穿透性角膜移植患者植片衰竭和植片排斥的危险因素分析(英文) 被引量：2

Risk factors for corneal graft failure and rejection in penetrating keratoplasty

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摘要目的:评价穿透性角膜移植(PK)手术眼科患者中,影响角膜植片存活和植片发生免疫排斥反应的临床因素。方法:回顾性分析解放军总医院眼科1993/2003年间,212例患者,224眼穿透性角膜移植手术的临床资料,以Kaplan-Meir’s方法计算其预期10a植片存活率及10a植片无免疫排斥存活率,对各因素水平间采用log-rank检验比较其差异,计算不同因素的相对危险度(RR),并采用Cox回归模型评价各因素对植片存活率的影响。结果:224眼总预期10a存活率和预期10a无免疫排斥存活率分别为81.4%和78.2%。与植片衰竭相关的高危因素包括角膜血管化、再次移植、无晶状体眼、人工晶状体眼、虹膜前粘连、虹膜后粘连、手术时间长(≥90min)和受者年龄大(≥60a)等。与植片发生免疫排斥反应相关的高危因素包括:角膜血管化和手术时间长(≥90min)。Cox回归模型显示只有角膜血管化(RR=2.46,P=0.04)、再次移植(RR=5.67,P<0.01)、无晶状体眼(RR=3.64。 AIM: To evaluate risk factors of graft failure and allograft rejection after penetrating keratoplasty (PK). · METHODS: Clinical data of PKs on 224 eyes (212 patients) from 1993 to 2003 we re studied retrospectively. The graft survival rate and rejection-free survival rate over 10a were estimated with Kaplan-Meir's life table method, and differenc es between levels of each factor were compared with log-rank test. Cox regressio n was also performed to further assess the impact of related clinical factors on the prognosis of the corneal graft. · RESULTS: The overall rates of graft survival and rejection-free graft surviva l at 10a after PK were 81.4% and 78.2% respectively. Relatively higher risk of g raft failure was associated with corneal vascularization, regraft, aphakia or ps eudophakia, presence of anterior or posterior synechia, long (≥90min ) operatio n time and older (≥60a) age of recipient. Relatively higher risk of rejection w as associated with corneal vascularization and long operation time. Cox regressi on analysis showed corneal vascularization(RR =2.46, P =0.04), regraft (RR =5.67 ,P <0.01), aphakia (RR =3.64,P <0.05), or pseudophakia (RR =6.83,P <0.01), prese nce of anterior (RR =2.76,P = 0.05) or posterior synechia (RR =3.12, P =0.05) we re independent risk factors for corneal graft failure. · CONCLUSION: The risk factors for graft failure after PK were corneal vascular ization, regraft, aphakia or pseudophakia, presence of anterior or posterior syn echia. The risk factors after PK for allograft rejection were corneal vasculariz ation and long operation time. ·

作者杨艳峰黄一飞王丽强尹东方张鲲

机构地区中国北京解放军总医院眼科

出处《国际眼科杂志》 CAS 2004年第6期989-993,共5页 International Eye Science

基金中国国家自然科学基金项目(No.30471855)~~

关键词穿透性角膜移植植片衰竭植片排斥危险因素 penetraing keratoplasty graft failure allograft rejection risk factor

分类号 R779.65 [医药卫生—眼科]

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