肝移植术后神经精神并发症的临床分析

目的探讨肝移植术后神经系统并发症的种类、发病率及其相关因素.方法回顾性分析133例原位肝移植患者的临床资料.结果 133例肝移植受者发生神经系统并发症51例,发生率为38.3%;神经系统并发症种类包括脑病、癫痫、脑出血、脑梗死.出现神经系统并发症的患者中有48例痊愈,3例死亡,与神经系统相关病亡率为5.9%.结论神经系统病变是肝移植术后常见并具有潜在危险的并发症,产生的原因是多因素的,免疫抑制剂的神经毒性只是一个促进因素.脑出血的发生多提示预后不良,针对病因的综合治疗和免疫抑制剂的及时调整有利于改善预后.     

体外膜肺氧合相关中枢神经系统并发症及防治策略

体外膜肺氧合(extra corporeal membrane oxygenation, ECMO)是危重患者生命支持的重要救治技术,同时也伴随有许多并发症,其中ECMO相关中枢神经系统并发症是导致患者严重不良转归的重要危险因素之一。目前ECMO相关中枢神经系统并发症的真实患病率尚不清楚,据报道其发生率约13%～27%,主要表现为以下五种类型:缺血性卒中、脑出血、癫痫、全脑缺血-缺血缺氧性脑病、脑死亡。ECMO合并中枢神经系统并发症包含多种危险因素,治疗主要依靠内科手段。近些年的研究热点集中在脑电监测(electroencephalography, EEG)等无创监测方面。合并中枢神经系统并发症患者的病死率较未发生者明显升高。通过神经功能监测,可早期发现神经功能损伤进而早期干预并可能改善患者预后。     

肝移植术后主要神经系统并发症的发生和治疗

目的 观察肝移植术后主要神经系统并发症的类型及临床表现,并探讨其病因、易发因素及防治策略.方法 回顾性分析2003年10月至2005年9月完成的467例肝移植患者的临床资料,对肝移植术后出现神经系统并发症的病例进行统计分析并结合文献进行讨论.结果 共有91例(19.49%)患者发生神经系统并发症,其中弥漫性脑病72例,脑血管意外12例,癫痫发作4例,脑桥中央髓鞘溶解症3例,中枢神经系统感染2例.高龄、术前高胆红素血症、高渗透压、低血小板、肺部严重感染与弥漫性脑病密切相关.5例脑病患者施行了持续的肾脏替代治疗,8例脑出血患者中5例施行了开颅血肿清除术.出现神经系统并发症的患者中有79例痊愈,12例死亡,与神经系统相关死亡率为10.98%.结论 神经系统病变是肝移植术后常见并具有潜在危险的并发症,产生的原因是多因素的,免疫抑制剂的神经毒性只是一个促进因素.脑出血的发生多提示预后不良,针对病因的综合治疗和免疫抑制剂的及时调整有利于改善预后.     

探讨脂肪肝供肝在肝脏移植中的价值

目的探讨应用不同脂肪沉着程度供肝对肝移植患者预后的影响。方法选取64例进行肝移植术患者,依据供肝浸润程度,随机分为轻度脂肪肝组、中度脂肪肝组、重度脂肪肝组、无脂肪肝组共四组,每组各16例,比较四组患者肝功能(主要观察ALT、AST指标)、入住ICU的平均时间、1年移植物成活率、移植物原发无功发生率。结果轻度脂肪肝组入住ICU的平均时间、ALT和AST水平、移植物原发无功发生率与无脂肪肝组接近;中度脂肪肝组入住ICU平均时间、ALT和AST水平均较轻度组和无脂肪肝组明显增高,P0.05;重度脂肪肝组入住ICU平均时间、ALT和AST水平、移植物原发无功发生率明显较前三组为高,P0.05。结论轻、中度肝脏脂肪浸入可作为肝移植供肝,重度脂肪肝不能作为供肝的选择目标。     

An uncommon cause of acutely altered mental status in a renal transplant recipient

Introduction. Neurological complications are quite frequent in patients after solid organ transplantation presenting with focal or generalized neurologic symptoms as well as altered mental status. Posterior reversible encephalopathy syndrome is a rare cliniconeuroradiological entity characterized by headache, altered mental status, cortical blindness, seizures, and other focal neurological signs and a diagnostic magnetic resonance imaging.

