人工肝支持系统对高危患者肝移植术后生存率的影响

目的 观察重型肝炎肝移植术前进行人工肝支持系统(ALSS)治疗对术后生存率的影响.方法 将符合重型肝炎诊断标准且术前终末期肝病模型(MELD)评分＞35分的患者根据移植术前是否行ALSS治疗分成试验组(23例)和对照组(41例).两组患者分别在进入肝移植等待名单时和术前1 d进行全身情况评估,术后定期随访,使用Kaplan-Meier进行生存情况分析,用Log-Rank检验比较两组患者生存率的曲线.结果 两组患者在进入肝移植等待名单时凝血酶原时间、纤维蛋白原、总胆红素、血氨、肌酐、MELD评分比较差异均无统计学意义(均P＞0.05);ALSS治疗后试验组各项指标较对照组均明显改善(均P＜0.01).试验组术前1 d MELD评分较进入等待名单时分值显著下降(37.6±2.0)分比(41.4±2.2)分,P＜0.01],术前1 d与进入移植等待名单时MELD评分差值(AMELD)为-3.8分;对照组进入等待名单时与术前1 d的MELD评分E(40.6±1.7)分和(41.0±1.6)分]差异无统计学意义(P＞0.05),AMELD为+0.4分.试验组术中出血量和手术时间均显著低于对照组(4 070.0±688.1)ml比(4 905.9±1 142.1)ml,(9.4±1.1)h比(10.5±1.0)h,P＜0.05和P＜0.01].试验组30 d和1年生存率分别为91%和82%,对照组为76%和59%,Log-Rank检验示两组生存率差异有统计学意义(P=0.044).结论 ALSS通过改善患者术前全身情况,减少术中失血量,有利于移植肝功能及时恢复,可提高重型肝炎肝移植患者的早期生存率.

Effect of artificial liver support system on the survival rate of high risk patients after liver transplantation

Objective To observe the effect of artificial liver support system (ALSS) after liver transplantation on the survival rate of severe hepatitis patients.Methods Patients with severe hepatitis with model for end stage liver disease (MELD) score above 35 were divided into two groups according to whether pre-transplantation ALSS was instituted (n=23) or not (n=41).Evaluation was performed on the day when the patient entered into the waiting list and 1 day pre-transplantation.Survival rates and survival curves were estimated with Kaplan-Meier method.Log-Rank test for trends was used when comparing curves.Results There was no significant difference between two groups when comparing the parameters including prothrombin time,fibrinogen,total bilirubin,blood ammonia,creatinine,MELD score on the day of entering into the waiting list (all P＞0.05).After the therapy of ALSS,the parameters of ALSS group were significantly improved comparing to those of the control group (all P＜0.01).MELD score of ALSS group on the day pre-transplant was decreased significantly comparing to that on the day entering into the waiting list (37.6±2.0 vs.41.4±2.2,P＜0.01),with the difference in MELD score (AMELD) of-3.8.MELD score of control group on the day entering into the waiting list and 1 day pre-transplant was 40.6±1.7 and 41.0±1.6 respeetively,with AMELD of +0.4 (P＞0.05).The blood loss and operation time in ALSS group was significantly less than the control group(4 070.0±688.1) ml vs.(4 905.9±1142.1) ml,(9.4±1.1) hours vs.(10.5±1.0) hours,P＜0.05 and P＜0.01).Thirty days and 1 year survival rate of ALSS group was 91% and 82%,and that of control group was 76% and 59% respectively (P=0.044).Conclusion ALSS can improve the survival rate of patients with severe hepatitis undergoing liver transplantation through ameliorating physiological status,lessening blood loss during operation and operation time.