目的探讨终末期肝泡型棘球蚴病(又称“肝泡型包虫病”)患者接受体外肝切除联合自体移植(ex vivo liver resection and autotransplantation,ELRA)术后发生严重并发症(Clavien-Dindo分级Ⅲa级及以上者)的危险因素,并建立列线图预测模型...目的探讨终末期肝泡型棘球蚴病(又称“肝泡型包虫病”)患者接受体外肝切除联合自体移植(ex vivo liver resection and autotransplantation,ELRA)术后发生严重并发症(Clavien-Dindo分级Ⅲa级及以上者)的危险因素,并建立列线图预测模型。方法回顾性分析2014年1月至2024年6月期间在四川大学华西医院接受ELRA手术的终末期肝泡型棘球蚴病患者的临床资料。采用logistic回归分析ELRA术后严重并发症的危险因素;使用LASSO回归筛选风险因素后建立列线图预测模型,并通过受试者操作特征曲线、校准曲线和决策曲线分析评估列线图模型预测术后严重并发症发生的效能;同时采用广义线性回归模型探索影响总手术时间的术前风险因素。检验水准α=0.05。结果本研究共纳入132例接受了ELRA手术的终末期肝泡型棘球蚴病患者,术后有47例(35.6%)发生了严重并发症。多因素logistic回归分析发现,门静脉主干或对侧第一门静脉分支受侵(P2型,华西-PHI分型,下同)患者较病灶同侧第一门静脉分支受侵(P1型)患者术后发生严重并发症风险更高[比值比(odds ratio,OR)和95%可信区间(95%confidence interval,95%CI)=8.24(1.53,44.34),P=0.014],白蛋白胆红素指数分级1级者较2级及以上者术后发生严重并发症的风险更低[OR(95%CI)=0.26(0.08,0.83),P=0.023],随着总手术时间延长及自体血回输量增加术后发生严重并发症风险增高[OR(95%CI)=1.01(1.00,1.01),P=0.009;OR(95%CI)=1.00(1.00,1.00),P=0.043]。LASSO回归筛选出的2个风险因素白蛋白-胆红素指数分级和总手术时间构建的列线图预测模型对ELRA术后是否发生严重并发症的区分度良好[受试者操作特征曲线下面积(95%CI)为0.717(0.625,0.808)]。广义线性回归模型分析发现门静脉侵犯程度P2型和更远的对侧第二门静脉分支受侵(P3型)及有远处转移是影响总手术时间的风险因素[P2型/P1型:β(95%CI)=110.26(52.94,167.58),P<0.001;P3型/P1型:β(95%CI)=109.25(50.99,167.52),P<0.001;远处转移有/无:β(95%CI)=61.22(4.86,117.58),P=0.035]。结论从本研究分析结果看,对门静脉侵犯程度为P2型、白蛋白-胆红素指数分级2级及以上、总手术时间长和自体血回输量多的晚期肝泡型棘球蚴病患者需要密切关注,术前严格评估第一肝门侵犯和远处转移情况,以降低ELRA术后发生严重并发症的风险。本研究基于白蛋白-胆红素指数分级和总手术时间构建的列线图预测模型展现出对术后发生严重并发症的良好预测效能,可为临床制定干预决策提供参考。展开更多
It is controversial whether steroid therapy should be continued to prevent the recurrence of autoimmune hepatitis （AIH） in patients who have undergone liver transplantation （LTx） due to AIH. We report a case of re...It is controversial whether steroid therapy should be continued to prevent the recurrence of autoimmune hepatitis （AIH） in patients who have undergone liver transplantation （LTx） due to AIH. We report a case of recurrent autoimmune hepatitis after LTx despite a persistently normal range of alanine aminotransferase （ALT）. A S0-year-old woman was admitted to our hospital because of jaundice and severe liver dysfunction, where she was diagnosed with liver failure due to AIH. Steroid therapy was not effective enough and the patient received living-donor LTx in 1999. Following the operation, the level of ALT was maintained within a normal range and anti-nuclear antibody （ANA） became negative, however, the serum level of IgG gradually elevated and ANA became positive, while platelets decreased. A liver biopsy performed 6 years after LTx showed histological findings of AIH and she was diagnosed with recurrent AIH. A recurrence of AIH may occur after LTx even if the level of ALT remains within a normal range. We consider that a protocol liver biopsy should be performed in patients who undergo LTx due to AIH to decide the indication for steroid therapy.展开更多
