肝移植术后早期肝肾功能变化及其对预后的影响

Early posttransplant hepatorenal functions in the prediction of liver graft recipient＇s prognosis

目的观察肝移植术后受者早期肝肾功能的动态变化，并评估其对预后的影响。方法回顾性研究161例成人尸肝肝移植临床资料，观察本组肝移植术后受者1周内血清总胆红素（TB）、凝血酶原时间（PT）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和血清肌酐（SCr）的变化趋势；对患者移植术后1d的各参数进行多因素COX分析。结果患者肝移植术后1～7d，TB由116．2mmol／L降至66．7mmol／L（Z=5．901，P〈0．01），PT由19．4s降至15．0s（Z=11．657，P〈0．01），ALT由285U／L降至100U／L（Z=12．619，P〈0．01），AST由264U／L降至50U／L（Z=9．776，P〈0．01），SCr由103．4mmol／L降至86．6mmol／L（Z=1．353，P〉0．05）。COX分析结果显示，SCr（RR=3．477，P〈0．01）和TB（RR=2．088，P〈0．05）为受者预后的独立性影响因素。由此建立肝移植受者预后评分公式为1．276×lnSCr（mmol／L）＋0．730×lnTB（mmol／L）。结论肝移植术后受者肝功能可早期恢复，肝移植术后1d的SCr与TB水平影响受者预后。

Objective To monitor the dynamic changes of liver and kidney functions in the first week after liver transplantation and to assess the value of liver and kidney functions in predicting patient＇s survival. Methods clinical data of 161 recipients with benign liver diseases were retrospectively reviewed. Total bilirubin （TB）, aminoleucine transferase （ALT）, aspartate aminotransferase （AST）, prothrombin time （PT） and serum creatinine （SCr） were recorded and analyzed during the first post-transplant week. The data collected at dl were analyzed in the multivariate COX regression. Results From dl to d7 post-transplant, the median value changed from 116.2 mmol/L to 66. 7 mmol/L （Z =5. 901, P 〈0. 01 ） for TB, 19. 4 s to 15.0 s （Z = 11. 657, P 〈0. 01 ） for PT, 285 U/L to 100 U/L （Z = 12. 619, P 〈0. 01 ） for ALT, 264 U/L to 50 U/L （ Z = 9. 776, P 〈 0. 01 ） for AST, 103.4 mmol/L to 86. 6 mmoL/L （Z = 1. 353, P 〉 0. 05） for SCr. Post-transplant SCr （RR =3. 477, P 〈0. 001 ） and TB （RR =2. 088, P 〈0. 05） levels were independent factors influencing patient survival. A prognostic score formula was then established as 1. 276 × lnSCr （mg/dL） ＋ 0. 730 × lnTB （mg/dL）. Conclusion In a successful liver transplantation, transplanted liver function recovers promtly within one week. SCr and TB levels on post-transplant dl have good prognostic value.