单中心连续105例肝移植患者临床病理特点分析性研究

Analytic study of the clinicopathological characteristics of 105 consecutive liver transplantation patients in a single center

目的研究乙肝肝硬化和肝细胞癌(Hepatocellular Carcinoma,HCC)肝移植病理特点与临床参数的关系;分析影响肝移植术后预后的相关因素,并总结其他肝移植患者的病理特点。方法收集2015年1月至2021年3月安徽医科大学第一附属医院105例肝移植患者临床病理资料;收集患者肝脏组织病理学标本,进行HE染色及特殊染色;分析乙肝肝硬化炎症分级、肝细胞癌病理分化与临床参数关系;采用Kaplan Meier方法绘制生存曲线;采用Cox回归模型分析可能影响乙肝肝硬化肝移植受者预后的独立危险因素。结果肝移植患者中,乙肝肝硬化肝脏病理炎症分级与术前的终末期肝病模型(MELD)评分、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、血浆白蛋白(ALB)、谷丙转氨酶(ALT)水平相关(P均<0.05);肝癌病理分化与术前终末期肝病模型(MELD)评分、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、甲胎蛋白(AFP)水平相关(P均<0.05);术前NLR、PLR水平是影响乙肝肝硬化肝移植受者预后的独立危险因素(P均<0.05)。结论在肝移植患者中,血清学指标与肝组织病理学特征具有一定的相关性,术前NLR、PLR的水平可能是影响肝移植受者预后的独立危险因素。

Objective To study the relationship between the pathological features and clinical parameters of liver transplantation in patients with hepatitis B cirrhosis,and hepatocellular carcinoma(HCC).To analyze the related factors affecting prognosis of liver transplantation and to summarize the pathological characteristics of liver transplantation in other patients.Methods Clinicopathological data of 105 patients who underwent liver transplantation in the First Affiliated Hospital of Anhui Medical University were collected between January 2015 and March 2021.Liver histopathological specimens of the patients were collected for HE staining and special staining.The relationship between the inflammatory grade of hepatitis B cirrhosis,the pathological differentiation of HCC,and the clinical parameters were analyzed.The survival curve was plotted by Kaplan-Meier method,Cox regression model was used to analyze the independent risk factors that may influence the prognosis of liver transplant recipients with hepatitis B cirrhosis.Results The inflammatory grades was correlated with the preoperative level of Model of end-stage liver disease(MELD),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),plasma albumin(ALB),and Alanine aminotransferase(ALT)of hepatitis B cirrhosis recipients(P<0.05).The pathological differentiation was correlated with the preoperative level of alpha-fetoprotein(AFP),MELD,NLR,and PLR of hepatocellular carcinoma recipients(all P<0.05).Multivariate analysis showed that the preoperative level of NLR and PLR were independent risk factors for the prognosis of liver transplant recipients with hepatitis B cirrhosis(P<0.05).Conclusion In.patients undergoing liver transplantation,serological indicators are associated with pathological characteristicsin.The level of NLR and PLR before operation may be an independent risk factor for the prognosis of liver transplantation recipients.