Case report. We present a case of a 57-year-old woman with one episode of seizures and sudden onset of altered mental status (time and person perception) accompanied with headache at the thirtieth postoperative day after renal transplantation.

Conclusion. Posterior reversible encephalopathy syndrome, although an uncommon post-renal transplantation complication, should be considered in these patients, as several factors surrounding the setting of transplantation have been implicated in its development. Thus, physicians should be aware of this condition in order to establish the diagnosis and offer appropriate treatment.     

肝脏移植患者术后血糖变异性与ICU内谵妄的相关性研究

  目的  研究肝脏移植患者术后血糖变异性与在重症监护室（ICU）发生谵妄的相关性。  方法  回顾性纳入2016年8月?2018年12月期间肝脏移植术后入住ICU的患者,根据是否发生ICU内谵妄将患者分为两组,采集患者指尖血,采用多因素logistic回归进行组间血糖变异性〔以血糖不稳定指数(GLI)作为血糖变异性的参数〕的比较,并运用Cochran-Armitage趋势检验分析血糖变异水平和谵妄发生率之间的线性关系。  结果  研究共纳入242例患者,其中ICU内谵妄发生率为14.9%（36/242）。多因素logistic回归分析发现血糖变异性是肝移植患者术后ICU内谵妄的独立危险因素（P=0.045),结果提示谵妄在血糖变异性较高的患者中更为常见（GLI第四分位组 vs. 第一分位组,比值比5.283, 95%可信区间:1.092～25.550, P=0.038）,Cochran-Armitage趋势检验分析发现血糖变异性水平和ICU谵妄率之间存在线性关系,随着血糖变异性水平增加,患者ICU内谵妄发生风险显著增加（P<0.001）。  结论  血糖变异性增加是肝移植术后患者ICU内谵妄的独立危险因素。     

分子吸附循环系统(MARS人工肝)在肝移植围手术期应用的临床研究

目的 总结肝移植围手术期应用分子吸附循环系统(MARS人工肝)的经验。方法 回顾分析19例48次MARS人工肝治疗的疗效。结果 单次6h(或多次)MARS人工肝治疗能显著降低血清总胆红素、间接胆红素、血氨、尿素氮、肌苷、尿酸等水平，其中15例病人成功过渡到肝移植，1例晚期肝硬化病人经人工肝治疗后肝性脑病症状得到缓解，因各种原因不愿再行肝移植，出院后2周死亡，另1例患者因上消化道大出血未能等到肝移植而死亡。2例肝移植术后患者，治疗后好转出院。治疗成功率为88．9％。结论 MARS人工肝分子吸附循环系统是治疗肝功能衰竭安全而有效的辅助方法，为过渡到肝移植创造了机会。     

索拉非尼治疗肝移植后肝细胞癌复发的单中心回顾性分析

目的:通过收集分析单中心索拉非尼治疗肝移植后肝细胞癌复发人群数据,探讨索拉非尼在肝细胞癌肝移植患者中的应用。方法:收集2011—2016年在天津市第一中心医院肝移植术后肝细胞癌复发使用索拉非尼和最佳支持治疗（BSC）的患者资料41例。索拉非尼组27例,BSC组14例。比较两组的生存时间差异,并探讨索拉非尼的安全性。结果:索拉非尼组复发后生存时间为4～48个月,中位生存时间11个月;BSC组生存时间1～24个月,中位生存时间4个月,两组中位生存时间差异具有统计学意义（P＜0.01）。27例服药患者资料中,不良事件发生率不高,3级以上1例,该患者严重腹泻,予停药。结论:服用索拉非尼整体生存率较BSC高,部分患者用药后可出现轻微不良事件。索拉非尼可以较好改善肝移植后肝细胞癌复发患者预后。     

