肝移植病人术后急性肾损伤的危险因素分析

Risk factors of acute kidney injury in liver transplant patients

目的分析原位肝移植术后急性肾损伤(acute kidney injury,AKI)的发生情况及其危险因素,探讨AKI对肝移植术后出院时间的影响。方法回顾性分析2018年3月至2019年8月在武汉大学人民医院行首次经典原位肝移植术病人的临床资料。根据改善全球肾脏病预后组织(KDIGO)指南诊断AKI并分期,比较AKI组与非AKI组病人术前、术中及术后的相关资料。应用Logistic回归分析肝移植病人术后发生AKI的危险因素。应用Kaplan-Meier生存曲线分析AKI与非AKI组病人术后总住院时间,观察AKI对病人短期预后的影响。结果共纳入51例病人,有30例(58.8%)出现AKI,其中AKI 1期14例(46.7%),AKI 2期11例(36.7%),AKI 3期5例(16.6%)。单因素分析结果显示:AKI组与非AKI组病人间术前血清白蛋白、红细胞计数、血清中性粒细胞百分比、尿量、手术时间、术中出血量与尿量比值的差异均有统计学意义(均P<0.05)。多因素分析显示,肝移植术后AKI的独立危险因素为:手术时间[OR=5.426,95%CI(1.035,28.477),P=0.045];术中尿量[OR=5.443,95%CI(1.061,27.815),P=0.042];术中出血量与尿量的比值[OR=3.198,95%CI(1.173,8.722),P=0.023]。Kaplan-Meier生存曲线分析显示:AKI组病人与非AKI病人的中位术后住院时间分别为28 d和22 d(χ^(2)=5.134,P=0.023)。结论肝移植术中尿量相对较少、术中出血量与尿量的比值大、手术时间长是影响肝移植术后AKI发生的独立危险因素。术中控制出血量与尿量的关系可能有助于减少肝移植术后AKI的发生,改善病人预后。

Objective To explore the incidence and risk factors of acute kidney injury(AKI)and examine its effect on discharge time after orthotopic liver transplantation.Methods From March 2018 to August 2019,clinical data were retrospectively analyzed of 51 patients undergoing initial allogeneic orthotopic liver transplantation.AKI was diagnosed and staged according to the guidelines of Kidney Disease:Improving Global Outcomes(KDIGO)and the relevant perioperative data were compared between AKI and non-AKI groups.Logistic regression was employed for analyzing the risk factors of AKI after liver transplantation.Kaplan-Meier survival curve was utilized for examining total postoperative hospital stay in both groups and observing the effect of AKI on short-term prognosis.Results AKI occurred(n=30,58.8%).The stage was1(n=14,46.7%),2(n=11,36.7%)and 3(n=5,16.6%).Univariate analysis revealed that preoperative serum albumin,red blood cells,serum neutrophil percentage,volume of intraoperative urine output,operative duration,ratio of volume of intraoperative blood loss/urine output were all correlated with the occurrence of AKI after liver transplantation(P<0.05).And multivariate analysis indicated that operative duration[OR=5.426,95%CI(1.035,28.477),P=0.045],intraoperative urine output[OR=5.443,95%CI(1.061,27.815),P=0.042]and ratio of volume of intraoperative blood loss/urine output[OR=3.198,95%CI(1.173,8.722),P=0.023]were independent risk factor for AKI after liver transplantation.Kaplan-Meier survival curve showed that the median discharge time was 28 and 22 days in AKI and non-AKI groups(χ^(2)=5.134,P=0.023).Conclusion A small amount of urine during liver transplantation,a large ratio of volume of intraoperative blood loss/urine output and long operative duration are independent risk factors for the occurrence of AKI after liver transplantation.And adjusting the relationship between intraoperative bleeding control and urine output may help reduce the incidence of AKI after liver transplantation and improve the prognosis of patients.