摘要
目的评价体重指数(BMI)预测脑-心双死亡器官捐献(donation after brain plus cardiac death,DBCD)供肝脂肪肝的价值。方法回顾性分析2011年7月至2013年3月在广东省佛山市第一人民医院移植中心实施的22例DBCD供体的临床资料。根据供体BMI将22例供体和17例受体分为体重正常组(18.0～22.9kg/m2)和体重过重组(≥23.0kg/m2)。比较两组供体的术前临床指标及供肝脂肪肝程度,比较两组受体术后7d肝酶学指标、凝血功能及并发症发生情况。采用Pearson法分析供体BMI和供肝脂肪肝程度的相关性,采用受试者工作特征(ROC)曲线分析BMI预测供肝脂肪肝的灵敏度和特异度,并计算最佳截点值及相应的灵敏度和特异度。结果 DBCD供体BMI为(22.5±1.3)kg/m2,其中体重正常组13例,体重过重组9例,所有捐献者BMI均未超过28.0kg/m2。体重过重组的平均年龄及供肝脂肪肝程度高于体重正常组,两组比较差异有统计学意义(均为P<0.05)。两组受体术后7d的临床指标比较,体重过重组的丙氨酸转氨酶峰值高于体重正常组(P<0.05)。两组受体术后未发生移植物失功或功能不全和急性排斥反应。供体BMI与供肝脂肪肝呈中等程度相关(r=0.572,P=0.005)。ROC曲线分析显示BMI预测肝细胞脂肪变性率≥30%的曲线下面积为0.87(95%可信区间为0.68～1.00,P=0.005),最佳截点值为BMI≥23.0kg/m2,此时的灵敏度为0.875,特异度为0.643,具有中等程度的预测价值。结论 DBCD供体BMI可以较好地预测供肝脂肪肝,但特异度有待进一步提高。
Objective To assess the value of body mass index （BMI） on predicting fatty liver with donation after brain plus cardiac death （DBCD）. Methods Clinical data of 22 donors of DBCD in the First People＇s Hospital of Foshan from July 2011 to March 2013 were analyzed retrospectively. According to the donors＇ BMI, 22 donors and 17 recipients were divided into with normal weight group （ 18.0-22. 9 kg/m2 ） and overweight group （ ≥ 23.0 kg/m2 ） . The clinical indicators and the degree of fatty liver in donors were compared between two groups. The indicators of liver enzymology, coagulation function and complications in recipients were compared between two groups at 7 d after transplantation. Correlation between donors＇ BMI and the degree of fatty liver was analyzed by Pearson test. Sensitivity and specificity of BMI on predicting fatty liver were analyzed by receiver operation characteristic （ROC） curve. The appropriate cut-off value, sensitivity and specificity were calculated. Results The BMI was （22. 5 ± 1.3 ） kg/m2 in DBCD donors, with 13 donors innormal weight group and 9 donors in overweight group. No one＇s BMI was over 28.0 kg/m2. The mean of age and the degree of hepatic steatosis in overweight group were higher than those in normal weight group （ all in P 〈 0. 05 ）. Among the clinical indicators of recipients at 7 d after transplantation, peak level of alanine aminotransferase in overweight group was higher than that in normal weight group （ P 〈 0. 05 ）. No primary non- function, dysfunction or acute rejection occurred in recipients of two groups. The moderate correlation was identified between the donors＇ BMI and the degree of fatty liver （ r = 0. 572, P = 0. 005 ）. The ROC curve analysis showed that area under the curve of BMI predicting the rate of hepatic steatosis ≥ 30% was 0. 87 （95% confidence interval was 0. 68-1.00, P =0. 005）. The appropriate cut-off value of BMI was≥23.0 kg/m2, while the sensitivity was 0. 875 and specificity was 0. 643 with mo
出处
《器官移植》
CAS
CSCD
2013年第4期191-195,203,共6页
Organ Transplantation
关键词
体重指数
脑-心双死亡器官捐献
脂肪肝
供体评估
Body mass index
Donation after brain plus cardiac death
Fatty liver
Donor assessment