肝移植术后严重中枢神经系统并发症的病因探讨

目的 探讨肝移植术后早期严重中枢神经系统并发症的种类、发病原因及防治措施.方法 回顾性分析2001年7月至2006年7月实施的347例肝移植患者临床资料,比较分析肝移植后早期无神经系统并发症和有严重中枢神经系统并发症两组与原发疾病、血钠、血镁、血浆渗透压、凝血功能等的关系.结果 347例肝脏移植患者中71例(20.46%)出现与移植相关的精神神经系统并发症,其中6例(1.73%)出现严重中枢神经系统并发症,包括脑水肿、脑出血、脑桥中央髓鞘溶解症(central pontine myelinolysis,CPM),其中5例死亡.肝硬化失代偿、脾亢的患者术后严重中枢神经系统并发症发病率高.与无神经系统并发症组比较,脑出血患者术前均有脾亢、凝血功能不良明显;CPM和脑水肿患者移植前均存在严重的顽固性、慢性低钠血症,移植术前后48 h内血钠及血浆渗透压变化明显.结论 肝移植受体术后严重中枢神经系统并发症的发生与原发疾病有关,并可能与术前慢性低钠血症、围手术期血钠和血浆渗透压大幅波动、凝血功能未及时纠正有关.     

Acute and subacute fulminant hepatic failure: the role of liver transplantation

OBJECTIVES: To report the experience of the Australian National Liver Transplant Unit with patients with fulminant hepatic failure and to describe the role of liver transplantation. PATIENTS: Twenty-seven patients presented with acute or subacute fulminant hepatic failure during the period from January, 1986, to March, 1990. Twenty-two had acute and five had subacute fulminant hepatic failure. The causes were hepatitis B in 10 patients, presumed non-A, non-B (NANB) hepatitis in eight patients, drug-induced hepatic damage in five patients, and Wilson's disease in four patients. There were 13 males and 14 females. Ages were 2-43 years (mean, 23). Twenty patients (74%) were in grade IV encephalopathy on presentation. RESULTS: Six patients (22%) began to improve soon after admission and went on to full recovery. Spontaneous recovery was more frequent in patients with drug-induced hepatic damage (four patients [80%]) and was less frequent in those with hepatitis B (one patient [10%]) and NANB hepatitis (one patient [12%]). The other 21 patients (78%) were considered for orthotopic liver transplantation. Eight (30%) were judged to be unsuitable and went on to early death. Thirteen (48%) were suitable for transplantation. Of these five (19%) died before a liver donor became available and eight (30%) received liver grafts and went on to full recovery. Overall, 14 patients (52%) survived and 13 (48%) died. Patients with Wilson's disease (four [100%]) were most suitable for orthotopic liver transplantation whereas eight (44%) of those with hepatitis B or NANB hepatitis were unsuitable. Of the eight patients receiving liver grafts one had hepatitis B, three had NANB hepatitis and four had Wilson's disease. Five were in grade IV encephalopathy at the time of operation. The mean waiting time for transplantation was 6.4 days. Five patients received ABO blood group compatible grafts and three received ABO incompatible grafts. Of the latter group, two subsequently required secondary orthotopic liver transplantation with ABO compatible grafts. All eight patients who received transplants are alive and well 3-24 months after the operation. No patient has any neurological sequelae. CONCLUSIONS: Orthotopic liver transplantation is a preferred option for patients with fulminant hepatic failure whose condition is not responding to conservative management. ABO incompatible livers transplanted in emergency circumstances may prove life-saving either by functioning successfully or by providing time during which ABO compatible grafts become available.(ABSTRACT TRUNCATED AT 400 WORDS)     

