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目的:探讨流式细胞仪交叉配型(flow cytometry crossmatch,FCXM)对移植肾一年存活率的影响。方法:应用χ2检验比较FCXM阳性与阴性组间1年移植肾死亡有无差异。以“移植后1年肾脏的存活状况(是/否)”为应变量,以移植后早期排斥反应(移植后1月内发生)、血管性排斥反应、移植肾功能延迟(移植后1周内需做血液透析)、FCXM、群体抗原反应抗体(PRA)、HLA-A,B配型、HLA-DR配型、供者类型(尸肾/活体供肾)、既往移植次数、免疫抑制药物的使用、血清巨细胞病毒状态、冷缺血时间、供者和受者年龄等可疑影响因素为自变量建立Logistic回归模型,探讨流式细胞仪交叉配型对移植肾1年存活有无影响。结果:258例患者平均随访时间为25个月(12~60个月),期间30例移植肾死亡,其中23例发生在移植后1年内。χ2检验显示,FCXM阳性与阴性组间1年移植肾死亡无统计学差异(P=0.157 0)。Logistic回归显示,对移植肾1年死亡有影响的因素包括移植肾功能延迟(OR=8.00,P=0.001 4),供者类型为尸肾(OR=9.30,P=0.001 7)和血管排斥反应(OR=5.05,P=0.021 9)。FCXM的结果不会影响移植肾一年存活率(OR=1.60,P=0.534 6)。结论:FCXM对移植肾1年后存活尚无肯定的影响。
Objective: To investigate the effect of flow cytometry crossmatch (FCXM) on the one-year graft survival rate. Methods: Chi-square test was used to compare the difference of 1-year renal allograft death between FCXM positive group and negative group. The survival of the kidneys at 1 year after transplantation (yes / no) was used as a measure of response to early posttransplant rejection (occurring within 1 month after transplantation), vascular rejection, delayed graft function (within 1 week after transplantation (Hemodialysis), FCXM, PRA, HLA-A, B matching, HLA-DR typing, donor type (corpse / donor donor), number of previous transplants, use of immunosuppressive drugs , Serum cytomegalovirus status, cold ischemia time, donor and recipient age and other suspicious factors as independent variables to establish Logistic regression model to investigate the cross-match flow cytometry 1 year graft survival have no effect. Results: The average follow-up of 258 patients was 25 months (range, 12 to 60 months) with 30 deaths in the transplant recipients, 23 of which occurred within 1 year of transplantation. Chi-square test showed that there was no significant difference in 1-year renal allograft death between FCXM positive and negative groups (P = 0.157 0). Logistic regression showed that the factors affecting the one-year death of renal allografts included delayed graft function (OR = 8.00, P = 0.001 4), donor type of dead kidney (OR = 9.30, P = 0.001 7) and vascular rejection (OR = 5.05, P = 0.021 9). The results of FCXM did not affect the one-year graft survival (OR = 1.60, P = 0.534 6). CONCLUSION: FCXM has no positive effect on survival of graft kidney one year later.