合并肾功能衰竭的肝移植患者接受肾脏替代治疗的价值  

Evaluation of the renal replacement therapy on the liver transplant patients with acute renal failure

作　　者：袁金忠[1] 叶启发[2] 张浩[1] 明英姿[2] 桂明[1] 季迎[1] 孙剑[1] 王建文[1] 任祖海[2] 成柯[2] 赵于军[2] 孙培龙[2] 伍锟[1] 季龙振[1] 

机构地区：[1]中南大学湘雅三医院肾内科,长沙410013 [2]卫生部移植医学工程技术研究中心

出　　处：《中华肝脏病杂志》2009年第5期334-337,共4页Chinese Journal of Hepatology

基　　金：湖南省自然科学基金（INJJ6017）;2004年卫生部重大课题（98040362）

摘　　要：目的回顾性分析合并急性肾功能衰竭的肝移植受体移植术前的危险因素，并探讨肾脏替代治疗（RRT）作为其移植前过渡治疗措施的价值。方法收集2001年1月-2008年1月在卫生部移植医学工程技术研究中心由于急性肾功能衰竭而接受RRT的肝移植受体患者，依据不同预后对肝移植受体的临床特征进行分组对比分析；按接受不同RRT种类对肝移植受体的临床特征进行分组对比分析。用逻辑回归法分析能预测合并肾功能衰竭肝移植受体病死率的指标。对数据进行t检验、χ^2检验、Logistic回归分析。结果在接受RRT的患者中，有31．25％的患者因为肝移植而生存或者出院，68．75％的患者在等待移植期间死亡。死亡组患者与移植组相比，有更高的多器官功能障碍评分（4．98±2．32与4．45±2．02，P=0．008）、更低的平均动脉压[（56．5±7．1）mmHg与（65．4±12．9）mmHg，P=0．040；1mmHg=0．133kPa]。RRT的平均治疗天数在连续性肾脏替代治疗组和间歇血液透析组之间的差异没有统计学意义。与间歇血液透析组相比，连续性肾脏替代治疗组有更高的多器官功能障碍评分（4．82±2．12与3．45±1．91，P=0．040）、更低的平均动脉压[（56．0±14．2）mmHg与（68．5±15．3）mmHg，P=0．002]、更低的血清肌酐浓度[（320．12±185．15）μmol／L与（420．55±158．32）μmol／L，P=0．008]。肾功能衰竭受体术前平均动脉压越低，则死亡风险越高。结论对患有急性肾功能衰竭的肝移植受体应用RRT是可取的。尽管病死率仍高，但可使部分患者得以肝移植而生存。Objective To analyze the preoperative risk factors on liver transplant recipients with acute renal failure（ARF）, and to evaluate renal replacement therapy （RRT） as a transitonary therapy before liver transplantation. Methods Liver transplant recipients with acute renal failure treated with renal replace- ment therapy between January 1st, 2001 and January 1st, 2008 in our center were retrospected. Clinical characteristics, the kinds of RRT and prognosis were analyzed; Logistic regression was applied to analyze the parameters that can forecast the morality of the liver transplant recipients with acute renal failure. Results Of the patients who received RRT, 30% survived to liver transplantation, 67.5% died while waiting for liver transplantation. The dead had a higher multiple organ dysfunction score （MODS）, and lower mean arterial pressure than those survived to liver transplantation. There was no significant difference in the duration of RRT between continuous renal replacement therapy （CRRT） patients and hemodialysis patients.. CRRT patients had a higher MODS, lower mean arterial pressure, lower serum creatinine than hemodialysis patients. Lower mean arterial pressure was statistically associated with higher risk of mortality. Conclusion Though mortality was high, RRT helps part （30%） of patients survive to liver transplantation. Therefore, considering the high mortality without transplantation, RRT is acceptable for liver transplant recipients with ARF.

关 键 词：肝移植 肾功能衰竭 急性 肝 人工 肾脏替代治疗 

分 类 号：R692.5[医药卫生—泌尿科学] R657.3[医药卫生—外科学]