110例肝硬化病人转归分析

目的：为了了解肝硬化转归的相关因素，我们将五年来在我院住院诊治的110名肝硬化患者的情况进行回顾性的分析总结。方法：回顾性肝硬化病人的初诊年龄；复诊次数；肝硬化病因；肝功能损害的程度(child分级)；并发症发生的情况；以及病人死亡的情况及原因，将数据进行统计学处理并进行分析。结果：1．110例患者平均年龄58．8岁。男女性两组的年龄差别无显著性(P＞0．05)。2．肝硬化的主要病因为病毒性肝炎。3．第一次就诊时肝功能损害程度：①Child C级58.0％；②Child B级，38．2％；③Child A级3．6％。其中出院者中，BiL异常41．3％；死亡者中，BiL异常76．7％，两者差异较显著(P＜0．01)。4．病人转归情况：110例患者中，1次或多次住院后好转出院的患者为69．1％(76/110)；1次或多次住院后，死亡的患者为27．3％(30/110)。5．并发症及其转归：①消化道出血37．3％(37／110人)；②感染30．9%（30/110人)，其中颅内感染5例；③肝性脑病18．3％(30／110人)；④原发性肝癌15．5％(17／110)；⑤肝肾综合征12．7％(14／110)；⑥其它合并症11．8％(13／110)。其中好转出院的病人中有并发症的占51．3％(41／80；死亡患者中存在有并发症的占93.3％(38／30）。两者比较有显著的差异(P＜0．01)。6．死亡原因：1)肝性脑病40％(12／视)；2)消化道出血26．7％(8/30)；3)肝肾综合征10％(3／30)；4)其他23．3％(7／30）。7．存活时间：死亡者平均存活时间为4．7年；好转出院者乎均存活时间8．3年。结论：与肝硬化的转归相关因素有：①首诊的肝功能损害程度，特别是血清胆红素的水平有关，肝功能损害重，胆红素水平高，预后差。②有严重并发症存在预后差。存活时间明显缩短。②对慢性肝病患者在早期进行干预和健废教育指导，对延长患者生命，提高生活质量应该是十分有意义的。     

肺癌的神经系统表现

本文报告822例肺癌有神经系统表现者105例(19.5％)。以神经系统表现为首发症状者64例(61％),依次为头痛、偏瘫、癫痫,截瘫、精神症状,腰背痛、眩晕、坐骨神经痛、面瘫等。105例中属转移性损害93例,转移部位包括大脑、脊髓、脑膜、小脑等。非转移性损害12例,其中有癌性脑病、肌病、皮肌炎等     

对肝、肺移植术后患者在ICU的监测治疗

目的:观察肝移植及肺移植术后患者在ICU的监测治疗,总结其成功的经验.方法:分析4例肝移植及1例肺移植术后患者在ICU期间的情况,观察如下指标:拔管时间、血流动力学参数、利尿剂用量、尿量及在ICU滞留的时间.结果:4例肝移植患者平均拔管时间为23h,1例肺移植患者为60h,前者的血流动力学参数明显高于后者,其利尿剂用量和尿量也高于后者.4例肝移植患者在ICU的平均滞留时间为60h,1例肺移植患者为110h.结论:尽早拔管,维持较高的血流动力学参数,加强利尿剂的用量,保证充足的尿量,并尽早转出ICU,可能是使肝移植术后患者在ICU监测治疗成功的关键措施.反之,适当延长拔管时间,防止肺水肿,适时转出ICU,则可能是肺移植患者顺利渡过ICU的原因.     

Reduced-size orthotopic liver transplantation with different grade steatotic grafts in rats

