影响慢性重型肝炎肝移植生存率的相关危险因素分析

Analysis of risk factors related to survival of patients with chronic severe hepatitis after liver transplantation

目的观察和评价肝移植治疗慢性重型肝炎的疗效，分析影响其生存率的危险因素。方法回顾性分析2004年8月至2006年12月首都医科大学附属北京佑安医院64例接受原位肝移植的慢性重型肝炎病人的临床资料，比较术后3个月死亡组和生存组病人术前临床生化指标、术前并发症、终末期肝病模型（MELD）评分的差异；分析术式、转流与否、血浆置换等对生存率的影响。筛选出影响生存率的一些变量。结果64例肝移植病人术后3、6个月和1年生存率分别为84．38％、82．81％和79．69％。应用单因素分析生存组和死亡组的各项指标，结果术前MELD评分、血清肌酐、INR、术前气管插管、合并感染及合并肝肾综合征有显著性差异；而手术方式、术前血浆置换与否、术中出血量与预后无关。将生存率作为因变量，进行Logistic回归的统计分析，结果术前合并肝肾综合征及合并感染仍保留在回归方程中，与生存率相关并有统计学意义。结论肝移植能有效救治慢性重型肝炎病人；通过对病人术前一些指标的评价，能在一定程度上预计慢性重型肝炎肝移植病人的预后。

Objective To observe the efficacy and investigate the risk factors related to the survival of the patients with chronic severe hepatitis （CSH） after liver transplantation. Methods Consecutive data of 64 patients with CSH undergoing liver transplantation between August 2004 and November 2006 in our hospital were retrospectively analyzed. The 64 patients were allocated to the 3 month survival group and the dead group. Biochemical parameters, the complications before operation, the MELD scores, by-pass or not and the operative procedures were compared between the two groups to screen out the variables affecting the post operative survival. Results Among 64 cases, the 3-month survival rate was 84.38%, the 6 month one 82.81% and the 1 year one 79.69%. There were signifi cant differences between the two groups in the following variables： the MELD scores, INR, Cr, tracheal intuhatton and hepato-renal syndrome prior to operation. Analysis of the relationship between multivariate risk factors and 3 month survival rate by logistic regression showed that hepato-renal syn drome prior to the operation and pre-OLT infection was risk factors. Conclusion Liver transplantation is an effective treatment for the CSH. Some variables prior to the operation can be used as indexes predicting the survival of the patient% with CSH after liver transplantation.