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摘要:
目的 探讨儿童肝移植术后的生长发育状况。 方法 选择2006年9月至2014年5月于北京友谊医院及天津市第一中心医院接受肝移植术的70例患儿为研究对象, 分别计算每例患儿移植时和术后6个月、1年、2年、3年、4年和5年的身高Z评分(ZH)、体重Z评分(ZW)。分析患儿ZH、Zw评分在各个时间点的变化趋势, 并将其各个时间点的ZH和ZW评分与2005年中国九省/市儿童体格发育调查数据制定的生长标准均数0(标准均数)进行比较; 按照移植时ZH、ZW评分将患儿分别分为Z≥-2组和Z < -2组, 比较各组患儿ZH、ZW评分的变化趋势。 结果 肝移植时患儿ZH和ZW评分均数分别为-1.63±1.35和-1.53±1.52。接受肝移植术后, ZH、Zw评分逐渐提高。患儿的ZH和ZW评分在移植时和术后6个月的平均水平均明显低于标准均数(均为P < 0.01), 其余术后时间段ZH和ZW评分与标准均数比较, 差异无统计学意义(均为P>0.05)。ZH评分 < -2组和≥-2组患儿的ZH评分在移植时、术后6个月、术后1年比较, 差异有统计学意义(均为P < 0.05)。ZW评分 < -2组和≥-2组患儿的ZW评分在移植时、术后6个月、术后1年、术后2年比较, 差异均有统计学意义(均为P < 0.05)。 结论 儿童肝移植患儿在术后生长发育逐渐恢复, 术后1年出现明显快速增长。 Abstract:Objective To investigate the growth and development of children after liver transplantation. Methods Seventy children who underwent liver transplantation in Beijing Friendship Hospital and Tianjin First Central Hospital from September 2006 to May 2014 were included in the study. Height Z-scores (ZH) and weight Z-scores (ZW) of each child were respectively calculated at transplantation and 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after transplantation. The change trends of ZH and ZW at each time point were analyzed. Moreover, ZH and ZW at each time point were compared with the standardized mean of growth 0 (standardized mean) formulated according to the survey data of children's physical development in nine provinces and municipalities in 2005. Children were divided into Z≥-2 group and Z < -2 group according to ZH and ZW at transplantation. And the change trend of ZH and ZW of each group was compared. Results The mean of ZH and ZW at the time of liver transplantation was -1.63±1.35 and -1.53±1.52 respectively. After liver transplantation, ZH and ZW increased gradually. ZH and ZW of children before transplantation and 6 months after transplantation were significantly lower than standardized mean (all in P < 0.01). ZH and ZW in other postoperative periods had no statistical significance with standardized mean (all in P>0.05). There were significant difference between ZH≥-2 group and ZH < -2 group at transplantation and 6 months and 1 year after transplantation (both in P < 0.05). Zw of Zw≥-2 group and Zw < -2 group at transplantation and 6 months, 1 year and 2 years after transplantation had difference with statistical significance (all in P < 0.05). Conclusions The growth and development of children with liver transplantation recover gradually and increase significantly at 1 year after transplantation. -
Key words:
- Children /
- Liver transplantation /
- Growth /
- Development
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图 1 肝移植患儿ZH和Zw评分在各个时间点的变化趋势
Figure 1. Change trend of ZH and ZW score of children after liver transplantation
图 2 移植时Z评分不同各组肝移植患儿在各个时间点的ZH和Zw评分的变化趋势
Figure 2. Change trend of ZH and ZW score at each time point of children after liver transplantation in different groups of Z score at transplantation
表 1 肝移植患儿在各个时间点的Z评分与标准均数的比较
Table 1. Comparison between Z score and standard mean of children after liver transplantation at each time point(x±s)
时间点 n ZH评分 ZW评分 分值 统计值 P值 分值 统计值 P值 移植时 70 -1.64±1.34 -10.247# 0.000 -1.54±1.52 -8.459# 0.000 术后6个月 70 -1.01±1.69 -5.001# 0.000 -0.76±1.35 -4.668# 0.000 术后1年 62 -0.31±1.51 -1 170.5* 0.091 -0.09±1.08 -0.688# 0.494 术后2年 29 0.16±1.43 0.594# 0.557 0.25±1.05 1.268# 0.215 术后3年 15 0.03±1.28 0.091# 0.929 0.27±0.75 1.390# 0.186 术后4年 11 -0.16±0.99 -2* 0.898 -0.02±0.58 -0.109# 0.915 术后5年 7 0.30±0.36 2.164# 0.074 0.05±0.30 0.439# 0.676 注：ZH评分、ZW评分的标准均数为0；#采用独立样本t检验；*采用独立样本的秩和检验 
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表 2 各组肝移植患儿在各个时间点的ZH和ZW评分的比较
Table 2. Comparison of ZH and ZW score between different groups of children after liver transplantation at each time point (x±s)
时间点 分组 ZH评分 ZW评分 n 分值 统计值 P值 n 分值 统计值 P值 移植时 Z≥-2 41 -0.73±0.68 -7.088* 0.000 44 -0.60±0.95 -6.953* 0.000 Z＜-2 29 -2.93±0.90 26 -3.13±0.81 术后6个月 Z≥-2 41 -0.57±1.64 2.708# 0.009 44 -0.08±1.05 7.079# 0.000 Z＜-2 29 -1.63±1.58 26 -1.89±1.00 术后1年 Z≥-2 36 0.18±1.41 -3.089* 0.002 41 0.26±1.05 4.007# 0.000 Z＜-2 26 -0.97±1.40 21 -0.78±0.78 术后2年 Z≥-2 17 0.54±1.56 1.762# 0.089 21 0.47±1.08 -2.489* 0.013 Z＜-2 12 -0.38±1.07 8 -0.33±0.76 术后3年 Z≥-2 7 0.45±1.18 -1.389* 0.165 11 0.45±0.65 -1.568* 0.117 Z＜-2 8 -0.34±1.32 4 -0.22±0.87 注：ZH评分、ZW评分的标准均数为0；#采用独立样本的t检验；*采用独立样本的秩和检验
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