU X, ZHANG M, et al Prevalence of chronic kidney disease in China: results from the Sixth China Chronic Disease and Risk Factor Surveillance[J]. JAMA Intern Med, 2023, 183(4): 298-310. DOI: 10.1001/jamainternmed.2022.6817. [6] COOPER DKC, PIERSON RN 3RD. Milestones on the path to clinical pig organ xenotransplantation[J]. Am J Transplant, 2023, 23(3): 326-335. DOI: 10.1016/j.ajt.2022.12.023. [7] REESE PP, GELB BE, PARENT B. Unique problems for the design of the first trials of transplanting porcine kidneys into humans[J]. Kidney Int, 2023, 103(2): 239-242. DOI: 10.1016/j.kint.2022.10.009. [8] TATAPUDI VS, GRIESEMER AD. Physiologic considerations of pig-to-human kidney xenotransplantation[J]. Curr Opin Nephrol Hypertens, 2023, 32(2): 193-198. DOI: 10.1097/MNH.0000000000000858. [9] PORRETT PM, ORANDI BJ, KUMAR V, et al. First clinical-grade porcine kidney xenotransplant using a human decedent model[J]. Am J Transplant, 2022, 22(4): 1037-1053. DOI: 10.1111/ajt.16930. [10] MONTGOMERY RA, STERN JM, LONZE BE, et al. Results of two cases of pig-to-human kidney xenotransplantation[J]. N Engl J Med, 2022, 386(20): 1889-1898. DOI: 10.1056/NEJMoa2120238. [11] ADAMS AB, LOVASIK BP, FABER DA, et al. Anti-C5 antibody tesidolumab reduces early antibody-mediated rejection and prolongs survival in renal xenotransplantation[J]. Ann Surg, 2021, 274(3): 473-480. DOI: 10.1097/SLA.0000000000004996. [12] KIM SC, MATHEWS DV, BREEDEN CP, et al. Long-term survival of pig-to-rhesus macaque renal xenografts is dependent on CD4 T cell depletion[J]. Am J Transplant, 2019, 19(8): 2174-2185. DOI: 10.1111/ajt.15329. [13] FIRL DJ, LASSITER G, HIROSE T, et al. Clinical and molecular correlation defines activity of physiological pathways in life-sustaining kidney xenotransplantation[J]. Nat Commun, 2023, 14(1): 3022. DOI: 10.1038/s41467-023-38465-x. [14] EL MASRI J, AFYOUNI A, GHAZI M, et al. Current state of clinical trials on xenograft[J]. Xenotransplantation, 2023, 30(3): e12801. DOI: 10.1111/xen.12801. [15] DELAURA I, ANWAR IJ, LADOWSKI J, et al. Attitudes of patients with renal disease on xenotransplantation: a systematic review[J]. Xenotransplantation, 2023, 30(2): e12794. DOI: 10.1111/xen.12794. [16] 杨树军, 卫浩, 许勇, 等. 六基因编辑猪-食蟹猴异种肾移植围手术期监测初步报道[J]. 器官移植, 2023, 14(4): 521-528. DOI: 10.3969/j.issn.1674-7445.2023.04.008.YANG SJ, WEI H, XU Y, et al. Preliminary report of perioperative monitoring of six-gene-edited pig-to-cynomolgus monkey kidney xenotransplantation[J] Organ Transplant, 2023, 14(4): 521-528. DOI: 10.3969/j.issn.1674-7445.2023.04.008. [17] 张玄, 王琳, 张洪涛, 等. 多基因编辑猪-猴心脏、肝脏、肾脏移植临床前研究初步报道[J]. 器官移植, 2021, 12(1): 51-56. DOI: 10.3969/j.issn.1674-7445.2021.01.008.ZHANG X, WANG L, ZHANG HT, et al. Preliminary report of preclinical trial of multi-genome engineering pig-to-macaque heart, liver and kidney transplantation[J]. Organ Transplant, 2021, 12(1): 51-56. DOI: 10.3969/j.issn.1674-7445.2021.01.008. [18] 李涛. 多基因修饰猪-猴异种肾移植临床前研究[D]. 海口: 海南医学院, 2022. [19] 冯豪. 国产基因工程猪到猕猴异种肾移植的实验研究[D]. 武汉: 华中科技大学, 2022. [20] CENGIZ N, WAREHAM CS. Ethical considerations in xenotransplantation: a review[J]. Curr Opin Organ Transplant, 2020, 25(5): 483-488. DOI: 10.1097/MOT.0000000000000796. [21] ENTWISTLE JW, SADE RM, DRAKE DH. Clinical xenotransplantation seems close: ethical issues persist[J]. Artif Organs, 2022, 46(6): 987-994. DOI: 10.1111/aor.14255. [22] RODGER D, HURST DJ, COOPER DK. Xenotransplantation: a historical-ethical account of viewpoints[J]. Xenotransplantation, 2023, 30(2): e12797. DOI: 10.1111/xen.12797. [23] 许皓, 张玄, 窦科峰. 异种移植临床试验的有关问题[J]. 