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供体风险指数对慢加急性肝衰竭肝移植治疗早期预后的影响:单中心159例经验

周政俊 李杰群 宾阳阳 陈广顺 李强 齐海智 司中洲 胡伟

周政俊, 李杰群, 宾阳阳, 等. 供体风险指数对慢加急性肝衰竭肝移植治疗早期预后的影响:单中心159例经验[J]. 器官移植, 2019, 10(3): 318-322. doi: 10.3969/j.issn.1674-7445.2019.03.016
引用本文: 周政俊, 李杰群, 宾阳阳, 等. 供体风险指数对慢加急性肝衰竭肝移植治疗早期预后的影响:单中心159例经验[J]. 器官移植, 2019, 10(3): 318-322. doi: 10.3969/j.issn.1674-7445.2019.03.016
Zhou Zhengjun, Li Jiequn, Bin Yangyang, et al. Effect of donor risk index on early prognosis of liver transplantation for acute-on-chronic liver failure: experience of 159 cases in one single center[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 318-322. doi: 10.3969/j.issn.1674-7445.2019.03.016
Citation: Zhou Zhengjun, Li Jiequn, Bin Yangyang, et al. Effect of donor risk index on early prognosis of liver transplantation for acute-on-chronic liver failure: experience of 159 cases in one single center[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 318-322. doi: 10.3969/j.issn.1674-7445.2019.03.016

供体风险指数对慢加急性肝衰竭肝移植治疗早期预后的影响:单中心159例经验

doi: 10.3969/j.issn.1674-7445.2019.03.016
基金项目: 

国家自然科学基金 81102241

湖南省自然科学基金 2018JJ2561

详细信息
    作者简介:

    周政俊,男,1992年生,硕士,住院医师,研究方向为器官移植和普通外科,Email:18711147642@163.com

    通讯作者:

    胡伟,男,1968年生,博士,副主任医师,研究方向为器官移植和胃肠外科,Email:huwei4660@126.com

  • 中图分类号: R617, R575.3

Effect of donor risk index on early prognosis of liver transplantation for acute-on-chronic liver failure: experience of 159 cases in one single center

More Information
  • 摘要:   目的  探讨供体的供体风险指数(DRI)对慢加急性肝衰竭(ACLF)行肝移植治疗早期预后的影响。  方法  回顾性分析接受肝移植治疗的159例ACLF受体临床资料,根据供体DRI计算公式将受体分为DRI < 1.65组(96例)和DRI≥1.65组(63例);根据慢性肝衰竭联盟-慢加急性肝衰竭评分(CLIF-C ACLFs),将受体分为CLIF-C ACLFs < 48组(78例)和CLIF-C ACLFs≥48组(81例)。分别观察各组受体肝移植术后早期预后指标[重症监护室(ICU)住院时间、术后住院时间]。应用Kaplan-Meier生存曲线分析受体肝移植术后90 d生存率,应用Cox比例风险回归模型分析影响ACLF受体肝移植术后早期预后的危险因素。  结果  DRI < 1.65组与DRI≥1.65组的ICU住院时间、术后住院时间比较,差异均无统计学意义(均为P > 0.05)。CLIF-C ACLFs<48组和CLIF-C ACLFs≥48组术后住院时间比较,差异无统计学意义(P > 0.05)。CLIF-C ACLFs < 48组的ICU住院时间为4(3~14)d,明显短于CLIF-C ACLFs≥48组的7(1~33)d(P < 0.05)。CLIF-C ACLFs评分是影响ACLF受体肝移植术后早期预后的危险因素(P < 0.05)。DRI < 1.65组与DRI≥1.65组的术后90 d生存率比较,差异无统计学意义(P > 0.05),CLIF-C ACLFs < 48组受体术后90 d生存率为94%,明显高于CLIF-C ACLFs≥48组的79%(P < 0.05)。  结论  ACLF受体肝移植术后早期预后与其自身病情严重程度相关,而与选用供体的DRI无明显相关性,应早期及时行肝移植治疗。

     

  • 图  1  各组ACLF受体的生存曲线

    A图为DRI < 1.65组与DRI≥1.65组受体术后90 d生存率比较;B图为CLIF-C ACLFs < 48组与CLIF-C ACLFs≥48组受体术后90 d生存率比较;与CLIF-C ACLFs < 48组比较,aP < 0.05

    Figure  1.  Survival curves of ACLF recipients in each group

    表  1  ACLF受体早期预后的多因素分析

    Table  1.   Multivariate analysis of early prognosis of ACLF recipients

    影响因素 回归系数(β 标准误(SE Wald P 相对危险度
    受体
      年龄 0.002 0.037 0.004 0.952 1.002
      MELD评分 —0.038 0.041 0.883 0.347 0.962
      Child-Pugh评分 —0.012 0.292 0.002 0.968 0.988
      CLIF-SOFAs评分 0.012 0.194 0.004 0.952 1.012
      CLIF-C OFs评分 —0.335 0.365 0.846 0.358 0.715
      CLIF-C ACLFs评分 0.188 0.071 7.005 0.008 1.207
    供体
      BMI 0.055 0.091 0.360 0.548 1.056
      死因 0.791 0.512 2.386 0.122 2.205
    下载: 导出CSV
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出版历程
  • 收稿日期:  2019-03-03
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-05-15

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