急性肾损伤对肝移植患者术后早期预后的影响  

Effects of Acute Kidney Injury on the Patients' Prognosis in the Early Post-Liver Transplantation Period

作　　者：张毅[1] 胡晓燕[1] 张秋艳[1] 叶啟发[1,2] ZHANG Yi;HU Xiaoyan;ZHANG Qiuyan;YE Qifa(Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, ＆ Hubei Key Laboratory of Medical Technology on Transplantation ,Wuhan 430071 , China;The 3rd Xiangya Hospital of Central South University ＆ Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, Changsha 410013, China)

机构地区：[1]武汉大学中南医院/武汉大学肝胆疾病研究院/武汉大学移植医学中心/移植医学技术湖北省重点实验室,湖北武汉430071 [2]中南大学湘雅三医院/卫生部移植医学工程技术研究中心,湖南长沙410013

出　　处：《武汉大学学报（医学版）》2017年第6期936-938,942,共4页Medical Journal of Wuhan University

基　　金：湖北省自然科学基金面上项目(编号:2015CFB702)

摘　　要：目的:探讨肝移植术后急性肾损伤(AKI)的发生情况及其对其他合并症和预后的影响。方法:采用回顾性对照研究方法,分析106例肝移植术后患者早期AKI的发生情况,分为3组:N组,未发生AKI;M组,轻、中度AKI组(包括AKI 1、2期);S组,严重AKI组(AKI 3期);比较3组患者其他严重合并症放发生情况、ICU停留时间及早期死亡率。结果:术后患者丙氨酸氨基转移酶(ALT)峰值,N组为(652.34±520.90)U/L,显著低于M组(997.12±784.66)U/L及S组(983.71±576.33)U/L(P<0.05);术后患者天冬氨酸氨基转移酶(AST)峰值,N组为(1 221.03±1 001.01)U/L,M组为(1 253.67±782.47)U/L,均显著低于S组(2 272.14±1 620.81)U/L(P<0.05)。106例患者中,AKI的发生率为66.98%(71/106);术后4周内,N组患者(35例)血肌酐值均恢复正常,M组(AKI 1期、AKI 2期)92.91%的患者血肌酐水平恢复正常,而S组仅有63.63%的患者血肌酐水平恢复正常,显著低于前两组(P<0.05)。术后早期血行感染(BSI)的发生率为43.40%(46例),其中N组BSI的发生率为37.14%(13/35),M组为40.82%(20/49),均显著低于S组59.09%(13/22)(P<0.05)。术后早期肺部感染的发生率为40.57%(43例),其中N组为28.57%(10/35),M组为38.78%(19/49),均显著低于S组63.63%(14/22)(P<0.05)。3组患者的ICU停留时间,N组为(123.33±106.25)h,M组为(142.82±115.71)h,均显著低于S组(296.39±173.05)h(P<0.05)。术后早期N组患者仅有1例死亡,死亡率为2.9%,M组患者死亡3例,死亡率为6.12%,均显著低于S组患者(死亡6例,死亡率27.27%)(P<0.05)。结论:患者在肝移植术后急性肾损伤的发生率高,严重的急性肾损伤会显著增加患者其他脏器严重并发症的发生率及死亡率。Objective： To investigate the effects of acute kidney injury （AKI） on the patients＇ prognosis in the early post-liver transplantation period. Methods： The 106 eases of patients were divided in-to three groups： N group（without AKI）, M group（including AKI 1 and AKI 2 stage） and S group（AKI 3 stage）. A retrospective study of 71 epsodes of AKI in the early post-liver transplan- tation period were conducted to assess the effects of AKI on the patients＇ prognosis. Results： The peak level of ALT in N group（F652.34±520.90] U/L ） was lower significantly as compared with M group （E997.12±784. 66-] U/L） and S group（[983. 71±576.33] U/L）（P〈0.05）. And the peak levels of AST in N group （[1 221. 03±1 001. 01] U/L ） and in M group（[1 253. 67±782.47] U/L） were lower significantly as compared with S group（[2 272.14±1 620.81] U/L） （P〈0.05）. The AKI developed in 71 patients（66.98%）. The levels of Cr in N group were all return to normal, and there were 92.91% patients＇ Cr levels returning to normal in M group, but only 63.63% patients＇ Cr levels returning to normal in S group within 4 weeks after opera- tion （P〈0.05）. There were 13 cases of BSI in N group （37.14%） and 20 cases of BSI in M group （40.82%）, which was significantly lower than in S group （59.09%） （P〈0.05）. There were 10 cases of pulmonary infection in N group（28.57%） and 19 cases of pulmonary infection in M group （38. 78%）, which was significantly less than in S group（63. 63%） （P〈0.05）. The ICU stay time of N group was （123.33±106.25）h and M group was （142.82±115.71）h, which was sig- nificantly shorter than in S group（[296.39±173.05]h） （P〈0.05）. Conclusion.. The mortality rate of N group was 2.9% and M group was 6.12%, which was significantly lower than S group （27.27%） （P〈0.05）.

关 键 词：急性肾损伤 肝移植 预后 

分 类 号：R657.3[医药卫生—外科学] R692[医药卫生—临床医学]