中华外科杂志, 2022, 60(10): 888-893. DOI: 10.3760/cma.j.cn112139-20220626-00286.XU H, ZHANG X, DOU KF. Key issues related to clinical trials of xenotransplantation[J]. Chin J Surg, 2022, 60(10): 888-893. DOI: 10.3760/cma.j.cn112139-20220626-00286. [24] HURST DJ, PADILLA LA, COOPER DKC, et al. Factors influencing attitudes toward xenotransplantation clinical trials: a report of focus group studies[J]. Xenotransplantation, 2021, 28(4): e12684. DOI: 10.1111/xen.12684. [25] MITCHELL C, LIPPS A, PADILLA L, et al. Meta-analysis of public perception toward xenotransplantation[J]. Xenotransplantation, 2020, 27(4): e12583. DOI: 10.1111/xen.12583. [26] LIU C, LIU S. Knowledge of and attitude toward xenotransplantation among medical students in China: a cross-sectional study[J]. Xenotransplantation, 2021, 28(1): e12654. DOI: 10.1111/xen.12654. [27] 徐莹, 陈佳弘, 何松哲, 等. 移植相关人群对异种肾移植的态度及影响因素[J]. 器官移植, 2023, 14(5): 683-690. DOI: 10.3969/j.issn.1674-7445.2023118.XU Y, CHEN JH, HE SZ, et al. Attitudes and influencing factors of transplantation-related populations towards kidney xenotransplantation[J]. Organ Transplant, 2023, 14(5): 683-690. DOI: 10.3969/j.issn.1674-7445.2023118. [28] 王振迪, 夏秋翔, 曾宪鹏, 等. 公众对异种移植态度的问卷调查分析[J]. 中华器官移植杂志, 2022, 43(9): 536-543. DOI: 10.3760/cma.j.cn421203-20220304-00033.WANG ZD, XIA QX, ZENG XP, et al. A public attitude survey on organ xenotransplantation[J]. Chin J Organ Transplant, 2022, 43(9): 536-543. DOI: 10.3760/cma.j.cn421203-20220304-00033. [29] GRIFFITH BP, GOERLICH CE, SINGH AK, et al. Genetically modified porcine-to-human cardiac xenotransplantation[J]. N Engl J Med, 2022, 387(1): 35-44. DOI: 10.1056/NEJMoa2201422. [30] SADE RM, MUKHERJEE R. Ethical issues in xenotransplantation: the first pig-to-human heart transplant[J]. Ann Thorac Surg, 2022, 113(3): 712-714. DOI: 10.1016/j.athoracsur.2022.01.006. [31] REARDON S. First pig-to-human heart transplant: what can scientists learn?[J]. Nature, 2022, 601(7893): 305-306. DOI: 10.1038/d41586-022-00111-9. [32] HAWTHORNE WJ. World first pig-to-human cardiac xenotransplantation[J]. Xenotransplantation, 2022, 29(1): e12733. DOI: 10.1111/xen.12733. [33] COOK PS. What constitutes adequate public consultation? xenotransplantation proceeds in Australia[J]. J Bioeth Inq, 2011, 8: 67-70. DOI: 10.1007/s11673-010-9269-8. [34] HAWTHORNE WJ, THOMAS A, PIERSON RN. Ethics and theoretical issues in kidney xenotransplantation[J]. Semin Nephrol, 2022, 42(4): 151288. DOI: 10.1016/j.semnephrol.2022.151288. [35] LOIKE JD, KRUPKA RM. The Jewish perspectives on xenotransplantation[J]. Rambam Maimonides Med J, 2023, 14(4): e0024. DOI: 10.5041/RMMJ.10511. [36] TARABEIH M, AMIEL A, NA'AMNIH W. The view of the three monotheistic religions toward xenotransplantation[J]. Clin Transplant, 2023, 27(4): e12579. DOI: 10.1111/ctr.15192. [37] EBNER K, OSTHEIMER J, SAUTERMEISTER J. The role of religious beliefs for the acceptance of xenotransplantation. exploring dimensions of xenotransplantation in the field of hospital chaplaincy[J]. Xenotransplantation, 2020, 27(4): e12579. DOI: 10.1111/xen.12579. [38] 邱艳, 李霄, 窦科峰. 异种移植的神学及社会心理学的伦理问题[J]. 器官移植, 2017, 8(2): 171-173. DOI: 10.3969/j.issn.1674-7445.2017.02.015.QIU Y, LI X, DOU KF. The ethical issues of theology and social psychology in xenotransplantation[J]. Organ Transplant, 2017, 8(2): 171-173. DOI: 10.3969/j.issn.1674-7445.2017.02.015. [39] 宋重军, 许荣梅, 王柏利, 等. 宗教信仰对老年人身心健康的双重作用[J]. 中国老年学杂志, 2021, 41(7): 1539-1542. DOI: 10.3969/j.issn.1005-9202.2021.07.054.SONG ZJ, XU RM, WANG BL, et al. The dual effects of religious beliefs on the physical and mental health of the elderly[J]. Chin J Gerontol, 2021, 41(7): 1539-1542. DOI: 10.3969/j.issn.1005-9202.2021.07.054. [40] 邢海晶, 杨静. 宗教中国化研究的进路与趋势分析——基于CiteSpace知识图谱的分析[J]. 西南民族大学学报(人文社会科学版), 2023, 44(6): 60-68. DOI: 10.3969/j.issn.1004-3926.2023.06.008.XING HJ, YANG J. Analysis of the approaches and trends in the study of sinicization of religion: based on the CiteSpace knowledge graph[J]. J Southwest Univ Natl (Humanit Soc Sci), 2023, 44(6): 60-68. DOI: 10.3969/j.issn.1004-3926.2023.06.008. [41] PADILLA LA, HURST D, LOPEZ R, et al. Attitudes to clinical pig kidney xenotransplantation among medical providers and patients[J]. Kidney360, 2020, 1(7): 657-662. DOI: 10.34067/KID.0002082020.