摘要
目的探索术前估测肾小球滤过率(estimated glomerular filtration rate,eGFR)正常的成年人肝移植术后新发慢性肾脏病(new-onset chronic kidney disease,NOCKD)的围手术期危险因素,为NOCKD高危人群的筛查提供早期预测模型。方法采用回顾性病例对照研究方法,选择2018年1月至2020年1月在北京清华长庚医院接受原位异体肝移植的成年受体,通过医院电子病例系统采集受体围手术期数据。对病例进行纳排筛选和分组后,先后运用单因素分析和多因素二元Logistic回归分析确定肝移植后1年内NOCKD发生率的独立危险因素。采用Kaplan-Meier和log-rank检验评估NOCKD受体和非NOCKD受体的生存时间。结果本研究共纳入164例受体,28例(17.1%)出现了肝移植后NOCKD。多因素二元Logistic回归分析模型显示,术前糖尿病史[比值比(odds ratio,OR)=3.477,95%CI(1.163,10.394)]、终末期肝病模型(model for end stage liver disease,MELD)评分[OR=1.119,95%CI(1.038,1.208)]、术后行连续肾脏替代治疗(continuous renal replacement therapy,CRRT)[OR=11.329,95%CI(1.855,69.171)]是移植后1年NOCKD的独立危险因素。NOCKD受体的1年生存率明显低于非NOCKD受体(89.3%比98.5%,χ^(2)=6.004,P=0.014)。结论受体术前合并糖尿病、术前较高的MELD评分和术后行CRRT是原位异体肝移植术后NOCKD的独立危险因素,可为制定个体化临床决策和预测受体术后1年病死率提供参考。
Objective To explore the perioperative risk factors of new-onset chronic kidney disease(NOCKD)after liver transplantation in adults with normal preoperative estimated glomerular filtration rate(eGFR),and to provide an early prediction model for the screening of high-risk NOCKD population.Methods A retrospective case-control study was performed.Adult recipients who underwent orthotopic liver transplantation in Beijing Tsinghua Changgung Hospital from January 2018 to January 2020 were selected.Perioperative data were collected using the center's electronic medical record system.After screening and grouping,univariate and multivariate logistic regression analyses were performed to determine the independent risk factors of NOCKD within one year after liver transplantation.Kaplan-Meier and log-rank tests were used to evaluate the survival time of NOCKD and non-NOCKD recipients.Results A total of 164 patients were included in this study,where 28 patients(17.1%)developed NOCKD after liver transplantation.The multivariate logistic regression model showed that preoperative diabetes mellitus[odds ratio(OR)=3.477,95%confidence interval(CI)(1.163,10.394)],model for end stage liver disease(MELD)score[OR=1.119,95%CI(1.038,1.208)],and postoperative continuous renal replacement therapy(CRRT)[OR=11.329,95%CI(1.855,69.171)]were the independent risk factors for NOCKD one year after liver transplantation.The one-year survival rate of NOCKD recipients was significantly lower than that of non-NOCKD recipients(88.5%vs 98.2%,χ^(2)=6.004,P=0.014).Conclusions Preoperative diabetes mellitus,preoperative high MELD score and postoperative CRRT are the independent risk factors for NOCKD after orthotopic liver transplantation,which may provide evidence for making individualized decision and predicting the one-year postoperative mortality of the recipients.
作者
段怡
高志峰
王晓宇
孟园园
崔蕾
陈烨
张欢
Duan Yi;Gao Zhifeng;Wang Xiaoyu;Meng Yuanyuan;Cui Lei;Chen Ye;Zhang Huan(Department of Anesthesiology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)
出处
《国际麻醉学与复苏杂志》
CAS
2022年第1期51-57,共7页
International Journal of Anesthesiology and Resuscitation
关键词
肝移植
慢性肾脏病
围手术期
危险因素
糖尿病
Liver transplantation
Chronic kidney disease
Perioperative period
Risk factor
Diabetes mellitus
