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DCD供肝肝移植术后早期急性肾损伤相关危险因素分析

王万里 李青山 周颖 王丽 沙焕臣 田敏 师建华 董健 刘学民 张晓刚 刘昌 于良 吕毅 王博

王万里, 李青山, 周颖, 等. DCD供肝肝移植术后早期急性肾损伤相关危险因素分析[J]. 器官移植, 2018, 9(2): 130-136. doi: 10.3969/j.issn.1674-7445.2018.02.007
引用本文: 王万里, 李青山, 周颖, 等. DCD供肝肝移植术后早期急性肾损伤相关危险因素分析[J]. 器官移植, 2018, 9(2): 130-136. doi: 10.3969/j.issn.1674-7445.2018.02.007
Wang Wanli, Li Qingshan, Zhou Ying, et al. Analysis of risk factors of early acute kidney injury after liver transplantation from DCD donor liver[J]. ORGAN TRANSPLANTATION, 2018, 9(2): 130-136. doi: 10.3969/j.issn.1674-7445.2018.02.007
Citation: Wang Wanli, Li Qingshan, Zhou Ying, et al. Analysis of risk factors of early acute kidney injury after liver transplantation from DCD donor liver[J]. ORGAN TRANSPLANTATION, 2018, 9(2): 130-136. doi: 10.3969/j.issn.1674-7445.2018.02.007

DCD供肝肝移植术后早期急性肾损伤相关危险因素分析

doi: 10.3969/j.issn.1674-7445.2018.02.007
基金项目: 

国家自然科学基金面上项目 81270521

四川省医学科研青年创新课题 Q15087

详细信息
    作者简介:

    王万里,男,1985年生,博士研究生,主治医师,研究方向为普通外科、肝胆外科、肝脏再生及肝移植,Email:wanli-wang0728@foxmail.com

    通讯作者:

    王博,男,1975年生,博士,博士研究生导师,主任医师,研究方向为肝胆外科、肝移植、异种移植、肝脏再生及肝窦内皮细胞,Email: bobwang75@126.com

  • 中图分类号: R617, R657.3

Analysis of risk factors of early acute kidney injury after liver transplantation from DCD donor liver

More Information
  • 摘要:   目的  分析心脏死亡器官捐献(DCD)供肝肝移植术后早期急性肾损伤(AKI)的相关危险因素。  方法  回顾性分析184例DCD供肝肝移植供、受体资料。根据术后早期是否发生AKI分为AKI组和非AKI组,并且对AKI组行AKI分期。比较两组一般资料和术前、术中、术后相关指标的差异。用Kaplan-Meier曲线分析非AKI组和AKI组不同分期累积存活率等预后情况。  结果  本研究纳入病例184例,术后早期发生AKI 68例(37.0%),其中AKI 1期31例,AKI 2期26例,AKI 3期11例,且发生多在术后3 d内。单因素分析结果显示术前白蛋白 < 35 g/L、术前血清钠≤ 137 mmol/L、手术时间>7.5 h、术中出血量>3 000 mL、术中红细胞输注量>15 U、术中尿量≤ 100 mL/h这6项指标为肝移植术后早期发生AKI的危险因素(均为P < 0.05)。Logistic多变量回归分析结果表明术中红细胞输注量>15 U是肝移植术后早期发生AKI的独立危险因素[比值比(OR)1.061,95%可信区间(CI)1.008~1.118,P=0.024]。Kaplan-Meier生存曲线结果表明随着AKI程度不断加重,其累积存活率逐渐降低,差异有统计学意义(均为P < 0.05)。  结论  肝移植患者术后早期AKI的发生率较高,且严重程度与受体的短期和长期预后密切相关,术中大量输注红细胞是AKI发生的独立危险因素。

     

  • 图  1  AKI不同分期患者与非AKI患者KaplanMeier生存曲线

    Figure  1.  Kaplan-Meier survival curves of AKI patients in different stage and non-AKI patients

    表  1  AKI组与非AKI组一般资料和围手术期指标的比较

    Table  1.   Comparison of general information and perioperative indexes between AKI group and non-AKI group

