原位肝移植患者术后发生早期移植物功能不全的危险因素及其列线图模型构建  

Risk factors of early allograft dysfunction after orthotopic liver transplantation and establishment of its nomogram model

作　　者：杨杰杰 肖晶晶 吕超 刘徐洋 杜君 谷化剑 YANG Jiejie;XIAO Jingjing;LYU Chao;LIU Xuyang;DU Jun;GU Huajian(Department of Hepatobiliary Surgery,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Pediatric Surgery,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附属医院肝胆外科,贵州贵阳550004 [2]贵州医科大学附属医院小儿外科,贵州贵阳550004 [3]贵州医科大学

出　　处：《贵州医科大学学报》2024年第10期1506-1513,共8页Journal of Guizhou Medical University

基　　金：贵州省科技计划项目(黔科合基础-ZK〔2023〕一般368)。

摘　　要：目的探讨原位肝移植(OLT)患者术后发生早期移植物功能不全(EAD)的危险因素并建立相关的列线图模型。方法选取行肝移植患者受体106例,根据术后是否发生EAD分为EAD组(n=42)和非EAD组(n=64),收集两组受体术前一般临床资料[年龄、性别、终末期肝病模型(MELD)评分、美国麻醉医师协会(ASA)分级、Child-Pugh评分、肝恶性肿瘤病史、白细胞(WBC)、中性粒细胞百分比、淋巴细胞百分比、中性粒细胞与淋巴细胞比值(NLR)、谷草转氨酶(AST)、谷丙转氨酶(ALT)及总胆红素(TBIL)]及供体术前一般临床资料[年龄、性别、体质量指数(BMI)、死亡原因、是否行心肺复苏术、是否使用体外膜肺氧合(ECMO)、供受体血型是否相合、是否合并病毒性肝炎、冷缺血时间(CIT)、热缺血时间(WIT)、供肝获取时间、重症监护室(ICU)住院时间、捐献前最近1次的白蛋白(ALB)、AST、ALT、钠离子浓度及凝血酶原时间(PT)],同时收集受体术中相关变量(有无脾切除、手术时长、术中失血量、血小板输注量、红细胞输注量、血浆输注量及无肝期时间),采用单因素和多因素logistic回归分析受体发生EAD的危险因素;通过计算机产生随机数方法将受体以3∶1分为训练集(n=79)及验证集(n=27),基于训练集数据建立相关列线图模型,并用验证集进行模型内部验证。结果EAD组受体的MELD评分、术中红细胞输注量及供体BMI、ALT、CIT水平高于非EAD组,差异有统计学意义(P<0.05);多因素logistic回归分析显示,受体MELD评分及供体BMI、ALT、CIT是术后EAD的独立危险因素(P<0.05);在预测OLT术后发生EAD风险的训练集(n=79)中,列线图受试者工作特征(ROC)的曲线下面积(AUC)=0.906、95%CI为0.849~0.963;验证集(n=27)对EAD预测有相似的预测价值(AUC=0.91,95%CI为0.847~0.974),校准曲线对EAD预测发生率和实际发生率具有较好的一致性,决策曲线分析(DCA)显示其具有良好的临床净获�Objective To investigate the risk factors of early allograft dysfunction(EAD)after orthotopic liver transplantation(OLT)and establish a related nomogram model.Methods A total of 106 patients who received OLT were selected and divided into EAD group(n=42)an non-EAD group(n=64)according to whether they had EAD after operation.Preoperative general clinical data were collected,including age,gender,model for end-stage liver disease(MELD)score,American Society of Anesthesiologists(ASA)grade,Child-Pugh score,history of liver malignancy,white blood cell(WBC),neutrophil percentage,lymphocyte percentage,neutrophil to lymphocyte ratio(NLR),aspartate aminotransferase(AST),alanine aminotransferase(ALT),bilirubin(TBIL),general clinical data of the donors before surgery[age,gender,body mass index(BMI),cause of death,whether the donors were given with cardiopulmonary resuscitation,whether the donors were given with extracorporeal membrane oxygenation(ECMO),whether blood types of the donors and the recipients were compatible,whether it was accompanied by viral hepatitis,cold ischemia time(CIT),warm ischemia time(WIT),donor liver acquisition time,length of stay in intensive care unit(ICU),the most recent albumin(ALB)before donation,AST,ALT,sodium ion concentration,prothrombin time(PT),and liverless period duration].At the same time,the relevant variables of the recipients were collected during the operation(whether the recipients had splenectomy,operation duration,intraoperative blood loss,platelet transfusion volume,red blood cell transfusion volume,plasma transfusion volume and liverless period duration).Univariate and multivariate logistic regressions were performed to analyze the risk factors of EAD for the recipients.The recipients were divided into a training dataset(n=79)and a validation dataset(n=27)in a ratio of 3∶1 using a computer-generated random number method.A relevant nomogram was established based on the training dataset data,and the nomogram was verified using the validation set.Results Recipients'MELD scores an

关 键 词：肝移植 危险因素 列线图 原位肝移植 早期移植物功能不全 冷缺血时间 供体 受体 

分 类 号：R657.3[医药卫生—外科学]