Objective To explore the survival time, pathological change and liver regeneration in different kinds of reduced-size liver transplantation in rats using steatotic grafts. Methods Macrovesicular and microvesicular steatotic rat liver models were established by feeding rats with a diet consisting of 79% standard chow, 20% lard and 1% cholesterol for different time periods. With modified two cuff vascular anastomoses and end-to-end sutures on the bile duct, reduced-size orthotopic rat liver transplantations were performed in an attempt to explore the ratio of graft weight to recipient body weight, recipient original liver weight and histological and electron-microscopic findings in comparison with whole rat liver transplantations. Results A one-week survival rates for the rats undergoing whole liver transplantation, and those in the 70% reduced-size orthotopic liver transplantation (ROLT) group, the 60%ROLT group and the 50%ROLT group (grade Ⅰ macrosteatotic grafts) were 91.67%, 75%, 75% and 25%. A 2-week survival rate was 83.33%, 75%, 58.33% and 0 respectively. And their graft recipient body weight (GRBW) values SD were 3.56%±0.36%, 2.53%±0.15%, 2.28%±0.12% and 1.83%±0.16%, respectively. In grade Ⅱ macrosteatotic grafts, the one-week survival rate for those undergoiong whole liver transplantation and those in the 70% ROLT group was 83.33% and 25%. In the microsteatosis grafts for whole liver transplantation, 70% ROLT, 60% ROLT and 50% ROLT, the one-week survival rate was 83.33%, 75%, 75% and 33.33%; and the 2-week survival rate was 75%, 66.67%, 66.67% and 0, respectively. The survival rate of the 50% ROLT group using grade Ⅰ macrosteatotic grafts or grafts mainly with microsteatosis was significantly different from that of other groups. While using macrosteatotic grafts in grade Ⅱ, the 1-week survival rate of the 70% ROLT group was very poor. Pathological findings after operation included liver regeneration and portal space with mild lymphocyte infiltration. Improvement in steatosis and dilation of the central vein and sinusoids was observed in some rats.Conclusions In the successful and long-term survival of rat reduced-size liver transplantation using grade Ⅰmacrosteatotic grafts or grafts with microsteatosis, the GRBW values should be over 2.28%±0.12%, and the value of graft-recipient liver weight should be over 60%. Steatotic livers in grade Ⅱ should not be used as grafts in ROLT. Steatosis was improved and even totally cured in some long-term survival rats.     

终末期肝硬化患者低氧血症相关因素分析

目的:分析终末期肝硬化患者肝移植术前严重低氧血症及肝肺综合征(hepatopulmonary syndrome,HPS)发生情况,筛选相关危险因素,为临床围手术期麻醉管理提供依据。方法:回顾性分析2001年5月至2005年9月间长征医院行肝移植术治疗的214例终末期肝硬化患者的临床资料,分析其肝移植术前的氧合情况;以肺泡-动脉氧分压差(AaPO2)>20 mmHg(1 mmHg=0.133 kPa)、PaO2<70 mmHg为标准,筛选严重低氧血症及HPS的相关危险因素;分析术前PaO2与术后机械通气时间、ICU停留时间的相关性。结果:214例肝硬化患者术前常伴随低氧血症。PaO2与Child分级、胸水有无、总胆红素、血氨、乳酸相关(相关系数r=-0.22、-0.16、-0.17、0.20、-0.29);PaCO2与术前Hb、白蛋白水平直接相关(r=0.23、0.13)。AaPO2与肝掌、蜘蛛痣、Child分级无显著相关性;PaO2与Child分级显著相关,但与肝掌、蜘蛛痣无显著相关性。PaO2与术后机械通气时间和移植术后ICU停留时间呈负相关(r=-0.388 81,P=0.000 1;r=-0.176 84,P=0.010 4)。结论:终末期肝硬化患者常伴随严重低氧血症;低氧血症的发生与术前肝功能分级及相关因素有关,对术后机械通气时间及ICU停留时间有较大影响;终末期肝硬化患者肝移植术前应全面评估严重低氧血症、HPS发生情况,以利于围手术期采取相应处理。     

尸体肾移植203例次报告

目的：探讨尸体肾移植的临床特点。方法：总结我院1992年12月－2001年4月197年例203例次尸体肾移植临床资料。结果：①本组1、3、5年人／肾存活率分别为94．2％、89．0％、87．6％／78．8％、75．0％／66．7％。②高危尿毒症患者118例,其中1、3、5年人／肾存活率分别为92．5％／87．7％、83．1％／76．1％、68．2％、54．5％,与普通尿毒症患者间的差异无统计学意义。③肾移植术后主要的严重并发症为肺部感染、心功能衰竭、肝功能严重损;是肾移植术后死亡的主要原因。④肾移植术后恶性肿瘤发生率为2．5％。结论：①尸体肾移植有较满意的人／肾存活率。②肾移植术后免疫抑制剂的合理应用,对术后并发症的预防和及时治疗是提高尸体肾移植人／肾存活率的重要因素。     

