成人首次肝移植术后早期预后分析  

Early prognosis judgment in adult recipients after first liver transplantation

作　　者：谭永法[1] 周杰[1] 谭凯[1] 张起帆[1] 张胜[1] 罗振超[1] 陈立言[1] 

机构地区：[1]南方医科大学南方医院肝胆外科,广州510515

出　　处：《中华消化外科杂志》2012年第6期541-545,共5页Chinese Journal of Digestive Surgery

基　　金：广东省自然科学基金（8151051501000029）

摘　　要：目的应用逐步判别分析法对成人首次肝移植术后早期（术后90d内）预后进行判断，筛选出预后的主要影响因素。方法回顾性分析2004年8月至2011年2月南方医科大学南方医院施行的221例肝移植患者的临床资料，将符合研究条件的218例患者分为训练样本（2004年8月至2010年6月，188例）和验证样本（2010年7月至2011年2月，30例）。根据术后患者的生存情况，将患者分为死亡组（术后生存时间≤90d，34例）和生存组（术后生存时间〉90d，184例）。用逐步判别分析法对单因素分析有统计学意义的相关因素进行研究，建立早期预后的判断函数并分析主要影响因素。计量资料采用t检验或秩和检验，计数资料采用R×C表的）（。检验或Fisher确切概率法。结果死亡组与生存组受者平均年龄分别为（544-11）岁和（514-11）岁，两组比较，差异无统计学意义（t=-1．681，P〉0．05）；术前平均Hb分别为106．7g／L和119．2g／L，两组比较，差异有统计学意义（t=2．809，P〈0．05）。两组患者的肌酐、尿素氮、Alb、TBil、IBil、Na^＋、PT、活化部分凝血活酶时间、国际标准化比值、纤维蛋白原、凝血酶原活动度、PLT、营养危险指数、终末期肝病模型评分、术前肝性脑病、术前肝肾综合征、术前消化道出血、术前感染、术前糖尿病、Child—Tureotte—Pugh肝功能分级、心功能分级、麻醉危险度分级、手术时间、无肝期时让、术中输血量、腹腔积液量以及术中尿量比较，差异有统计学意义（Z=-2．277，-2．595，-3．290，-3．486，-2．562，-2．577，-3．670，-3．882，-3．625，-3．557，-3．837，-1．974，-3．693，-3．815，X。=19．632，9．756，28．143，Z：-4．175，-3．905，-4．865，-3．564，-5．822，P〈0．05）。影响成人首次肝移植术后早期预后的主要因素为术前肝性脑病、术前肝肾综合征、手术时间、�Objective To judge the prognosis of adult recipients after first liver transplantation by stepwise discriminant analysis, and screen out the main influencing factors. Methods The clinical data of 221 patients who received liver transplantation at the Nanfang Hospital of Southern Medical University were retrospectively analyzed. A total of 218 patients who met the criteria were divided into the training samples （188 patients admitted from August 2004 to June 2010） and checking samples （30 patients admitted from July 2010 to February 2011 ）, and then all patients were re-divided into dead group （survival time ~〈 90 days, 34 patients） and surviving group （survival time 〉 90 days, 184 patients）. Factors which had significant difference after the univariate analysis was further analyzed by the stepwise discriminant analysis method. All data were analyzed by the t test, rank sum test, chi-square test or Fisher exact probability test. Results The ages of the recipients in the dead group and the living group were （54 ＋ ll）years and （51 ~ ll）years, respectively, with no significant difference between the 2 groups （t =- 1. 681, P 〉 0.05 ）. The preoperative levels of hemoglobin in the dead group and the living group were 106.7 g/L and 119.2 g/L, respectively, with a significant difference between the 2 groups （t = 2. 809, P 〈0.05）. There were significant differences in the levels of serum creatinine, urea nitrogen, albumin, total bilirnbin, indirect bilirnbin, Na ＋ , prothrombin time, activated partial thromboplastin time, international normalized ratio, fibrinogen, prothrombin activity, platelet, nutrition risk index, model for end-stage liver disease score, number of patients with preoperative hepatic encephalopathy （HE） , preoperative hepatorenal syndrome （ HRS）, preoperative digestive tract bleeding, preoperative infection, preoperative diabetes, Child-Tureotte-Pugh score, cardiac function classification and anesthesia risk rating operation time, anhepatic time, volume

关 键 词：肝移植 早期预后 逐步判别分析法 肝肾综合征 肝性脑病 

分 类 号：R657.3[医药卫生—外科学]