原位肝移植术后胆道并发症发生的影响因素分析  

Analysis of influencing factors on biliary complications after orthotopic liver transplantation

作　　者：朱明强 杨大帅 裴俊鹏 熊祥云 苏洋 丁佑铭[1] ZHU Mingqiang;YANG Dashuai;PEI Junpeng;XIONG Xiangyun;SU Yang;DING Youming(Department of Hepatobiliary Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肝胆外科,武汉430060

出　　处：《临床肝胆病杂志》2023年第7期1627-1632,共6页Journal of Clinical Hepatology

基　　金：国家重点研发计划(2022YFC2407304)。

摘　　要：目的 分析原位肝移植术后胆道并发症相关的血清学指标、手术指标,探究其影响因素及预测指标。方法 回顾性收集武汉大学人民医院2016年1月-2022年6月101例行原位肝移植患者的临床资料。根据患者术后6个月是否出现胆道并发症,分为胆道并发症组(BC组,n=21)和非胆道并发症组(非BC组,n=80)。计量资料两组间比较采用成组t检验或 Mann-Whitney U检验,计数资料两组间比较使用χ^(2)检验。单因素与多因素分析采用Logistic回归分析,并以受试者工作特征曲线(ROC曲线)评估联合指标的预测效能。结果 101例患者中21例(20.8%)发生胆道并发症。Logistc多因素分析结果显示,MELD评分(OR=0.134,95%CI:0.031~0.590,P=0.008)、全身炎症反应指数(SⅡ)/Alb(OR=1.415,95%CI:1.181~1.696,P=0.001)、输入血浆量(OR=1.001,95%CI:1.000~1.002,P=0.032)是肝移植患者术后发生胆道并发症的独立影响因素。MELD 评分、SⅡ/Alb、输入血浆量、MELD+SⅡ/Alb、MELD+SⅡ/Alb+输入血浆量预测肝移植术后胆道并发症的ROC曲线下面积(AUC)分别为 0.712、0.870、0.712、0.900、0.918。结论 SⅡ/Alb、输入血浆量及MELD评分是肝移植术后胆道并发症发生的影响因素,三者联合具有较好的预测价值和临床指导意义。Objective To analyze the serological markers and surgical indicators associated with biliary complications after orthotopic liver transplantation,explore their influencing factors and predictive indicators.Methods A retrospective analysis was performed for the clinical data of 101 patients who underwent orthotopic liver transplantation in Renmin Hospital of Wuhan University from January 2016 to June 2022,according to the presence or absence of biliary complication(BC)at 6 months after surgery,they were divided into BC group with 21 patients and non-BC group with 80 patients.The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.Univariate and multivariate Logistic regression analyses were performed,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive performance of combined indicators.Results Among the 101 patients,21(20.8%)experienced BC.The multivariate Logistic regression analysis showed that MELD score(odds ratio[OR]=0.134,95%confidence interval[CI]:0.031-0.590,P=0.008),SⅡ/Alb(OR=1.415,95%CI:1.181-1.696,P=0.001),and plasma transfusion volume(OR=1.001,95%CI:1.000-1.002,P=0.032)were independent risk factors for the development of BC in patients after liver transplantation.MELD score,SⅡ/Alb,plasma transfusion volume,MELD+SⅡ/Alb,and MELD+SⅡ/Alb+plasma transfusion volume had an area under the ROC curve of 0.712,0.870,0.712,0.900,and 0.918,respectively,in predicting BC after liver transplantation.Conclusion SⅡ/Alb,plasma transfusion volume and MELD score are independent risk fators for BC after liver transplantation.The combination of three indicators has good predictive value and clinical guiding significance for BC after liver transplantation.

关 键 词：肝移植 手术后并发症 系统免疫炎症指数 MELD评分 

分 类 号：R657.3[医药卫生—外科学]