脾功能亢进在肝移植术后的转归及顽固性脾亢的危险因素分析

Outcome of hypersplenism after liver transplantation and risk factors of refractory hypersplenism

目的探讨脾功能亢进在肝移植术后的转归情况,并分析影响术后出现顽固性脾亢的危险因素及其对患者预后的影响。方法收集105例术前合并脾功能亢进的肝移植患者的临床资料,比较脾脏长径、RBC、WBC、Plt和Hb在肝移植术前和术后超过1年时的变化,同时进行术前脾脏长径与RBC、WBC、Plt、Hb的线性回归分析;根据术后是否存在顽固性脾亢,将纳入的患者分成脾亢缓解组和顽固性脾亢组,将两组间单因素分析差异具有统计学意义的变量纳入多因素Logistic回归模型,分析得出影响肝移植术后出现顽固性脾牌亢的独立危险因素;并进行两组间的生存分析。结果脾功能亢进在肝移植术后1年时的完全缓解率为74.3%,脾脏长径在肝移植术后>1年时显著减小(P<0.05),RBC、WBC、Plt和Hb在肝移植术后>1年时显著升高(P<0.05),术前WBC和Plt与脾脏长径呈线性负相关(P<0.05);脾脏长径>16cm、BMI>24kg/m^(2)、WBC≤3×10^(9)/L、PLT≤50×10^(9)/L、术后并发胆道狭窄是肝移植术后出现顽固性脾亢的独立危险因素,年龄>45岁是保护性因素;脾亢缓解组的术后累积生存率好于顽固性脾亢组(P<0.05)。结论肝移植能有效缓解患者术前合并的脾功能亢进,且大部分都能完全缓解,而少部分脾功能亢进在肝移植术后持续存在,术前脾大程度高、白细胞和血小板计数低,超重及术后并发胆管狭窄,会增加肝移植术后顽固性脾亢发生的风险,同时顽固性脾亢更容易在年轻患者中出现,最终对患者的预后造成不利影响。

Objective To investigate the outcome of hypersplenism after liver transplantation,and analyze the risk factors of refractory hypersplenism and the impact on the prognosis of patients.Methods The clinical data of 105 liver transplant patients with preoperative hypersplenism were collected.The changes of the length of spleen,RBC,WBC,Plt and Hb before liver transplantation and more than 1 year after liver transplantation were compared,and the linear regression analysis of the length of spleen and RBC,WBC,Plt and Hb before liver transplantation was performed.According to whether there was refractory hypersplenism after liver trans-plantation,the enrolled patients were divided into hypersplenism remission group and refractory hypersplenism group.The variables with statistically significant differences between the two groups were included in the multivariate Logistic regression model to analyze the independent risk factors affecting the occurrence of refractory hypersplenism after liver transplantation.Survival analysis was performed between the two groups.ResultsThe complete remission rate of hypersplenism at 1 year after liver transplantation was 74.3%.The long diameter of spleen was significantly decreased at>1 year after liver transplantation(P<0.05),while RBC,WBC,Plt and Hb were significantly increased at>1 year after liver transplantation(P<0.05).The long diameter of spleen>16cm,BMI>24kg/m^(2),WBC≤3×10^(9)/L,PLT≤50×10^(9)/L and postoperative biliary stricture were independent risk factors for refractory hypersplenism after liver transplantation,and age>45 years was a protective factor.The postoperative cumulative survival rate of the remission group was better than that of the refractory hypersplenism group(P<0.05).Conclusion Liver transplantation can effectively relieve preopera-tive hypersplenism in patients,and most of them can achieve complete remission,while a small proportion of hypersplenism persists af-ter liver transplantation.Preoperative high degree of splenomegaly,low white blood cell and platelet count,overweight and postopera-tive complicated with bile duct stenosis will increase the risk of refractory hypersplenism after liver transplantation.Meanwhile,refrac-tory hypersplenism is more likely to occur in younger patients.Finally,it has an adverse impact on the prognosis of patients.