原位肝移植后发生早期急性肾损伤危险因素及预后分析  

Analysis of risk factors and prognosis for early acute kidney injury after orthotopic liver transplantation

作　　者：陈怡宁 张慧 康俊伟 郑智滢 刘新阳 潘熊熊 Chen Yining;Zhang Hui;Kang Junwei;Zheng Zhiying;Liu Xinyang;Pan Xiongxiong(Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Hepatobiliary Surgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,南京210029 [2]南京医科大学第一附属医院肝胆中心,南京210029

出　　处：《中华消化外科杂志》2024年第7期952-960,共9页Chinese Journal of Digestive Surgery

基　　金：江苏省卫生健康委医学科研项目面上项目(M2021059)。

摘　　要：目的分析原位肝移植后发生早期急性肾损伤(AKI)的危险因素和预后。方法采用回顾性研究方法。收集2016年1月至2020年1月南京医科大学第一附属医院收治的340对行原位肝移植供者及受者的临床病理资料;供者男262例,女78例;受者男268例,女72例,年龄为(51±11)岁。340例受者中,217例术后未发生早期AKI设为非AKI组,123例术后发生早期AKI设为AKI组。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验。偏态分布的计量资料以M(IQR)表示,组间比较采用Mann‑Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验。等级资料比较采用非参数检验。多因素分析采用二元Logistic回归模型前进法。采用R软件及其RMS软件包(R3.6.1)构建列线图预测模型。采用受试者工作特征曲线的曲线下面积(AUC)验证预测模型的效能,Bootstrap法对预测模型进行内部验证。采用Kaplan‑Meier法绘制生存曲线,Log‑rank检验进行生存分析。结果(1)非AKI组和AKI组供者及受者术前临床特征比较。非AKI组和AKI组供者超重比较,差异有统计学意义(P<0.05)。非AKI组和AKI组受者术前高血压、病毒性肝炎、病理学类型、国际标准化比值、纤维蛋白原、血小板、血红蛋白、贫血比较,差异均有统计学意义(P<0.05)。(2)非AKI组和AKI组受者手术情况比较。非AKI组和AKI组受者术中尿量、术中出血量、灌注后血清钾峰值、大量输血、术中输注血浆、术中输注冷沉淀、使用氨甲环酸比较,差异均有统计学意义(P<0.05)。(3)术后发生早期AKI的影响因素和列线图预测模型的构建及评价。多因素分析结果显示:供者超重,受者术前高血压、非病毒性肝炎、术前血小板重度减少、术中尿量、灌注后严重低血压、灌注后血清钾峰值、术中输注血浆是术后发生早期AKI的独立危险因素(优势比=1.982,3.365,0.519,3.615,0.169,2.480,1.500,1.001,Objective To analyze the risk factors and prognosis for early acute kidney injury(AKI)after orthotopic liver transplantation(OLT).Methods The retrospective study was conducted.The clinicopathological data of 340 pairs of donor and recipients undergoing OLT in The First Affiliated Hospital of Nanjing Medical University from January 2016 to January 2020 were collected.There were 262 males and 78 females of donors.There were 268 males and 72 females of recipients,aged(51±11)years.Of 340 recipients,217 cases without postoperative early AKI were divided into the non-AKI group and 123 cases with postoperative early AKI were divided into the AKI group.Measure-ment data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(IQR),and comparison between groups was conducted using the Mann-Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi‐square test.Comparison of ordinal data was conducted using the non-parameter test.Multivariate analysis was conducted using the binary Logistic regression model with forward method.The nomogram predictive model was constructed using the R software with its RMS package(R3.6.1).The efficacy of the predictive model was validated using the area under curve(AUC)of the receiver operating characteristic(ROC)curve,and internal validation of the predictive model was performed using the Bootstrap method.The Kaplan-Meier method was used to draw survival curves,and Log‐rank test was used for survival analysis.Results(1)Comparison of preoperative clinical characteristics between donors and recipients of the non‐AKI group and the AKI group.There was a significant difference in overweight of donors between the non‐AKI group and the AKI group(P<0.05).There were significant differences in preoperative hypertension,viral hepatitis,pathological types,international normalized r

关 键 词：原位肝移植 急性肾损伤 危险因素 列线图 预测 

分 类 号：R657.3[医药卫生—外科学] R692[医药卫生—临床医学]