钙防卫蛋白S100A9对儿童活体肝移植术后急性肺损伤的预测价值  

The predictive value of S100A9 for in acute lung injury after pediatric living living-donor liver transplantation

作　　者：曹颖莉 盛明薇[2] 任恒昌[2] 张晨[2] 高伟[3] 杜洪印[2] 喻文立[2] Cao Yingli;Sheng Mingwei;Ren Hengchang;Zhang Chen;Gao Wei;Du Hongyin;Yu Wenli(School of Medical,Nankai University,Tianjin 300071,China;Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China;Department Liver Transplantation,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]南开大学医学院,天津300071 [2]天津市第一中心医院麻醉科,天津300192 [3]天津市第一中心医院肝移植科,天津300192

出　　处：《中华器官移植杂志》2025年第2期150-155,共6页Chinese Journal of Organ Transplantation

基　　金：天津市自然科学基金面上项目(21JCYBJC00160);天津市卫生健康科技项目(TJWJ2021QN014)。

摘　　要：目的:探究胆道闭锁儿童活体肝移植术中钙防卫蛋白S100A9浓度升高对术后早期急性肺损伤(acute lung injury,ALI)的预测价值。方法:回顾性分析2019年1月至2021年1月在天津市第一中心医院因胆道闭锁行左外叶背驮式活体肝移植术的280例儿童受者资料,根据所有儿童受者术中新肝期30 min血清S100A9的中位浓度将其分为高S100A9组(≥9.05μg/L,141例)和低S100A9组(<9.05μg/L,139例),比较两组儿童受者的一般资料,采用单因素和多因素logistic回归分析S100A9与术后早期ALI发生的相关性,以接受者操作特征曲线(receiver-operating characteristic curve,ROC curve)的曲线下面积(area under the curve,AUC)评价危险因素的预测价值。结果:共纳入符合标准的280例儿童受者作为研究对象,其中高S100A9组ALI发生率为31.2%,低S100A9组发生率为10.8%。术前肌酐浓度升高(OR=1.191,95%CI=1.069~1.321,P=0.002)、术中S100A9浓度升高(OR=1.426,95%CI=1.272~1.599,P=0.021)和术中输血量增加(OR=0.985,95%CI=0.973~0.997,P=0.017)是儿童活体肝移植术后发生ALI的独立危险因素,S100A9浓度预测ALI的AUC=0.816(95%CI:0.758~0.874),灵敏度为80.5%,特异度为73.7%,最佳临界值为9.49μg/L。术前白蛋白浓度和肌酐浓度与术中S100A9升高具有相关性。结论:术中S100A9浓度升高、术前肌酐浓度升高和术中输血量增加是儿童活体肝移植术后早期ALI的独立危险因素,S100A9浓度升高对ALI发生有较好预测价值。Objective:To investigate the predictive value of elevated calprotectin S100A9(S100A9)concentration during living-donor liver transplantation(LDLT)for early acute lung injury(ALI)in children with biliary atresia.Method:A retrospective analysis was conducted on 280 pediatric patients with biliary atresia who underwent LDLT using hyperreduced left lateral segment grafts at Tianjin First Central Hospital between January 2019 and January 2021.Based on intraoperative serum S100A9 levels at 30 minutes after graft reperfusion,patients were divided into the high S100A9 group(≥9.05μg/L,141 cases)and the low S100A9 group(<9.05μg/L,139 cases).General clinical characteristics were compared between the two groups.Univariate and multivariate logistic regression analyses were performed to examine the correlation between S100A9 levels and early postoperative ALI.The predictive value of risk factors was assessed using receiver operating characteristic(ROC)curve analysis with calculation of the area under the curve(AUC).Result:A total of 280 eligible children were included in the study,with 141 in the high S100A9 group and 139 in the low S100A9 group.The incidence of ALI was significantly higher in the high S100A9 group(31.2%)compared to the low S100A9 group(10.8%).Multivariate regression analysis identified elevated preoperative creatinine levels(OR=1.191,95%CI:1.069~1.321,P=0.002),increased intraoperative S100A9 concentrations(OR=1.426,95%CI:1.272~1.599,P=0.021),and higher intraoperative blood transfusion volume(OR=0.985,95%CI:0.973~0.997,P=0.017)as independent risk factors for postoperative ALI in pediatric LDLT.The predictive value of intraoperative S100A9 levels for ALI was significant,with an AUC of 0.816(95%CI:0.758~0.874),a sensitivity of 80.5%,a specificity of 73.7%,and an optimal cutoff value of 9.49μg/L.Furthermore,preoperative albumin and creatinine levels were found to be correlated with increased intraoperative S100A9 levels.Conclusion:Elevated intraoperative S100A9 levels,increased preoperative creatinine levels

关 键 词：肝移植 儿童活体肝移植 钙防卫蛋白S100A9 急性肺损伤 危险因素 

分 类 号：R726.5[医药卫生—儿科]