MELD-Na评分对逆行灌注法原位肝移植术后早期急性肾损伤发生的预测作用

目的  探讨术前终末期肝病模型联合血清钠（MELD-Na）评分对肝移植术后早期急性肾损伤（AKI）发生率的预测效果。方法  回顾性分析315例行经下腔静脉逆行灌注法原位肝移植受者的临床资料。根据术前MELD-Na评分，将患者分为3组：A组为MELD-Na评分≤ 10分（115例）；B组为10分20分（82例）。比较3组受者术前、术中各项指标。术前指标包括血清肌酐（Scr）、血尿素氮（BUN）、白蛋白（Alb）、总胆红素（TB）、凝血酶原时间国际标准化比值（PT-INR）、平均动脉压（MAP）、血清Na⁺等；术中指标包括手术时间、腔静脉阻断时间、出血量、输红细胞量、输血浆量、总补液量等。统计3组受者肝移植术后早期AKI的发生率及分期情况，并采用Spearman等级相关分析术前MELD-Na评分与AKI分期之间的关系。结果  3组受者术前BUN、Alb、TB、PT-INR、MAP、Na⁺比较，差异均有统计学意义（均为P < 0.05），术中的腔静脉阻断时间、出血量、输红细胞量、输血浆量比较，差异亦均有统计学意义（均为P < 0.05）。315例肝移植受者，术后早期1周内AKI发生率64.8%（204/315），其中A、B、C组术后AKI发生率分别为43%（49/115）、71%（84/118）、87%（71/82），3组间比较差异有统计学意义（P < 0.05）。经Spearman等级相关分析，术前MELD-Na评分与AKI分期存在正相关（r=0.442，P=0.000）。结论  MELD-Na评分不仅可以作为术前病情评估指标，也是术后发生AKI的重要预测指标。

Value of MELD-Na score for prediction of the incidence of acute kidney injury early after orthotopic liver transplantation using retrograde perfusion

Objective To evaluate the value of preoperative model for end-stage liver disease combined with serum sodium (MELD-Na) score for the prediction of the incidence of acute kidney injury (AKI) early after liver transplantation. Methods Clinical data of 315 recipients undergoing orthotopic liver transplantation by retrograde inferior vena caval perfusion were retrospectively analyzed. According to preoperative MELD-Na score, all patients were divided into group A (MELD-Na score ≤ 10, n=115), group B (10n=118) and group C (MELDNa score>20, n=82). Preoperative and intraoperative parameters of the recipients were statistically compared among three groups. Preoperative parameters included serum creatinine (Scr), blood urea nitrogen (BUN), albumin (Alb), total bilirubin (TB), prothrombin time-international normalized ratio (PT-INR), mean arterial pressure (MAP) and serum Na+, etc. Intraoperative parameters included operation time, vena caval occlusion time, hemorrhage volume, quantity of red blood cell infusion, quantity of plasma transfusion and total fluid infusion volume, etc. The incidence and staging of AKI early after liver transplantation in the recipients were statistically compared among three groups. Spearman's rank correlation analysis was performed to analyze the correlation between preoperative MELD-Na score and AKI staging. Results Preoperative BUN, Alb, TB, PT-INR, MAP and Na+ in the recipients significantly differed among three groups (all P < 0.05). Intraoperative vena caval occlusion time, hemorrhage volume, quantity of red blood cell infusion and quantity of plasma transfusion significantly differed among three groups (all P < 0.05). In 315 recipients undergoing liver transplantation, the incidence of AKI within postoperative 1 week was 64.8% (204/315), and 43% (49/115), 71% (84/118) and 87% (71/82) in group A, B and C. Statistical significance was identified among three groups (all P < 0.05). Spearman's rank correlation analysis revealed that preoperative MELD-Na score was positively correlated with AKI staging (r=0.442, P=0.000). Conclusions MELD-Na score not only acts as a parameter evaluating preoperative patients' conditions, but also serves as a pivotal parameter predicting postoperative incidence of AKI.