公民死亡器官捐献肝移植术后早期感染及细菌耐药性分析  

Analysis of early infection and bacterial drug resistance in liver transplant patients from organ donation after death

作　　者：王华翔 许蜂蜂 柯瑞盛 杨芳[3] 蔡秋程[3] 刘建勇 黄兴华 江艺 Wang Huaxiang;Xu Fengfeng;Ke Ruisheng;Yang Fang;Cai Qiucheng;Liu Jianyong;Huang Xinghua;Jiang Yi(Department of Hepatobiliary Surgery,Dongfang Hospital Affiliated to Xiamen University,Fuzhou 350025,China;School of Medicine,Fuzhou General Hospital of Fujian Medical University,Fuzhou 350025,China;Department of Hepatobiliary Surgery,Fuzhou General Hospital of Chinese People's Liberation Army,Fuzhou 350025,China)

机构地区：[1]厦门大学附属东方医院肝胆外科,福州350025 [2]福建医科大学福总临床医学院,福州350025 [3]中国人民解放军福州总医院肝胆外科,福州350025

出　　处：《中华肝脏外科手术学电子杂志》2019年第6期507-511,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：福建省自然科学基金重点项目（2016J01585）;全军后勤医学研究重大基金资助项目（CNJ15J002,12ZX22）;福建医科大学启航基金博士生创新项目（2017XQ2048）

摘　　要：目的探讨不同来源供肝对移植术后患者早期感染和细菌耐药性的影响。方法回顾性分析2009年1月至2017年12月在厦门大学附属东方医院接受原位肝移植的296例患者临床资料。其中男216例,女80例;平均年龄(49±13)岁。患者均签署知情同意书,符合医学伦理学规定。根据供肝来源不同将其分为两组,司法途径标准供肝(SCD)组197例,公民死亡器官捐献供肝(DCD)组99例。采用倾向评分匹配(PSM)平衡两组术前、术中协变量,分析两组术后早期感染情况和细菌耐药性,率的比较采用χ2检验。结果经PSM后两组均为89例。DCD组患者2个月内总体感染率为60%(53/89),明显高于SCD组的43%(38/89)(χ^2=5.059,P<0.05)。其中DCD组腹腔感染率为47%(42/89),明显高于SCD组的33%(29/89)(χ^2=3.960,P<0.05);而DCD组和SCD组肺部感染率分别为30%(27/89)、24%(21/89),差异无统计学意义(χ^2=1.027,P>0.05)。DCD组和SCD组患者在术后分别培养出81、66例病原体,其中细菌占病原体的百分率分别为81%(66/81)、86%(57/66),细菌均以革兰氏阳性菌为主。DCD、SCD组患者多药耐药率分别为39%(26/66)、47%(27/57),差异无统计学意义(χ^2=1.306,P>0.05)。结论与SCD来源供肝相比,DCD移植术后腹部感染率增加,但并不增加多药耐药细菌的感染率和肺部感染发生率。Objective To investigate the effects of liver grafts from different sources on the early infection and bacterial drug resistance in the recipients after liver transplantation.Methods Clinical data of 296 recipients undergoing orthotopic liver transplantation in Dongfang Hospital Affiliated to Xiamen University from January 2009 to December 2017 were retrospectively analyzed.Among them,216 patients were male and 80 female,aged(49±13)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.According to different sources of liver grafts,the recipients were divided into the standard criteria donor(SCD,n=197)and donation after citizen's death groups(DCD,n=99).Preoperative and intraoperative covariates between two groups were balanced with propensity score matching(PSM).Early postoperative infection and bacterial drug resistance of two groups were analyzed.The rate comparison was performed by using Chi-square test.Results After PSM,89 eligible patients were recruited in each group.The overall infection rate in the DCD group within postoperative 2 months was 60%(53/89),significantly higher than 43%(38/89)in the SCD group(χ^2=5.059,P<0.05).The abdominal infection rate in the DCD group was 47%(42/89),significantly higher compared with 33%(29/89)in the SCD group(χ^2=3.960,P<0.05).The lung infection rates in DCD and SCD groups were 30%(27/89)and 24%(21/89),respectively,where no significant difference was observed(χ^2=1.027,P>0.05).Postoperatively,81 and 66 pathogens were cultured in DCD and SCD groups,respectively.The percentage of bacteria among pathogens in two groups was respectively 81%(66/81)and 86%(57/66).Gram-positive bacteria were the main bacteria.The multidrug resistance rates in DCD and SCD groups were 39%(26/66)and 47%(27/57),where no significant difference was observed(χ^2=1.306,P>0.05).Conclusions Compared with liver grafts procured from SCD,the abdominal infection rate increased in patients of DCD liver transplantation,but in the infection

关 键 词：肝移植 公民死亡器官捐献 感染 多药耐药 

分 类 号：R54[医药卫生—心血管疾病]