终末期肝病肝移植受体的术后生存状况及影响因素分析  

Survival status and risk factors of post-transplantation patients with end-stage liver disease

作　　者：申川[1] 彭承宏[1] 沈柏用[1] 严佶祺[1] 陈皓[1] 谢俊杰[1] 金佳斌[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院器官移植中心,200025

出　　处：《器官移植》2012年第6期306-311,共6页Organ Transplantation

基　　金：国家自然科学基金(81070358)

摘　　要：目的了解终末期肝病肝移植受体术后的生存状况,探讨影响肝移植受体特别是恶性终末期肝病受体长期生存的危险因素。方法 2005年10月至2009年10月,在上海交通大学附属瑞金医院器官移植中心接受同种异体肝移植且随访记录完整的受体99例,收集其临床资料进行回顾性分析。所有患者均签署知情同意书,符合医学伦理学规定。根据肝移植受体的原发病分为良性组(54例)和恶性组(45例)。应用Kaplan-Meier法计算肝移植受者术后的1年、2年、3年、4年存活率,绘制生存曲线,并用Log-rank法比较生存曲线。将肝移植受体围手术期的12项指标和恶性组10项指标进行Cox比例风险回归模型分析,筛选出影响受者生存的危险因素。结果截止至2009年10月,生存64例,死亡35例,受体术后的1年、2年、3年、4年存活率分别为68%、57%、53%、53%。良性组术后的1年、2年、3年、4年存活率分别为78%、70%、61%、61%,恶性组术后的1年、2年、3年、4年存活率分别为60%、46%、46%、46%。两组术后各年存活率比较,差异无统计学意义(均为P>0.05)。良性组的存活时间为(35.8±3.0)个月,恶性组的存活时间为(28.7±2.9)个月,两组比较差异无统计学意义(P>0.05)。Cox比例风险回归模型分析表明,围手术期的12项指标中,急性生理和慢性健康评估(acute physiology and chronic health evaluation,APACHE)Ⅱ评分(优势比1.21,95%可信区间1.05～1.39,P<0.01)和无肝期时间(优势比2.28,95%可信区间1.26～4.13,P<0.01)对肝移植受体术后存活时间的影响有统计学意义。恶性组的10项指标中,术前甲胎蛋白水平(优势比5.94,95%可信区间2.49～14.16,P=0.001)和肿瘤微卫星灶(优势比3.40,95%可信区间1.50～7.74,P<0.01)对肝移植受体术后存活时间的影响有统计学意义。结论终末期肝病肝移植受体术前APACHEⅡ评分和术中无肝期时间是影响受体术后长期生存的主要危险因素,而术前甲胎Objective To analyze the postoperative survival status of hver transplant recipients with end-stage liver disease and to explore the risk factors of long-term survival in liver transplant recipients especially with end-stage hver malignancy. Methods Clinical data of 99 adult patients underwent allogenic liver transplantation with complete follow-up records in Ruijin Hospital, Medical School of Shanghai Jiaotong University from October 2005 to October 2009 were analyzed retrospectively. This study was approved by local ethical committee and the informed consent of all participating subjects was obtained. According to the primarydiseases, the patients were divided into the benign group （n = 54 ） and malignancy group （n = 45 ）. The 1-, 2-, 3-, 4-year survival rate of recipients were calculated by Kaplan-Meier method and survival curve was drawn and analyzed by Log-rank method. The 12 perioperative variables and 10 variables of liver transplant recipients in the malignancy group were compared by Cox risk regression model to select the risk factors to the recipients＇ survival. Results Sixty-four cases survived and 35 cases died by October 2009. The 1-, 2-, 3-, 4- year survival rate of recipients were 68% , 57%, 53% and 53%. The 1-, 2-, 3-, d-year survival rate in the benign group were 78%, 70%, 61% and 61%, while in the malignancy group were 60%, 46%, 46% and 46%. There was no significant difference in the 1-, 2-, 3-, 4-year survival rate between two groups （all in P 〉 0. 05 ）. The survival time in the benign group was （35.8 ± 3.0 ） months while in the malignancy group was （28. 7 ± 2. 9 ） months. There was no significant difference between two groups （P 〉 0. 05 ）. Cox risk regression analysis showed that the acute physiology and chronic health evaluation （APACHE） 11 scores （odds ratio： 1.21, 95% confidence interval： 1.05-1.39, P 〈0. 01 ） of the 12 perioperative variables and the time of anhepatic phase （ odds ratio ： 2. 28, 95% confidence interval ： 1.26- 4. 13, P �

关 键 词：肝移植 生存分析 终末期肝病 甲胎蛋白 急性生理和慢性健康评估 

分 类 号：R617[医药卫生—外科学]