胆道闭锁患儿肝移植术后急性肾损伤危险因素分析  

Risk factors of acute kidney injury in children with biliary atresia after liver transplantation

作　　者：王亚军 林瑾[1] 刘培[1] 张萌[1] 支德源 段美丽[1] Wang Yajun;Lin Jin;Liu Pei;Zhang Meng;Zhi Deyuan;Duan Meili(Department of Critical Care Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院重症医学科,北京100050

出　　处：《国际外科学杂志》2023年第4期229-235,共7页International Journal of Surgery

摘　　要：目的分析胆道闭锁患儿肝移植术后发生急性肾损伤(AKI)的危险因素。方法采用回顾性病例对照研究方法。收集2018年12月-2020年11月首都医科大学附属北京友谊医院首次接受肝移植手术的115例胆道闭锁患儿的临床病例资料。根据改善全球肾脏疾病预后组织诊断标准,分为AKI组(n=39)和非AKI组(n=76)。比较两组各临床指标间的差异,对具有统计学意义的变量进行多因素logistic回归分析,进一步确定肝移植术后发生AKI的独立危险因素。正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用t检验。非正态分布的计量资料用M(Q_(1),Q_(3))表示,组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验或Fisher确切概率法。结果胆道闭锁患儿肝移植术后AKI发生率为33.9%。单因素分析发现,AKI组与非AKI组患儿在年龄(OR=0.721,95%CI:0.553~0.938,P=0.014)、术前存在感染(OR=3.307,95%CI:1.294~8.468,P=0.013)、PELD评分(OR=1.065,95%CI:1.031~1.101,P<0.001)、血清肌酐值(OR=0.745,95%CI:0.657~0.858,P<0.001)、术中输红细胞(OR=1.034,95%CI:1.028~1.051,P<0.001)、术中输血浆(OR=1.055,95%CI:1.025~1.086,P=0.002)方面,差异均有统计学意义(P<0.05)。根据单因素分析筛选指标,进行多因素logistic回归分析,结果发现,术前存在感染(OR=3.763,95%CI:1.185~11.945,P=0.025)、血清肌酐值(OR=0.685,95%CI:0.570~0.823,P<0.001)、术中输注红细胞(OR=1.033,95%CI:1.015~1.056,P=0.028)与肝移植术后发生AKI独立相关(P<0.05)。两组患儿住ICU时间、住院时间,差异有统计学意义(P<0.05)。结论术前存在感染、低肌酐值、术中输红细胞是胆道闭锁患儿肝移植术后发生AKI的独立危险因素,AKI延长了住ICU和住院时间。Objective To analyze the incidence and risk factors of acute kidney injury in children with biliary atresia after liver transplantation.Methods The retrospective case-control study was conducted.The clinical data of 115 children with biliary atresia who received liver transplantation for the first time in Beijing Friendship Hospital Affiliated to Capital Medical University from December 2018 to November 2020 were collected.The patients were divided into AKI group(n=39)and non-AKI group(n=76)according to the diagnostic criteria of the Kidney Disease Improving Global Outcomes(KDIGO).The differences of clinical indicators between the two groups were compared,and multivariate logistic regression analysis was performed for statistically significant variables(P<0.05)to further determine the independent risk factors for AKI after liver transplantation.The measurement data of normal distribution were expressed as mean±standard deviation(x±s),and t-test was used for comparison between groups.Measurement data with non-normal distribution were represented by M(Q_(1),Q_(3)),and Mann-Whitney U test was used for comparison between groups.Count data were expressed as cases and percentage,and comparisons between groups were made using Chi-square test or Fisher′s exact test.Results The incidence of AKI in biliary atresia patients after liver transplantation was 33.9%.Univariate analysis showed that there were statistically significant differences in age(OR=0.721,95%CI:0.553-0.938,P=0.014),preoperative infection(OR=3.307,95%CI:1.294-8.468,P=0.013),PELD score(OR=1.065,95%CI:1.031-1.101,P<0.001),serum creatinine numerical value(OR=0.745,95%CI:0.657-0.858,P<0.001),intraoperative red blood cell transfusion(OR=1.034,95%CI:1.028-1.051,P<0.001)and intraoperative plasma transfusion(OR=1.055,95%CI:1.025-1.086,P=0.002)between the AKI group and the non-AKI group(P<0.05).Multivariate logistic regression analysis was performed on the selected indicators by univariate analysis,and the results showed that preoperative infection(OR=3.763,95%C

关 键 词：肝移植 胆道闭锁 儿童 急性肾损伤 

分 类 号：R726.5[医药卫生—儿科]