肝移植术后早期急性肾衰竭的危险因素分析

目的探讨肝移植术后早期急性肾衰竭(acuterenalfailure,ARF)的危险因素。方法以临床资料完整的362例肝移植患者为研究对象,按术后早期(术后1个月内)有否发生ARF分为ARF组(71例)和非ARF组(291例)。对两组的36项围手术期可能危险因素进行单因素分析,并对单因素分析中P<0.05的变量进行Logistic逐步回归分析。结果经单因素分析,术前肝性脑病、术前血清肌酐(Scr)水平、术前血红蛋白水平、术前凝血酶原活动度、术前总胆红素水平、终末期肝病模型(modelforend-stageliverdisease,MELD)评分、总手术时间、术中失血量、术中输血量、术中尿量、术中低血压及术后合并感染等因素,两组间比较差异有统计学意义(P<0.05～0.001)。对上述12项指标进行Logistic逐步回归分析,结果显示术前Scr水平增高[比数比(oddsra-tio,OR)=0.92]、术前凝血酶原活动度低(OR=1.015)、MELD评分高(OR=1.588)、术中出血量多(OR=1.012)、术后合并感染(OR=12.260)与肝移植术后发生ARF密切相关(均为P<0.05)。结论术前Scr水平增高、凝血酶原活动度低、MELD评分高,术中失血量多和术后合并感染是肝移植术后早期ARF的独立危险因素。

Analysis of risk factors for acute renal failure in the early stage after liver transplantation

Objective To investigate the risk factors for acute renal failure(ARF)in the early stage after liver transplantation.Methods The 362 patients who underwent liver transplantation with full clinical data were selected as research object.They were divided into ARF group(n=71)and non-ARF group(n=291)according to whether occurrence of ARF in the early stage(within 1 month)after transplantation.One-way analysis was used in 36 possible perioperative risk factors.Logistic stepwise regression analysis was used in variables with P<0.05 in one-way analysis.Results According to the result of one-way analysis,12 variables,including hepatic encephalopathy pre-transplantation,serum creatinine(Scr)pre-transplantation,hemoglobin pre-transplantation,thrombinogen activity pre-transplantation,total bilirubin pre-transplantation,scores of model for end-stage liver disease(MELD),total operation time,intraoperative blood loss,intraoperative blood transfusion,intraoperative urine output,intraoperative low blood pressure and postoperative infection,had significant difference between two groups(P<0.05-0.001).Logistic stepwise regression analysis for 12 variables demonstrated that the increase of Scr pre-transplantation[odds ratio(OR)=0.92],the decrease of thrombinogen activity pre-transplantation(OR=1.015),high MELD scores(OR=1.588),the large volume of intraoperative blood loss(OR=1.012)and infection post-transplantation(OR=12.260)had close relationship with ARF after liver transplantation(all in P< 0.05).Conclusions The increase of Scr pre-transplantation,the decrease of thrombinogen activity pre-transplantation,high MELD scores,the large vo-lume of intraoperative blood loss and infection post-transplantation are the independent risk factors of ARF in the early stage after liver transplantation.