他克莫司血药浓度及相关指标对肝移植患者术后发生早期感染的评估价值  

Prognostic value of tacrolimus blood concentration and other related indexes in early postoperative infection in liver transplantation patients

作　　者：张文 冯天同 袁慧 侯晓雪 朱传龙 Zhang Wen;Feng Tiantong;Yuan Hui;Hou Xiaoxue;Zhu Chuanong(Department of Infectious Diseases,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210003,China)

机构地区：[1]南京医科大学第一附属医院感染病科,南京210003

出　　处：《中华传染病杂志》2024年第6期349-355,共7页Chinese Journal of Infectious Diseases

基　　金：江苏省科教能力提升工程(JSDW202207)。

摘　　要：目的探究他克莫司血药浓度及其他相关指标对肝移植患者术后早期发生感染的评估价值。方法筛选2014年1月至2019年12月于南京医科大学第一附属医院行肝移植手术且病历资料完整的患者。采用队列研究,收集患者人口学资料、实验室检查结果、他克莫司血药浓度等数据。将所有术后发生感染的患者分为术后2~4周、5~12周、13~52周及>52周组,并根据年龄±3岁对各组进行1∶1配对未感染患者。采用独立样本t检验和秩和检验比较术后感染与未感染组的临床指标。采用logistic回归分析探究肝移植术后早期(即术后2~4周)发生感染的影响因素。采取受试者操作特征曲线分析评估术后早期他克莫司浓度的相对安全值。结果共纳入肝移植术后感染患者150例,其中术后2~4周组65例,术后5~12周组31例,术后13~52周组27例,术后>52周组27例,4组匹配的未感染患者分别为52、30、32、39例。303例肝移植患者中男247例(81.52%),年龄范围为10~78岁;乙型肝炎肝硬化和肝细胞癌是主要原发疾病,分别占41.91%(127/303)和47.52%(144/303)。术后2~4周发生感染患者的他克莫司血药浓度为(11.46±4.94)μg/L,丙氨酸转氨酶为118.20(38.80,215.80)U/L,分别高于未感染组的(7.12±2.33)μg/L和39.40(23.40,142.70)U/L,差异均有统计学意义(t=6.26、Z=2.66,均P<0.05)。痰液来源的检出样本最多,占61.6%(98/159)。共分离出174株病原体,其中革兰阴性菌[55.2%(96/174)]居多,以肺炎克雷伯菌[20.1%(35/174)]和鲍曼不动杆菌[13.8%(24/174)]为主。多因素分析表明,他克莫司血药浓度[比值比(OR)=1.634,95%可信区间(CI)1.298~2.058,P=0.001]是肝移植患者术后2~4周发生感染的危险因素,而淋巴细胞计数(OR=0.165,95%CI 0.057~0.474,P=0.010)是其保护因素。他克莫司血药浓度判断患者术后2~4周发生感染的曲线下面积为0.817,临界值为8.7μg/L(P<0.05),灵敏度为0.708,特异度为0.846。结论肝移植患者主要感�Objective To explore the value of tacrolimus blood concentration and other related indexes in evaluating early postoperative infection in patients with liver transplantation.Methods Patients with complete medical records who underwent liver transplantation in the First Affiliated Hospital of Nanjing Medical University from January 2014 to December 2019 were screened.Cohort study was used,and demographic data,laboratory test results,tacrolimus blood concentration and other data of patients with liver transplantation were collected.All patients with postoperative infection were divided into four groups,inculding two to four weeks,five to 12 weeks,13 to 52 weeks and>52 weeks groups,and uninfected patients in each group were matched 1∶1 according to age±3 years old.Independent sample t test and rank sum test were used to analyze the differences in clinical data between postoperative infected and uninfected patients with liver transplantation patients.Logistic regression analysis was used to explore the influencing factors of infection in the early postoperative period(two to four weeks after operation).The relative safe value of tacrolimus blood concentration in the early postoperative period was evaluated by receiver operating characteristic curve.Results A total of 150 patients with infection after liver transplantation were included,including 65 patients in the two to four weeks group,31 patients in the five to 12 weeks group,27 patients in the 13 to 52 weeks group,and 27 patients in the>52 weeks group.There were 52,30,32,and 39 uninfected patients in the four groups,respectively.There were 247 males(81.52%)in 303 patients with liver transplantation,and the age ranged from 10 to 78 years old.Hepatitis B cirrhosis and hepatocellular carcinoma were the main primary diseases,accounting for 41.91%(127/303)and 47.52%(144/303),respectively.The tacrolimus blood concentration and alanine aminotransferase in patients with infection in the two to four weeks group were(11.46±4.94)μg/L and 118.20(38.80,215.80)U/L,respect

关 键 词：肝移植 移植后感染 他克莫司 

分 类 号：R51[医药卫生—内科学] R617[医药卫生—临床医学]