实时组织弹性成像技术对肝移植患者供肝质量及术后EAD发生的评估价值

Value of real-time tissue elastography in evaluating donor liver quality and postoperative early allograft dysfunction in liver transplantation patients

目的探讨实时组织弹性成像技术(RTE)对肝移植患者供肝质量及术后早期同种异体移植物功能障碍(EAD)发生的评估价值。方法选择2020年10月—2022年1月于我院器官移植中心接受肝移植手术的受者58例,根据受者术后早期肝功能恢复情况,将其分为EAD组和非EAD组。收集两组受者肝移植术前相应供肝常规超声检查及RTE测量结果、肝移植术前术后受者的肝功能和凝血功能结果、术前MELD评分等指标,并进行比较。对比较有差异的指标进行logistic回归分析,并绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),分析相关因素的判断效能。结果EAD组受者的供肝肝纤维化指数(LF Index)、术前MELD评分显著性高于非EAD组(t=4.822、2.902,P<0.05)。Logistic回归分析结果显示,供者肝脏LF Index>1.645是受者肝移植术后EAD发生的危险因素;ROC曲线显示,供肝LF Index预测受者术后EAD发生的AUC为0.840,灵敏度为82.4%,特异度为73.2%,截断值为1.645。结论供肝肝移植术前LF Index高是受者肝移植术后发生EAD的危险因素,术前通过RTE测量供肝LF Index对供肝质量的评估及受者EAD发生的预测具有一定价值。

Objective To investigate the value of real-time tissue elastography(RTE)in evaluating donor liver quality and postoperative early allograft dysfunction(EAD)in liver transplantation patients.Methods A total of 58 patients who received liver transplantation in Organ Transplantation Center of our hospital from October 2020 to January 2022 were enrolled,and according to the recovery of liver function in the early stage after surgery,the patients were divided into EAD group and non-EAD group.The two groups were compared in terms of the indicators such as the routine ultrasound examination and RTE measurement of donor liver before liver transplantation,liver function and coagulation function of recipients before and after liver transplantation,and preoperative Model for End-Stage Liver Disease(MELD)score.The logistic regression analysis was performed for the indicators with significant differences,and the receiver operating characteristic(ROC)curve was plotted to calculate the area under the ROC curve(AUC)and assess the performance of related factors.Results Compared with the non-EAD group,the EAD group had significantly higher liver fibrosis(LF)index of donor liver and MELD score of recipients(t=4.822,2.902,P<0.05).The logistic regression analysis showed that donor liver LF index>1.645 was a risk factor for EAD after liver transplantation,and the ROC curve analysis showed that donor liver LF index had an AUC of 0.840 in predicting EAD after surgery,with a sensitivity of 82.4%,a specificity of 73.2%,and a cut-off value of 1.645.Conclusion High LF index of donor liver before liver transplantation is a risk factor for EAD in recipients after liver transplantation,and RTE measurement for LF index of donor liver before li-ver transplantation has a certain value in assessing the quality of donor liver and predicting the onset of EAD.