应用瞬时弹性成像技术预测肝移植早期预后  

Prediction of liver transplantation prognosis by transient elastography

作　　者：丁元[1] 刘建华[1] 严盛[1] 张启逸[1] 周琳[1] 谢海洋[1] 郑树森[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科卫生和计划生育委员会多器官联合移植研究重点实验室,杭州310003

出　　处：《中华器官移植杂志》2014年第6期346-349,共4页Chinese Journal of Organ Transplantation

摘　　要：目的研究成人肝移植术后应用瞬时弹性成像（TE）技术检测肝脏弹性值（K｜M）评估受者早期预后的价值。方法收集2013年12月10日至2014年3月19日间43例肝移植受者及其术后应用TE技术检测LSM的临床资料，分析受者相关资料和肝肾功能各指标与LSM的相关性。根据术后第1和第7天的LSM，每个时点将受者各分为LSM〉16kPa组（高LSM组）和LSM〈16kPa组（低LSM组），比较两组受者间住重症监护室（ICU）时间、住院时间及严重并发症发生率。结果LSM与受者体质量指数、术前终末期肝病模型（MELD）评分、移植肝质量和受者体质量比、供肝热缺血时间均无明显相关性（P〉0．05）；术后第1天LSM与住ICU时间呈正相关[相关系数（R）：0．488，P=0．001]，术后第7天LSM与供肝冷缺血时间明显相关（R=0．335，P=0．028）。术后第1天和第7天LSM与天冬氨酸转氨酶、胆汁酸及血肌酐均呈正相关，与其他肝肾功能指标均无明显相关性（P〉0．05）。术后第1天高LSM组住ICU时间显著长于低LSM组（9±3和7±2d，P=0．013），术后第1天高LSM组住院时间显著长于低LSM组（34±6和23±2d，P=0．023）。术后第7天高LSM组与低LSM组在住ICU时间及住院时间方面的差异均无统计学意义。术后第1天和第7天高LSM组受者严重并发症发生率均高于低LSM组（78．57％和27．59％，P=0．002；70．00％和36．36％，P=0．061）。结论采用TE技术检测肝脏醛M与肝移植受者术后肝肾功能有一定关联，对肝移植后早期预后可能有预测价值。Objective To investigate the clinical value of transient elastography in adult after liver transplantation,by means of evaluating the correlation of liver stiffness measured by FibroScan with liver/renal functions. Method Forty-three patients received orthotopic liver transplant in our hospital during Dec. 10, 2013 and Mar. 19, 2014 were included in this study. Liver stiffness measurement （LSM） was performed after transplantation. Clinical data and laboratory tests including liver function and renal function were collected and analyzed. Result Bivariate correlation showed that body mass index （BMI）, MELD score, graft-to-recipient weight ratio （GRWR） and warm ischemia time had no correlation with LSM. LSM at the 1st day after transplantation （LSM-1） showed no correlation with cold ischemia time, but LSM at the 7th day after transplantation （LSM-7） did, with R = 0. 335, P = 0. 028. LSM-1 showed positive correlation with the ICU time （R = 0. 488, P = 0. 001 ）, but LSM-7 didn＇t. There was significantly positive correlation between LSM and aspartate aminotransferase, bile acid and creatinine, but no significant correlations were found between LSM and alanine aminotransferase, alkaline phosphatase, cholinesterase, gamma-glutamyl transferase, total bilirubin,direct bilirubin, indirect bilirubin, urea nitrogen and uric acid. The group with higher LSM-1 had longer ICU time than the lower group （9 d vs,7 d,P = 0. 013） ,and so was the hospital stay （34 d vs. 23 d, P = 0. 023）. For the LSM-7, there was no significant difference in ICU time and hospital stay between the two groups. The group with higher LSM-1 had higher serious complication incidence than the lower group （78. 57% vs. 27. 59%, P = 0. 002）, but the two groups in LSM-7 showed no significant difference in serious complication incidence. Conclusion The LSM partially correlates with the liver function and renal function of liver transplantation recipient, and may have its clinical value for assessing the early prognosis after l

关 键 词：瞬时弹性成像 肝移植 预后 

分 类 号：R657.3[医药卫生—外科学]