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肝移植术后早期并发症的危险因素分析
An analysis of risk factors for early complications after liver transplantation
文章发布日期:2018年06月11日  来源:  作者:解恩博, 轩凤慧, 孙晓东, 等.  点击次数:89次  下载次数:25次

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【摘要】:目的研究影响肝移植术后早期并发症的相关危险因素,以期改善患者预后。方法收集2011年9月-2017年4月于吉林大学白求恩第一医院肝移植中心接受原位肝移植术的147例肝移植患者的临床资料。根据早期并发症的有无分为无并发症组(n=11)和并发症组(n=136)。收集其可能发生术后早期并发症的相关因素,包括供体因素(年龄、供受体血型是否相符),受体因素[包括性别、年龄、原发病、MELD评分、AST、ALT、Alb、PLT、Hb、纤维蛋白原、TBil、肌酐、PLT/Alb比值(PAR)、中性粒细胞/淋巴细胞比值(NLR)],术中因素(包括冷缺血时间、热缺血时间、术中出血量、无肝期时间),术后因素(包括术后即时、12 h、24 h、48 h、72 h AST和ALT)。符合正态分布的计量资料2组间比较采用t检验;不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;多因素分析采用向后LR法logistic回归分析。结果单因素分析显示,MELD评分(t=-3.86,P=0002)、Alb(t=2.19,P=0049)、PLT(Z=467.00,P=0039)、PAR(Z=500.00,P=0068)、纤维蛋白原(t=180,P=0096)、TBil(Z=-1.98,P=0047)、术前AST(Z=417.00,P=0015)、术前ALT(Z=501.50,P=0070)与并发症的发生有关,差异均有统计学意义。PAR及术前AST为早期并发症发生的独立危险因素(比值比=3.84,95%可信区间:1.03~14.34,P<005;比值比=0.25,95%可信区间:0.07~094,P<0.05)。147例患者根据PAR大小可分为高PAR组(≥3×109/g,n=55)及低PAR组(<3×109/g, n=92),PAR水平与血管并发症及胆道并发症有关(χ2=2.87,P=0.090; χ2=3.54,P=0060);根据术前AST水平分为术前AST正常组(<40 U/L,n=93)及术前AST异常组(≥40 U/L,n=54),术前AST水平则对胸腔积液有影响(χ2=3.03,P=0.082)。结论纤维蛋白原、PLT、Alb、TBil、PAR、MELD评分、术前AST及ALT对肝移植早期并发症的发生可能有影响,其中PAR和术前AST是发生早期并发症的独立危险因素,针对肝移植受体在术前应充分评估,重视PAR水平,并有针对性的给予干预,以达到最终改善预后及提高术后生存率的目的。
【Abstract】:ObjectiveTo investigate the risk factors for early complications after liver transplantation and to improve the prognosis. MethodsThe clinical data of 147 patients who underwent orthotopic liver transplantation in the Hepatic Transplantation Center of The First Hospital of Jilin University from September 2011 to April 2017 were retrospectively analyzed. According to the presence or absence of early complications after surgery, these patients were divided into non-complication group (n=11) and complication group (n=136). The possible factors associated with early complications after surgery were collected, including donor factors (age and whether the blood type of the donor matches that of the recipient), recipient factors (sex, age, primary disease, Model for End-Stage Liver Disease [MELD] score, aspartate aminotransferase [AST], alanine aminotransferase[ALT], albumin [Alb], platelet [PLT], hemoglobin [Hb], fibrinogen, total bilirubin, creatinine, PLT/Alb ratio [PAR], and neutrophil/lymphocyte ratio [NLR]), intraoperative factors (cold ischemia time, warm ischemia time, intraoperative blood loss, and duration of anhepatic phase), and postoperative factors (AST and ALT immediately and 12, 24, 48, and 72 hours after operation). The clinical data were analyzed to investigate the association between these factors and early complications. The t test was used for comparison of normally distributed continuous data; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data. The chi-square test was used for comparison of categorical data. Backward logistic regression was used for multivariate analysis. ResultsMELD score (t=-3.86,P=0002), Alb (t=2.19,P=0049), PLT (Z=46700,P=0039), PAR (Z=500.00,P=0068), fibrinogen (t=1.80,P=0096), TBil (Z=-1.98,P=0047), preoperative AST (Z=417.00,P=0015), and preoperative ALT (Z=501.50,P=0070) were associated with postoperative complications. PAR and preoperative AST were independent risk factors for early complications (odds ratio [OR]=3.84, 95% confidence interval [CI]: 1.03-14.34, P<0.05; OR=0.25, 95% CI: 0.07-0.94, P<0.05). The 147 patients were divided into high-PAR group (PAR ≥3×109/g; n=55) and low-PAR group (PAR <3×109/g; n=92); PAR was associated with postoperative vascular and biliary complications (χ2=287, P=0.090; χ2=354,P=0060). The 147 patients were divided into normal preoperative AST group (AST <40 U/L; n=93) and abnormal preoperative AST group (AST ≥40 U/L; n=54); preoperative AST level was associated with postoperative pleural effusion(χ2=303,P=0082). ConclusionFibrinogen, PLT, Alb, TBil, PAR, MELD score, and preoperative AST and ALT are associated with the development of early complications after liver transplantation, and PAR and preoperative AST are independent risk factors for early complications. To improve the prognosis and postoperative survival, these factors, particularly PAR, should be fully assessed for the liver transplantation recipient before operation, and specific interventions should be provided accordingly.
【关键字】:肝移植; 手术后并发症; 危险因素
【Key words】:liver transplantation; postoperative complications; risk factors
【引证本文】:
XIE EB, XUAN FH, SUN XD, et al. An analysis of risk factors for early complications after liver transplantation[J]. J Clin Hepatol, 2018, 34(6): 1282-1288. (in Chinese) 解恩博, 轩凤慧, 孙晓东, 等. 肝移植术后早期并发症的危险因素分析[J]. 临床肝胆病杂志, 2018, 34(6): 1282-1288.

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