肝移植术后急性肾损伤的发生率及危险因素

目的 回顾性分析肝移植患者术后发生急性肾损伤（acute kidney injury,AKI）的临床特征及危险因素。方法 收集2013年6月1日至2016年10月31日入住首都医科大学附属北京友谊医院重症医学科的成年肝移植患者,除外肝肾联合移植、肾移植术后、二次肝移植、终末期肾病依赖透析患者、术前诊断AKI的患者。将所有入组的患者依据改善全球肾脏病预后组织（Kidney Disease：Improving Global Outcomes,KDIGO）标准分为急性肾损伤组和非急性肾损伤组。纳入分析的因素包括人口学特征,既往病史包括高血压、糖尿病病史,肝病分型,终末期肝病模型（model for end-stage liver disease,MELD）评分。术前化学检验指标：肌酐、白蛋白、总胆红素、丙氨酸氨基转移酶（alanine transaminase,ALT）、门冬氨酸氨基转移酶（aspartate transaminase,AST）。术中记录：手术时间、冷/热缺血时间、液体平衡。术后资料：重症监护病房（intensive care unit,ICU）住院天数,总住院天数和28 d病死率。用单因素方差分析找出两组间有差别的变量,再用Logistic回归分析筛选出发生急性肾损伤的危险因素,受试者工作特征（receiver operating characteristic,ROC）曲线建立预测模型。结果 在纳入的279例肝移植术后患者中,成年人（年龄 ≥ 18岁）124例,急性肾损伤68例,发生率为54.8%,在发生急性肾损伤患者中,根据KDIGO分期,Ⅰ期患者45例,所占比例为66.2%;Ⅱ期患者9例,所占比例为13.2%,Ⅲ期患者14例,所占比例为20.6%。Logistic回归模型分析显示成年人肝移植术后发生AKI的独立高危因素包括术中低血压时间比值比（odd ratio,OR）=1.020、术中失血量（OR=1.036）和术中液体正平衡（OR=1.015）,ROC曲线中其界值分别为27.5 min、32.5 mL/kg、31.2 mL/kg,曲线下面积分别为0.662（P=0.002,95% CI：0.567~0.757）、0.637（P=0.009,95%CI： 0.540~0.734）和0.624（P=0.017,95% CI：0.526~0.723）。结论 肝移植患者术后AKI发生率为54.8%,危险因素为术中低血压时间、术中失血量和术中液体正平衡,AKI组住院时间较非AKI组住院时间延长。     

Postoperative serious adverse events in a teaching hospital: a prospective study

OBJECTIVE: To assess the incidence and nature of postoperative serious adverse events (SAEs) among inpatients having surgery in a tertiary hospital, and to determine which subgroups of patients might be at greatest risk. DESIGN: Prospective observational study from 1 December 1998 - 31 March 1999. SETTING: Tertiary teaching hospital in Melbourne, Victoria. SUBJECTS: 1,125 subjects having inpatient surgery during the study period. MAIN OUTCOME MEASURES: Inhospital mortality, length of hospital stay, and SAEs (myocardial infarction, pulmonary embolism, acute pulmonary oedema, unscheduled tracheostomy, respiratory failure, cardiac arrest, stroke, severe sepsis, acute renal failure, and emergency admission to intensive care unit [ICU]). RESULTS: There were 414 SAEs in 190 of the 1,125 patients (16.9%); 80 patients died (7.1%). The most common adverse events were emergency admission to ICU (95), respiratory failure (52) and readmission to ICU (37). In patients without SAEs, mean duration of hospital stay was 18.4 days (95% Cl, 15.4-21.4), while in those with SAEs it was 38.5 days (95% CI, 35.3-41.7) (P < 0.0001). SAEs, including deaths, were more common after unscheduled surgery and in patients over 75 years of age. The combination of these two factors carried a 20% mortality. There were no differences in the incidence of SAEs among the major surgical specialties. CONCLUSIONS: SAEs are common and result in high mortality, especially in older surgical inpatients and those having unscheduled surgery. These findings raise important issues of optimal perioperative management in tertiary hospitals.     

