小儿活体肝移植术后急性肺损伤的危险因素及其预测价值

Risk factors for acute lung injury after pediatric living donor liver transplantation and the prediction value

目的筛选小儿活体肝移植(LDLT)术后急性肺损伤(ALI)的危险因素并评价其预测价值。方法选取2021年1月至12月在本中心进行LDLT术患儿(均诊断为先天性胆道闭锁)作为研究对象。通过电子病历系统获取患儿围术期资料,根据术后1周是否发生ALI将患儿分成非ALI组和ALI组。将组间比较差异有统计学意义的因素进行多因素logistic回归分析,筛选小儿LDLT术后ALI的危险因素,采用受试者工作特征(ROC)曲线评价危险因素的预测价值。结果共140例患儿纳入分析,ALI发生率为30.7%。多因素logistic回归分析结果显示:术前儿童终末期肝病模型(PELD)评分、术前血清氨基末端B型脑利钠肽前体(NT-pro-BNP)浓度、术中液体入量、再灌注综合征持续时间是小儿LDLT术后发生ALI的独立危险因素(P<0.05)。术前血清NT-pro-BNP浓度预测术后发生ALI的ROC曲线下面积为0.737(P<0.001),截断值为222.1 ng/L,灵敏度为0.628,特异度为0.732。结论术前PELD评分、血清NT-pro-BNP浓度、术中液体入量和再灌注综合征持续时间是小儿LDLT术后发生ALI的独立危险因素;术前血清NT-pro-BNP浓度可有效预测小儿LDLT术后ALI的发生。

Objective To identify the risk factors for acute lung injury(ALI)after pediatric living donor liver transplantation(LDLT)and evaluate the predictive value.Methods The pediatric patients(all diagnosed with congenital biliary atresia)who underwent parental liver transplantation in our center from January to December 2021 were selected.Perioperative data were obtained through the electronic medical record system,and the pediatric patients were divided into non-ALI group and ALI group according to whether ALI occurred or not at 1 week after surgery.The factors of which P values were less than 0.05 between groups would enter the multivariate logistic regression analysis to stratify the risk factors for ALI after pediatric LDLT,and the value of the risk factors in predicting intraoperative ALI was evaluated using the receiver operating characteristic curve.Results A total of 140 pediatric patients were enrolled in the analysis,and the incidence of ALI was 30.7%.The results of the multivariate logistic regression analysis showed that preoperative pediatric end-stage liver disease score,preoperative serum NT-pro-BNP concentrations,intraoperative volume of fluid transfused,and duration of postreperfusion syndrome were independent risk factors for ALI after LDLT in pediatric patients(P<0.05).The area under the receiver operating characteristic curve of the preoperative N-terminal pro-brain natriuretic peptide(NT-pro-BNP)concentration in predicting postoperative ALI was 0.737(P<0.001),with a cutoff value of 222.1 ng/L,sensitivity of 0.628,and specificity of 0.732.Conclusions Preoperative pediatric end-stage liver disease score,serum NT-pro-BNP concentrations,intraoperative volume of fluid transfused,and duration of postreperfusion syndrome are independent risk factors for ALI after LDLT in pediatric patients;preoperative serum NT-pro-BNP concentrations can effectively predict the development of ALI after pediatric LDLT surgery.