文摘目的探讨终末期肝泡型棘球蚴病(又称“肝泡型包虫病”)患者接受体外肝切除联合自体移植(ex vivo liver resection and autotransplantation,ELRA)术后发生严重并发症(Clavien-Dindo分级Ⅲa级及以上者)的危险因素,并建立列线图预测模型。方法回顾性分析2014年1月至2024年6月期间在四川大学华西医院接受ELRA手术的终末期肝泡型棘球蚴病患者的临床资料。采用logistic回归分析ELRA术后严重并发症的危险因素;使用LASSO回归筛选风险因素后建立列线图预测模型,并通过受试者操作特征曲线、校准曲线和决策曲线分析评估列线图模型预测术后严重并发症发生的效能;同时采用广义线性回归模型探索影响总手术时间的术前风险因素。检验水准α=0.05。结果本研究共纳入132例接受了ELRA手术的终末期肝泡型棘球蚴病患者,术后有47例(35.6%)发生了严重并发症。多因素logistic回归分析发现,门静脉主干或对侧第一门静脉分支受侵(P2型,华西-PHI分型,下同)患者较病灶同侧第一门静脉分支受侵(P1型)患者术后发生严重并发症风险更高[比值比(odds ratio,OR)和95%可信区间(95%confidence interval,95%CI)=8.24(1.53,44.34),P=0.014],白蛋白胆红素指数分级1级者较2级及以上者术后发生严重并发症的风险更低[OR(95%CI)=0.26(0.08,0.83),P=0.023],随着总手术时间延长及自体血回输量增加术后发生严重并发症风险增高[OR(95%CI)=1.01(1.00,1.01),P=0.009;OR(95%CI)=1.00(1.00,1.00),P=0.043]。LASSO回归筛选出的2个风险因素白蛋白-胆红素指数分级和总手术时间构建的列线图预测模型对ELRA术后是否发生严重并发症的区分度良好[受试者操作特征曲线下面积(95%CI)为0.717(0.625,0.808)]。广义线性回归模型分析发现门静脉侵犯程度P2型和更远的对侧第二门静脉分支受侵(P3型)及有远处转移是影响总手术时间的风险因素[P2型/P1型:β(95%CI)=110.26(52.94,167.58),P<0.001;P3型/P1型:β(95%CI)=109.25(50.99,167.52),P<0.001;远处转移有/无:β(95%CI)=61.22(4.86,117.58),P=0.035]。结论从本研究分析结果看,对门静脉侵犯程度为P2型、白蛋白-胆红素指数分级2级及以上、总手术时间长和自体血回输量多的晚期肝泡型棘球蚴病患者需要密切关注,术前严格评估第一肝门侵犯和远处转移情况,以降低ELRA术后发生严重并发症的风险。本研究基于白蛋白-胆红素指数分级和总手术时间构建的列线图预测模型展现出对术后发生严重并发症的良好预测效能,可为临床制定干预决策提供参考。
文摘It is controversial whether steroid therapy should be continued to prevent the recurrence of autoimmune hepatitis （AIH） in patients who have undergone liver transplantation （LTx） due to AIH. We report a case of recurrent autoimmune hepatitis after LTx despite a persistently normal range of alanine aminotransferase （ALT）. A S0-year-old woman was admitted to our hospital because of jaundice and severe liver dysfunction, where she was diagnosed with liver failure due to AIH. Steroid therapy was not effective enough and the patient received living-donor LTx in 1999. Following the operation, the level of ALT was maintained within a normal range and anti-nuclear antibody （ANA） became negative, however, the serum level of IgG gradually elevated and ANA became positive, while platelets decreased. A liver biopsy performed 6 years after LTx showed histological findings of AIH and she was diagnosed with recurrent AIH. A recurrence of AIH may occur after LTx even if the level of ALT remains within a normal range. We consider that a protocol liver biopsy should be performed in patients who undergo LTx due to AIH to decide the indication for steroid therapy.
