影响DCD供肝质量的多因素分析

Multifactor analysis on the quality of DCD donor liver

目的分析影响心脏死亡器官捐献(DCD)供肝质量的相关因素。方法回顾性分析67例青岛大学附属医院于2014年7月-2017年9月完成的器官捐献并于本院实施肝移植供者的临床资料,供者资料作为自变量,包括年龄、性别、原发病、救治时间、高血压、糖尿病、吸烟、饮酒、体重指数(BMI)、脂肪肝程度、白蛋白、血清钠、血糖、动脉血氧分压(PaO_2)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST),并收集相应受者术后15天肝功能水平,包括:AST、ALT、总胆红素(TBiL)、直接胆红素(DBi L),上述自变量分别与因变量作Spearman两两相关分析,筛选出显著性相关的变量进行多重线性回归分析,得出回归方程并进行方差分析,评估供肝质量的影响因素。结果年龄、高血压、吸烟、原发病与肝移植术后15天的TBi L显著性相关(r=0.227、2.7、0.338、0.288,均P<0.05),年龄、吸烟与肝移植术后15天DBiL显著性相关(r=2.78、0.26,均P<0.05)。拟合的回归模型:log_(10)TBi L=1.732+0.006×年龄+0.123×(1或0,1表示脑外伤,0表示脑出血)+0.151×(1或0,1表示吸烟,0表示不吸烟),调整R^2=0.224(F=6.962,P<0.01),log_(10)DBi L=1.795+0.011×年龄+0.17×(1或0,1表示吸烟,0表示不吸烟),调整R^2=0.186(F=8.416,P=0.001)。结论供者年龄、吸烟、原发病是影响肝移植术后早期移植肝肝功能异常的危险因素,脑外伤供肝患者肝移植术后总胆红素水平与脑出血供肝患者相比恢复较慢。

Objective To analyze factors related to the quality of donor livers donated after cardiac death（DCD）.Methods 67 patients who received liver transplantation in the Affiliated Hospital of Qingdao University between July 2014 and September 2017 were studied.Donor information,including age,sex,primary disease,treatment time,hypertension,diabetes,smoking,drinking,body mass index（BMI）,level of the fatty liver disease,albumin,serum sodium,blood glucose,arterial oxygen pressure（Pa O_2）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,as well as liver function of recipients,including AST,ALT,total bilirubin（TBi L）and direct bilirubin（DBi L）,were analyzed by Spearman correlation test.Factors correlated with the dependent variant were selectedand further analyzed by a multiple linear regression analysis.A regression model was establised by influence factors,to evaluate the quality of donor livers.Results Age,hypertension,smoking,and primary disease were significantly associated with TBi L on day 15 after liver transplantation（r=0.227,2.7,0.338,0.288,all P0.05）,age and smoking were significantly associated with DBi L on day 15 after liver transplantation（r=2.78,0.26,both P0.05）.The Fitting regression models were log_（10）TBi L=1.732＋0.006×Age＋0.123×（1 or 0,1 for traumatic brain injury,0 for intracerebral hemorrhage）＋0.151×（1 or 0,1 for smoking,0 for no smoking）,adjusted R^2=0.224（F=6.962,P0.01）and log_（10）DBi L=1.795＋0.011×Age＋0.17×（1 or 0,1 for smoking,0 for no smoking）,adjusted R^2=0.186（F=8.416,P=0.001）.Conclusion Hypertension,age,smoking,primary disease are the risk factors that affect the postoperative liver function in the early stage of liver transplantation,and the recovery of total bilirubin level after liver transplantation in patients with brain trauma is slower than that of patients with cerebral hemorrhage.