瞬时弹性成像预测肝移植受者近期预后

Application of transient elastography in early prognosis after liver transplantation

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。

Objective：To evaluate the application of transient elastography in early prognosis of patients after liver transplantation.Methods：Forty-three patients receiving orthotopic liver transplant in our hospital during December 2013 and March 2014 were included in this study.Liver stiffness measurement （ LSM） was performed by FibroScan on day 1 （LSM-1） and day 7 （LSM-7） after transplantation.Patients were divided into higher LSM group （LSM〉16 kPa） and lower LSM group （LSM〈16 kPa）.Clinical data and laboratory data were collected and the correlation of LSM with liver and renal function was analyzed.Results：The number of cases in higher LSM-1, lower LSM-7, higher LSM-7 and lower LSM-7 were 29, 11, 31 and 9, respectively.The cold ischemia time was corrected with LSM-7 （r=0.335, P=0.028）, but not with LSM-1 （r=0.037, P=0.812）;the length of ICU stay was positively correlated with LSM-1 （r=0.488, P=0.001）, but not with LSM-7 （ r =0.213, P =0.181）.LSM was positively correlated with aspartate aminotransferase, bile acid and creatinine levels. The higher LSM-1 group had longer length of ICU and hospital stay than lower LSM-1 group did （9 d vs 7 d, P=0.013;34 d vs 23 d, P=0.023）;and the higher LSM-1 group had higher incidence rate of serious complications than lower LSM-1 group did （78.57%vs 27.59%, P=0.002）.Conclusion： The LSM correlates with the liver function and renal function of liver transplantation recipients, and may have value for assessing early prognosis.