MELD评分程度与供肝脂肪变性程度对良性终末期肝病肝移植术后患者短期疗效的综合影响  

Association between MELD score combined with degree of fatty liver in donor liver and short-term outcome after liver transplantation in recipients with benign end-stage liver disease

作　　者：刘建勇[1] 潘凡[1] 吕立志[1] 江艺[1] 

机构地区：[1]南京军区福州总医院肝胆外科,福州350025

出　　处：《临床肝胆病杂志》2015年第12期2042-2046,共5页Journal of Clinical Hepatology

基　　金：福建省自然科学基金重点项目(2014Y0034);福建省福州市福州总院院内课题(2014J08)

摘　　要：目的探讨MELD评分与良性终末期肝病移植术后并发症及早期生存率之间的关系,并且分析不同MELD评分对供肝脂肪肝的选择要求。方法回顾性分析南京军区福州总医院自2008年1月-2013年12月行原位肝移植手术的良性终末期肝病受者145例,其中47例供肝术前行冰冻病理脂肪肝活组织检查,依据MELD评分结果将受者分为3组：A组28例,MELD评分≥30,平均35.7±5.5;B组35例,20≤MELD评分〈30,平均22.5±2.3;C组82例,MELD评分〈20,平均11.0±3.7,比较3组术前、术中和术后的生化指标,及术后并发症、生存率。依据MELD评分结果将47例行冰冻病理者分为2组：a组9例,MELD评分≥30;b组38例,MELD评分〈30,比较2组中供肝轻度、中度及重度脂肪肝受者1年生存率。计量资料组间比较采用t检验或方差分析,计数资料组间比较采用χ~2检验或Fisher精确概率法。结果 A组术后1个月生存率（71.4%）与B组（88.6%）及C组（89.0%）比较差异无统计学意义（P〉0.05）;A组术后3、6个月及1年生存率（64.3%、64.3%、64.3%）显著低于B组（88.6%、88.6%、88.6%）及C组（87.8%、86.6%、86.6%）,差异均有统计学意义（P值均〈0.05）。A组术后并发症发生率（82.14%）显著高于B组（42.86%）及C组（25.61%）,差异均有统计学意义（P值均〈0.05）。中度和重度脂肪肝受者a组术后1年生存率（20.0%）显著低于b组（81.8%）,差异有统计学意义（χ~2=5.111,P=0.014）。结论高MELD评分（≥30）受者术后并发症多,死亡率较高,中重度脂肪肝供肝应弃用。Objective To investigate the association of Model for End- Stage Liver Disease（ MELD） score with complications and early survival rate after liver transplantation for benign end- stage liver disease,and to analyze the criteria to select donor livers with fatty liver for patients with different MELD scores. Methods A total of 145 recipients of orthotopic liver transplantation with benign end- stage liver disease in Fuzhou General Hospital of Nanjing Military Command from January 2008 to December 2013 were analyzed retrospectively,and frozen fatty liver biopsy was performed for donor livers in 47 patients before transplantation. The patients were divided into the following three groups according to MELD score： group A with 28 patients（ MELD score ≥30,mean MELD score 35. 7 ± 5. 5）; group B with 35 patients（ 20≤ MELD score 30,mean MELD score 22. 5 ±2. 3）; group C with 82 patients（ MELD score 20,mean MELD score 11. 0 ±3. 7）. The preoperative,intraoperative,and postoperative biochemical parameters,postoperative complications,and survival rate were compared between these groups. The 47 patients receiving frozen biopsy were divided into the following two groups according to MELD score： group a with 9 patients（ MELD score ≥30）; group b with 38 patients（ MELD score 30）. The 1- year survival rates of the recipients of donor livers with mild,moderate,and severe fatty liver were compared between the two groups. Comparison of continuous data between the two groups was made by t test or ANOVA and comparison of categorical date was made by chi- square test or Fisher＇s exact. Results The 1- month survival rate after transplantation showed no significant difference between groups A,B,and C（ 71. 4%,87. 8%,and 86. 6%,respectively; P〈0. 05）; group A had significantly lower 3- month,6- month,and 1- year survival rates than groups B and C（ 64. 3% /64. 3% /64. 3% vs 88. 6% /88. 6% /88. 6% and 87. 8% /86. 6% /86. 6%,all P〈0. 05）. Group A had a significantly higher incidence of postoperat

关 键 词：肝移植 脂肪肝 MELD评分 存活率 

分 类 号：R657.3[医药卫生—外科学]