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

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,P＜0.05)、人工晶状体眼(RR=6.83,P＜O.01)和虹膜前(RR=2.76,P=0.05)及虹膜后粘连(RR=3.12,P=0.05)为角膜植片1Oa存活率的独立影响因素.结论与PK手术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、虹膜前或虹膜后粘连;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及手术时间长.

Risk factors for corneal graft failure and rejection in penetrating keratoplasty

· 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 were studied retrospectively.The graft survival rate and rejection-free survival rate over 10a were estimated with Kaplan-Meir′s life table method, and differences between levels of each factor were compared with log-rank test. Cox regression 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 survival at 10a after PK were 81.4% and 78.2% respectively. Relatively higher risk of graft failure was associated with corneal vascularization, regraft,aphakia or pseudophakia, presence of anterior or posterior synechia, long (≥90min) operation time and older (≥60a) age of recipient. Relatively higher risk of rejection was associated with corneal vascularization and long operation time. Cox regression 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), presence of anterior (RR=2.76, P=0.05) or posterior synechia (RR=3.12, P=0.05) were independent risk factors for corneal graft failure.· CONCLUSION: The risk factors for graft failure after PK were corneal vascularization, regraft, aphakia or pseudophakia, presence of anterior or posterior synechia. The risk factors after PK for allograft rejection were corneal vascularization and long operation time.