术前免疫炎症反应对原发性胆汁性胆管炎肝移植病人预后影响的双中心回顾性研究  

Effect of preoperative immunoinflammatory response on prognosis in patients undergoing liver transplantation for primary biliary cholangitis:a two-center retrospective study

作　　者：张磊[1] 毛家玺 李涛[1] 滕飞 孙克彦 ZHANG Lei;MAO Jiaxi;LI Tao;TENG Fei;SUN Keyan(Liver Transplantatior Center,Department of Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Organ Transplantation,Changzheng Hospital,The 2nd Hospital Navy Medical University,Shanghai 200003,China)

机构地区：[1]上海交通大学医学院附属瑞金医院外科肝移植中心,上海200025 [2]海军军医大学第二附属医院(上海长征医院)器官移植科,上海200003

出　　处：《外科理论与实践》2022年第2期158-164,共7页Journal of Surgery Concepts & Practice

基　　金：国家自然科学基金(81971503);国家自然科学基金青年项目(81702923);长征医院军事医学科研专项(2019CZJS222)。

摘　　要：目的:观察肝移植治疗原发性胆汁性胆管炎(primary biliary cholangitis,PBC)的疗效及预后。方法:回顾性分析上海交通大学医学院附属瑞金医院和上海长征医院2001年1月至2020年12月收治肝移植治疗PBC病人的临床资料。术前免疫炎症反应采用10个免疫炎症指标,包括全身免疫炎症指数、纤维蛋白原以及中性粒细胞、淋巴细胞、单核细胞、血小板、天冬氨酸转氨酶、CD4、CD8之间的比值。根据单核细胞与淋巴细胞的比值以及纤维蛋白原计算、得到评分。评分≥-0.12为高危组,<-0.12为低危组。生存率分析采用寿命表法。多因素分析采用二元Logistic回归模型和COX回归分析。结果:82例纳入研究。术后随访至2021年12月31日,时间4.54年(2 d~17.06年)。全部PBC肝移植病人的1、3、5、10、15年生存率为85%、79%、79%、79%、47%。中位生存期为12.92年。多因素分析显示,术前天冬氨酸转氨酶与血小板比值是影响PBC肝移植病人90 d生存的独立危险因素(P=0.013);术前单核细胞与淋巴细胞比值和术前纤维蛋白原是影响PBC病人肝移植术后住院时间的独立危险因素(P=0.002;P=0.007)。高危组总住院时间和住院费用都较低危组明显升高。结论:术前免疫炎症反应可能影响PBC肝移植病人的近期预后。Objective To observe the effect of liver transplantation in the treatment of primary biliary cholangitis(PBC)and prognosis.Methods The clinical data of PBC patients treated with liver transplantation from January 2001 to December 2020 in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine and Shanghai Changzheng Hospital were analyzed retrospectively.A total of 10 preoperative parameters for immunoinflammatory response including systematic immunoinflammatory index,fibrinogen,the ratio among neutrophil,lymphocyte,monocyte,platelet,aspartic aminotrans-ferase,CD4 and CD8 were used to reflect immunoinflammatory response.Score was calculated with monocyte-lymphocyte ratio and fibrinogen.There were higher risk group according to the score≥-0.12 and lower risk group according to the score<-0.12.Survival rate was analyzed using life table method,and multivariate analysis was done with Logistic regres-sion model and COX regression.Results Totally,82 patients were enrolled.Postoperative follow-up was performed until to December 31,2021 with a median 4.54 years follow-up from 2 day to 17.06 year.Survival rate of 1-,3-,5-,10-,and 15-year of 82 patients with PBC after liver transplantation were 85%,79%,79%,79%,47%,respectively,with survival time of 12.92 years.Multivariate analysis of PBC patients after liver transplantation using preoperative index showed that aspartate aminotransferase-to-platelet ratio was an independent risk factor for 90-day survival(P=0.013),and monocyte-tolymphocyte ratio with fibrinogen were independent risk factors for postoperative length of stay(P=0.002;P=0.007).Both hospitalization cost and length of stay in higher risk group was significant more than those in lower risk group.Conclusions Preoperative immunoinflammatory response may affect the short-term prognosis of patients with PBC after liver transplantation.

关 键 词：原发性胆汁性胆管炎 肝移植 术前免疫炎症指标 

分 类 号：R657.45[医药卫生—外科学] R657.3[医药卫生—临床医学]