术前肾功能正常患者肝移植术后急性肾损伤危险因素分析  

Risk factor analysis of acute kidney injury after liver transplantion in patients with normal preoperative renal function

作　　者：陈杰[1] 李伟杰[2] 王俊科[1] 马虹[1] VictorXia 

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳110001 [2]中国医科大学附属第一医院器官移植科,沈阳110001 [3]加利福尼亚大学洛杉矶分校麻醉科

出　　处：《上海医学》2010年第12期1079-1083,共5页Shanghai Medical Journal

基　　金：中华医学会麻醉学分会留学基金资助项目(20080102)

摘　　要：目的探讨术前肾功能正常的患者在肝移植(LT)术后新发生的急性肾损伤(AKI)的发生率及其危险因素。方法对加利福尼亚大学洛杉矶分校医学中心2005年11月—2008年12月术前肾功能正常(血肌酐≤133μmol/L)的成年患者进行病例对照研究。AKI的诊断标准为RIFEL(肾损伤风险、肾损伤、肾功能衰竭、肾功能丧失、终末期肾功能衰竭)。通过对两组患者术前、术中和术后多项变量进行分析,研究AKI的危险因素及其对预后的影响。结果 335例(46.9%)患者在行LT术前的肾功能正常,其中164例(49.0%)、45例(13.4%)、8例(2.4%)患者分别于LT术后1周、1个月和1年发生AKI。与非AKI组相比,AKI组术后1周、1个月行肾替代治疗及移植物功能衰竭的构成比均显著增加(P值均<0.01),术后1周、1个月的肾小球滤过率(GFR)显著降低(P<0.01)。但两组间术后1年上述指标及病死率的差异均无统计学意义(P值均>0.05)。体质指数(BMI)≥30 kg/m^2组术后AKI的发生率显著高于BMI<25 kg/m^2组(OR=3.139,P=0.012)。术前肌酐水平(OR=34.160,P<0.001)、低蛋白血症(OR=2.272,P=0.029)、红细胞压积(Hct)<30%(OR=3.085,P=0.001)、低血小板(血小板计数<70×10~9个/L,OR=2.222,P=0.030)、术中持续输注血管活性药(OR=2.004,P=0.045)和术中输注红细胞量>10 U(OR=1.084,P<0.001)均是LT术后发生AKI的危险因素。结论即使术前患者肾功能正常,AKI仍是LT术后的常见并发症。BMI≥25 kg/m^2、术前肌酐水平、HCT<30%、血小板计数<70×10~9个/L、术中输注红细胞量>10 U、术中持续输注血管活性药与术后AKI有相关性。然而,术后早期AKI对患者术后1年病死率和移植物功能衰竭没有明显影响。Objective To study the incidence and peri-operative risk factors of acute kidney injury（AKI） after liver transplantation（LT） in adults.Methods A case control study was performed in adult patients who had normal pre-operative renal function（serum creatinine[Cr]≤133μmol/L） were treated in the Medical Center,Los angeles branch of California University during Nov.2005 to Dec.2008.Postoperative AKI was determined by using the RIFLE criteria（Risk,Injury,Failure,Loss and End of stage）.The patients were divided into two groups according to their postoperative renal status：AKI and non-AKI groups.Perioperative variables were compared between two groups and independent risk factors of AKI were determined by multivariate logistic regression. Results A total of 335 patients who have normal renal function preoperatively were included in the present study. AKI occurred in 164（49.0%） patients one week after LT,in 45（13.4%） patient one month after LT,and in 8 （2.4%） patients one year after LT.Thirty（8.96%） patients needed renal replacement therapy（RRT） within one year after operation.Compared with non-AKI group,AKI Group had a significantly higher incidences of renal replacement therapy within one month,graft failure,and reoperation and significantly lower GFR（P0.01）. However,the above parameters and the mortalities were not significantly different between the two groups one year after LT.Among the variables examined,preoperative creatinine,BMI 25 - 29 kg/m^2（OR = 2.8,P = 0.012）,BMI≥30 kg/m^2（OR = 3.1,P = 0.022）,preoperative creatinine（OR = 34,P 0.001）, hypoalbuminemia（OR = 2.3,P = 0.029）,Hct30%（OR = 3.1,P = 0.001）,Platelet70×10~9/L（OR = 2.2, P = 0.030）,continuous infusion of vasopressors（OR = 2.0,P = 0.045） and intraoperative red blood cell transfused over 10 units（OR = 1.1,P0.001） were identified as independent risk factors of ARI.Conclusion Even in patients with normal preoperative renal function,AKI may occur frequently following LT.It is also dem

关 键 词：肝移植 急性肾损伤 体质指数 肌酐 输血 

分 类 号：R657.3[医药卫生—外科学]