成人原位肝移植受者术后急性肾损伤的危险因素分析  

Risk factors for acute kidney injury after adult orthotopic liver transplantation

作　　者：虞豪骋 温培豪[1] 张嘉凯[1] 何玉婷[1] 张水军[1] 郭文治[1] Yu Haocheng;Wen Peihao;Zhang Jiakai;He Yuting;Zhang Shuijun;Guo Wenzhi(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Henan Organ Transplantation Centre,Henan Engineering Technology Research Centre for Organ Transplantation,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科河南省器官移植中心河南省器官移植医学工程技术中心,郑州450052

出　　处：《中华肝胆外科杂志》2022年第6期408-412,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金面上项目(82170648、82170670)。

摘　　要：目的分析成人原位肝移植受者术后发生急性肾损伤(AKI)的危险因素。方法回顾性分析2019年1月至2021年4月于郑州大学第一附属医院进行原位肝移植手术的232例受者的临床资料,其中男性195例,女性37例,年龄(49.1±9.4)岁。依据术后7 d内是否发生AKI分为两组:AKI组(n=112)和非AKI组(n=120)。对比两组患者基本信息、术前血液学指标、手术时间、术后住院时长等临床资料。对原位肝移植术后AKI的相关因素进行单因素分析,将差异有统计学意义的因素纳入多因素logistic回归分析。结果在232例接受原位肝移植的患者中,有112例在术后发生AKI,发生率为48.3%(112/232),其中AKI 1期64例(57.1%,64/112),AKI 2期30例(26.8%,30/112),AKI 3期18例(16.1%,18/112)。logistic回归分析结果显示,高血压(OR=5.874,95%CI:1.931~17.863,P=0.002)和高终末期肝病模型(MELD)评分(OR=1.041,95%CI:1.010~1.074,P=0.010)是原位肝移植术后AKI的独立危险因素。结论高血压和高MELD评分是原位肝移植受者术后AKI的独立危险因素。Objective To study the risk factors for acute kidney injury(AKI)after adult orthotopic liver transplantation.Methods The clinical data of 232 recipients who underwent orthotopic liver transplantation at the First Affiliated Hospital of Zhengzhou University from January 2019 to April 2021 were retrospectively analyzed.There were 195 males and 37 females,aged(49.1±9.4)years old.The patients were divided into two groups according to whether AKI had occurred within 7 days of surgery into the AKI group(n=112)and the non-AKI group(n=120).Clinical data including basic information,preoperative hematological indexes,operation time and postoperative hospital stay were compared between the two groups.Factors associated with AKI after orthotopic liver transplantation were studied using univariate analysis and those factors with significant differences were included in multifactorial logistic regression analysis.Results Among 232 patients who underwent orthotopic liver transplantation,112 patients developed AKI after surgery,with an incidence of 48.3%(112/232).There were 64 patients with AKI stage 1(57.1%,64/112),30 patients with AKI stage 2(26.8%,30/112),and 18 patients with AKI stage 3(16.1%,18/112).Logistic regression analysis showed that hypertension(OR=5.874,95%CI:1.931-17.863,P=0.002)and high scores on the model for end-stage liver disease(MELD)(OR=1.041,95%CI:1.010-1.074,P=0.010)were independent risk factors for AKI after orthotopic liver transplantation.Conclusion Hypertension and MELD score were independent risk factors for postoperative AKI in orthotopic liver transplant recipients.

关 键 词：肝移植 急性肾损伤 危险因素 

分 类 号：R692[医药卫生—泌尿科学] R657.3[医药卫生—外科学]