急诊肝移植治疗良性终末期肝病的临床分析

目的探讨急诊肝移植救治良性终末期肝病患者的疗效及其预后影响因素,为制定急诊肝移植标准和预后评价体系提供理论基础。方法回顾性分析自2000年1月至2004年12月浙江大学医学院附属第一医院46例急诊肝移植患者的临床资料,比较存活组(32例)与死亡组(14例)患者的术前各临床与生化指标的差异,探讨Child-Turcotte-Pugh(CTP)评分和终末期肝病模型(MELD)评分对预后的预测价值。结果全组平均随访时间为529d±460d,存活组平均中位生存时间为575.5(257~1766)d,死亡组平均生存时间为30.5(5~267)d;全组术后3、6个月和1年生存率分别为73.9%、71.7%和69.6%;原发病为乙肝重型肝炎死亡比例达31.0%,显著高于乙肝肝硬化的0%(P<0.05);存活组和死亡组血清肌酐水平(96.6μmol/L±50.6μmol/L vs190.4μmol/L±138.7μmol/L)、MELD积分(35.5±9.0vs42.3±8.6)和CTP评分(10.5±1.4vs11.9±1.9)差异均有统计学意义;CTP和MELD评分各级别间生存率差异有统计学意义(P<0.05)。结论急诊肝移植能有效救治危重肝病患者;术前高血清肌酐水平与移植后预后不良密切相关;MELD评分较之CTP评分能更好地评估急诊肝移植患者的预后。

Clinical evaluation of emergency liver transplantation for patients with benign end-stage liver diseases

Objective To evaluate the efficacy of emergency liver transplantation in treating patients with benign end-stage liver diseases and explore the possible prognostic factors. Method The clinic data of 46 cases of recipients who underwent ELT were retrospectively analyzed. The clinicopathological variables (including age, gender, etiology, serum creatinine, PT, INR, albumin, total bilirubin) were compared between the survival group (n=32) and the dead group (n=14). And the prognostic values of CTP and MELD score were analyzed. Results Higher serum creatinine level, MELD score and CTP score were found in the dead group, as compared to those in survival group. The survival rates among CTP or MELD categories showed significant difference. Three-and six months and one year survival rates of total recipients were 73.9%, 71.7% and 69.6% respectively. Conclusion Emergency liver transplantation is an effective treatment to salvage patients in end-stage. Serum creatinine is the important prognostic factor to the posttransplant survival. MELD score system is more sensitive than CTP classification in predicting the prognosis.