肝移植术后肠道菌群失调及其危险因素分析

Analysis of the correlation between intestinal dysbacteriosis and infection after liver transplantation

目的分析肝移植术后肠道菌群失调的发生率及其危险因素。方法回顾性分析中山大学附属第三医院肝移植中心2008年1月至2009年6月行肝移植的患者。根据"肠道菌群诊断标准"将患者分为菌群失调组和非菌群失调组,分析其肠道菌群失调的发生率、发生时间,同时利用单因素分析及Logistic回归分析,筛选肠道菌群失调危险因素。结果共收集到179例患者资料,最终纳入141例。在141例肝移植患者中,术后3个月内发生肠道菌群失调共59例,发生率为41.84%(59/141),多发生于术后1个月内(53/59,89.83%),尤其术后14 d内(46/59,77.97%)。经Logistic回归分析得出:术前大量腹水、术后长时间全肠外营养(TPN)、肠功能障碍及长时间应用抗生素是肝移植术后肠道菌群失调的独立危险因素。结论肝移植术后肠道菌群失调的发生率高。术前大量腹水、术后长时间TPN、术后肠功能障碍及术后长时间抗生素应用是肝移植术后肠道菌群失调的独立危险因素。

Objective To observe the incidence rate and time and identify the risk factors of intestinal dysbacteriosis after liver transplantation（LT）. Methods This is a retrospective analysis. Patients who who received LT in the Liver Transplant Center of the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to June 2009 were collected. According to the diagnose criteria of intestinal dysbacteriosis, all these patients were devided into two groups, which were diagnosed within intestinal dysbacteriosis and without it respectively. The incidence rate of intestinal dysbacteriosis in 3 months after LT were calculated, and the time of occurrence of intestinal dysbacteriosis in each case was analyzed, the relationship between the 37 potential risk factors was investigated by means of logistic regression. Results 179 cases who received LT in the Liver Transplant Center of the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to June 2009 were collected, and data from 141 patients were selected. The incidence rate of intestinal dysbacteriosis in 3 months after LT was 41.84%（59/141）. Most of intestinal dysbacteriosis occurred within one month after LT（53/59, 89.83%）, especially within the 14 days（46/59, 77.97%）. Through one-way ANOVA, 9 factors among 37 to be significantly correlated （P〈0.05）. Through the logistic regression, 4 of the 9 factors were independent factors of intestinal dysbacteriosis after LT （P〈0.05） which were ascites before operation, total parenteral nutrition （TPN）, intestinal dysfunction and application of antibiotics after operation. Conclusions The rate of intestinal dysbacteriosis after LT is very high, most of intestinal dysbacteriosis occurred within one month after LT, the peak is within 14 days after LT. Four independent risk factors are found which were ascites before operation, total parenteral nutrition（TPN）, intestinal dysfunction and application of antibiotics after operation are independent risk factors of intestinal dysbacteriosis after LT （P〈0.05）.