    指标 AKI组(n=68) 非AKI组(n=116) P
    供体因素
      年龄(x±s,岁) 40.4±1.80 41.4±1.3 0.646
      性别(n/n 59/9 94/22 0.316
    受体因素
      一般资料
        年龄(x±s,岁) 46.8±1.3 45.1±1.0 0.303
        性别(n/n 54/14 95/21 0.678
        BMI(x±s,kg/m2 22.50±0.43 21.86±0.25 0.205
        糖尿病史[n(%)] 4(6) 2(2) 0.270
        高血压史[n(%)] 2(3) 2(2) 0.982
        上腹部手术史[n(%)] 29(43) 39(34) 0.221
        原发病[n(%)] 0.693
          乙肝后肝硬化 35(51) 62(53)
          丙肝后肝硬化 08(12) 8(7)
          胆源性肝硬化 2(3) 7(6)
          酒精性肝硬化 1(1) 4(3)
          原发性肝癌 013(19) 18(16)
          其他 009(13) 17(15)
      术前指标
        ALT(x±s,U/L) 114±33 089±21 0.480
        AST(x±s,U/L) 187±59 122±31 0.321
        TB(x±s,μmol/L) 122±19 114±13 0.833
        DB(x±s,μmol/L) 072±13 46±7 0.085
        白蛋白(x±s,g/L) 32.5±0.6 34.4±0.5 0.031
        血红蛋白(x±s,g/L) 100.7±2.50 109.0±2.70 0.032
        Scr(x±s,μmol/L) 59.2±2.6 74.9±5.0 0.004
        血清钠(x±s,mmol/L) 136.7±0.70 138.5±0.50 0.034
        eGFR[x±s,mL/(min·1.73m2)] 89.3±2.6 90.6±2.9 0.178
        PT(x±ss 19.7±0.6 18.7±0.4 0.167
        Child-Pugh评分(x±s,分) 10.43±0.25 10.02±0.18 0.181
        MELD评分(x±s,分) 18.6±1.0 18.2±0.8 0.851
        MELD-Na评分(x±s,分) 20.6±1.3 20.2±1.4 0.863
      术中指标
        手术时间(x±s,h) 06.86±0.15 06.44±0.10 0.024
        出血量(x±s,mL) 2 882±305 2 035±160 0.015
        下腔静脉阻断时间(x±s,min) 054.4±1.60 51.9±1.0 0.163
        冷缺血时间(x±s,h) 005.31±0.210 05.09±0.13 0.352
        热缺血时间(x±s,min) 009.84±0.430 09.29±0.20 0.252
        红细胞输注量[M(R),U] 10(6~18) 8(4~13) 0.015
        血浆输注量[M(R),mL] 1 600(1 050~2 400) 1 600(1 000~2 150) 0.481
        胶体输注量(x±s,mL) 1 001±730 983±48 0.824
        尿量(s,mL/h) 00218±1110 0275±131 0.003
        使用血管活性药物[n(%)] 22(32) 39(34) 0.860
        低血压状态[n(%)] 34(50) 55(47) 0.735
      术后指标
        ICU停留时间(x±s,h) 0182±104 144±58 0.006
        住院时间(x±s,d) 022±10 021±10 0.587
    乙肝为乙型病毒型肝炎; 丙肝为丙型病毒型肝炎
    下载: 导出CSV

    表  2  肝移植术后早期AKI危险因素的单因素分析

    Table  2.   Univariate analysis of the risk factors of early AKI after liver transplantation

    变量 OR 95%CI P
    术前白蛋白 < 35 g/L 1.949 1.037~3.663 0.038
    术前血清钠≤137 mmol/L 1.860 1.015~3.407 0.045
    手术时间 > 7.5 h 2.258 1.079~4.726 0.031
    术中出血量 > 3 000 mL 2.264 1.156~5.293 0.034
    术中红细胞输注量 > 15 U 2.145 1.060~4.340 0.034
    术中尿量≤100 mL/h 2.748 1.145~6.594 0.024
    下载: 导出CSV
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  • 收稿日期:  2017-12-16
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2018-03-15

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