瞬时弹性成像预测肝移植受者近期预后

目的：探索成人肝移植术后肝脏弹性值（LSM）与肝肾功能指标相关关系,研究其对受者术后近期预后的评估价值,为瞬时弹性成像技术在成人肝移植的应用提供依据。方法：收集浙江大学医学院附属第一医院2013年12月10日—2014年3月19日期间43例次肝移植受者临床资料及术后LSM,统计分析其相关关系;以LSM 16 kPa为界将受者分为LSM较高组和LSM较低组,比较两组间术后ICU时间、住院时间及严重并发症发生率。结果：① 受者术后第1天LSM与冷缺血时间无关联,但术后第7天LSM与冷缺血时间有统计学关联（r=0.335,P=0.028）。受者术后第1天LSM与术后ICU时间正相关（r=0.488,P=0.001）,但第7天LSM与ICU时间无关联。在纳入分析的12项肝肾功能指标中,谷草转氨酶、胆汁酸及肌酐均与术后第1天和第7天LSM呈正相关。② 术后第1天LSM较高组的ICU时间显著长于LSM较低组（7 d与9 d,P=0.013）,术后第1天LSM较高组住院时间显著长于LSM较低组（34 d与23 d,P=0.023）。术后第1天LSM较高组严重并发症发生率显著高于LSM较低组（78.57%与27.59%,P=0.002）。结论：肝脏瞬时弹性成像检测值与肝移植受者术后肝肾功能有一定关联,对肝移植受者近期预后可能有预测价值。     

Clinical Outcome of Autologous Hematopoietic Stem Cell Infusion via Hepatic Artery or Portal Vein in Patients with End-stage Liver Diseases

Objective To investigate the efficacy of hematopoietic stem cell （HSC） transplantation via the hepatic artery vs. the portal vein for end-stage liver disease （ESLD）. Methods Patients with hepatic decompensation were prospectively recruited from September 2010 to September 2012 to receive HSC transplantation via the hepatic artery or the portal vein. Liver function was examined at 3, 6, and 12 months after transplantation. Liver biopsy results were analyzed using the Knodell score. Results Eighty patients （58 males and 22 females） were enrolled in the study. The Child-Pugh score was grade B in 69 cases, and grade C in the remaining 11 cases. HSC transplantation was performed via the portal vein in 36 patients and via the hepatic artery in 44 patients. ALT levels decreased while serum albumin levels increased significantly in both groups at 6 and 12 months after HSC transplantation （P〈0.05 compared with pre-transplantation levels）. Total biliruhin levels decreased significandy in both groups at 3, 6, and 12 months after HSC transplantation （P〈0.05 compared with pre-transplantation levels）. Additionally, prothromhin time decreased in both groups at 12 months after HSC transplantation （P〈0.05 compared with pre-transplantation level）. There were no significant differences in ALT, total bilirubin and prothromhin time between the two groups either before or after transplantation. Moreover, Knodell score decreased significantly at 6 and 12 months. Histological examination showed that liver cell edema, degeneration, necrosis, and inflammation were significantly relieved at 3, 6, and 12 months after transplantation. The incidence of portal vein thrombosis, upper gastrointestinal bleeding, and hepatic encephalopathy were 1.25%, 3.75%, and 2.5% respectively. The one-year survival rate was 100%. Conclusions Autologous HSC transplantation improves liver function and histology in ESLD patients The administration route of HSC has no significant impact on the efficacy of transplantation.