肝移植术后中期肝脏血流动力学与肝功能异常的关系

胡维昱; 王建红; 胡骁; 付晓悦; 吴晓东; 张顺; 臧运金

doi:10.3969/j.issn.1674-7445.2016.04.010

肝移植术后中期肝脏血流动力学与肝功能异常的关系

doi: 10.3969/j.issn.1674-7445.2016.04.010

266000 青岛大学附属医院肝胆胰外科(胡维昱、胡骁、张顺)；器官移植中心(王建红、付晓悦、吴晓东、臧运金)

详细信息

通讯作者:
胡维昱，Email：huweiyucn@126.com

中图分类号: R617，R445.1
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- 被引次数: 0
出版历程
- 收稿日期: 2016-04-05
- 网络出版日期: 2021-01-19
- 刊出日期: 2016-07-15

Relationship between the mid-term hepatic hemodynamics and abnormal liver function after liver transplantation

Department of Hepatopancreatobiliary Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266000, China

摘要

摘要: 目的通过分析肝移植术后中期血流动力学的规律，探讨其与肝功能的关系。方法以2014年2月至2015年10月于青岛大学附属医院进行肝移植手术的56例肝移植受者为研究对象，按肝功能正常与否分为正常组(24例)和异常组(32例)。记录两组的一般资料及肝功能，并应用超声检测其肝移植术前及术后1、30、90 d的肝动脉峰值血流速度(HAP)、门静脉峰值血流速度(PVP)、门静脉灌注量(PVF)等，并计算肝动脉缓冲能力(BC)、校正BC等。对两组间肝脏血流动力学因素与肝功能关系进行单因素和多因素分析，并绘制受试者工作特征(ROC)曲线。结果异常组中移植术后30 d的PVP、PVF明显高于正常组(P=0.014、0.049)，正常组中BC及校正BC明显高于异常组(P=0.048、0.011)。多因素分析显示校正BC是其独立危险因素(P=0.047)，ROC曲线下面积(AUC)为0.705，灵敏度为0.652，特异度为0.750。结论肝移植术后30 d的PVP、PVF、BC及校正BC可能与肝功能异常有关，其中校正BC可作为诊断及干预肝功能异常的指标之一。
- 肝移植 /
- 血流动力学 /
- 肝动脉缓冲能力 /
- 肝功能异常
Abstract: Objective To analyze the law of the mid-term hepatic hemodynamics after liver transplantation and to investigate its relationship with liver function. Methods A total of 56 recipients underwent liver transplantation in the Affiliated Hospital of Qingdao University from February 2014 to October 2015 were studied, and divided into normal group (n=24) and abnormal group (n=32) according to the liver function. General information and liver function of both groups were recorded. Furthermore, hepatic artery peak velocity (HAP), portal vein peak velocity (PVP) and portal vein flow (PVF) before the liver transplantation and on postoperative day 1, 30 and 90 were measured through ultrasonic detection; hepatic arterial buffer capacity (BC) and adjustment BC were calculated. The univariable and multivariable analysis were performed to analyze the relationship between hepatic hemodynamics and liver function in two groups, and the receiver operating curve (ROC) was drawn. Results The PVP and PVF on postoperative day 30 in abnormal group were significantly higher than those of normal group (P=0.014, 0.049). The BC and adjustment BC in normal group were significantly higher than those of abnormal group (P=0.048, 0.011). The multivariable analysis showed that adjustment BC was the independent risk factor (P=0.047), with the area under the curve (AUC) of ROC of 0.705, sensitivity of 0.652 and specificity of 0.750. Conclusion PVP, PVF, BC and adjustment BC on postoperative day 30 may be related to abnormal liver function, of which adjustment BC can be used as one of the indicators for diagnosis and intervention of abnormal liver function.
- Liver transplantation /
- Hemodynamics /
- Hepatic arterial buffer capacity /
- Abnormal liver function

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图 1 校正BC的ROC曲线

Figure 1. ROC curve of adjusted BC

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表 1 两组患者的血流动力学因素单因素分析结果

Table 1. Univariable analysis results of hemodynamic factors of patients between two groups(mean)

指标	正常组(n=24)	异常组(n=32)	P值
术前
PVP	17	15	0.281
PVF	484	427	0.714
术后1 d
PVP	42	47	0.271
PVF	2 116	2 522	0.104
HAP	54	56	0.766
术后30 d
PVP	30	36	0.014
PVF	1 671	2 042	0.049
HAP	51	55	0.454
BC(×10^-3)	23.9	12.2	0.048
校正BC(×10^-3)	18.5	7.9	0.011

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表 2 两组患者的血流动力学因素多因素分析结果

Table 2. Multivariable analysis results of hemodynamic factors of patients between two groups

指标	B	SE	Wald χ²值	P值	Exp(B)
术后30 d PVP	0.110	0.091	1.478	0.224	1.116
术后30 d PVF	0	0.001	0.062	0.803	1.000
BC	-0.910	0.661	1.897	0.168	2.485
校正BC	-0.201	0.110	3.366	0.047	0.818
注：B为回归系数；B＞0为危险因素；B＜0为保护因素；SE为回归系数的标准误；Exp(B)为回归系数的指数

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