摘要
目的分析外周血嗜酸性粒细胞百分比与不同年龄儿童肝移植术后发生早期急性排斥反应的相关性,评估外周血嗜酸性粒细胞百分比对儿童肝移植术后早期排斥反应的预测价值。方法回顾性分析天津市第一中心医院2019年1月至2020年12月396例肝移植患儿的临床资料,患儿年龄分布:0~1岁282例(0~1岁组),1~6岁92例(1~6岁组),>6岁22例(>6岁组)。根据6个月内肝穿刺活检病理结果分为急性排斥组(n=71)和非排斥组(n=325)。比较不同年龄急性排斥组和非排斥组患儿术后早期外周血嗜酸性粒细胞百分比均值的差异,绘制轮廓图并对两组连续测量的嗜酸性粒细胞百分比进行重复测量方差分析,以确定术后早期外周血嗜酸性粒细胞百分比与发生急性排斥反应之间的相关性。运用ROC曲线确定急性排斥反应发生的早期嗜酸性粒细胞百分比的临界值。结果术后早期急性排斥反应发生率为17.93%(71/396)。在0~1岁儿童肝移植受者中,术后早期嗜酸性粒细胞百分比均值与急性排斥反应的发生显著相关(P<0.05),而其他年龄段的儿童肝移植受者术后早期嗜酸性粒细胞百分比均值与急性排斥反应的发生不存在相关性(P>0.05);术后1~7 d急性排斥组的嗜酸性粒细胞百分比的连续变化值显著高于非排斥组(F=25.380,P<0.001);在0~1岁儿童肝移植受者中,嗜酸性粒细胞百分比均值与急性排斥反应发生的ROC曲线显示,其曲线下面积为0.743(95%CI:0.668~0.817),灵敏度为63%,特异度为73%,临界值为3.23%,阳性预测值为31.18%(29/93),阴性预测值为91.05%(173/190)。结论在接受肝移植的儿童受者中,术后早期外周血嗜酸性粒细胞百分比均值对于0~1岁儿童肝移植后急性排斥反应的发生具有一定的预测价值,其特异度和阴性预测值较高,可作为早期风险筛查指标。
Objective To explore the correlation between the percentage of eosinophils in peripheral blood and the occurrence of acute rejection and evaluate the predictive value of the percentage of eosinophils in blood for early rejection in children after liver transplantation(LT).Methods From January 2019 to December 2020,clinical data were retrospectively reviewed for children undergoing LT.They were divided into two groups of acute rejection and non-rejection based upon the pathological findings of liver biopsy within 6 months.The mean percentage of early postoperative eosinophil was compared between two groups.With a contour graph,repeated measurement ANOVA was performed for determining the correlation with the occurrence of acute rejection.And receiver operating characteristic(ROC)curve was plotted for determining the critical mean percentage of eosinophil during an early stage of rejection.Results A total of 396 children undergoing LT were recruited.The postoperative incidence of early acute rejection was 17.93%(71/396).After stratification by age(0~1y/1-6y/>6y),the mean percentage of eosinophil during an early postoperative period was significantly correlated with the occurrence of rejection within 6 months in children aged 0~1 years,but not in children of other ages.The results of repeated measurement indicated that the mean percentage of eosinophil in acute rejection group was significantly higher than that in non-rejection group among children aged 0~1(F=25.38,P<0.001).ROC curve of the mean percentage of eosinophil predicting the rejection reaction at 1~7 days showed that its area under curve(AUC)was 0.743(95%CI:0.668-0.817)with a sensitivity of 65%,a specificity of 74%,a critical value of 3.23%,a positive predictive value of 31.18% and a negative predictive value of 91.05%.Conclusion Among pediatric LT recipients,the mean percentage of eosinophil at Day 1-7 has certain predictive value for the occurrence of acute rejection after LT in children aged 0~1 years.With high specificity and negative predictive value,i
作者
魏新哲
孙超
董冲
王凯
郑卫萍
张复波
韩潮
覃虹
杨洋
张国锋
徐敏
焦利俊
高伟
Wei Xinzhe;Sun Chao;Dong Chong;Wang Kai;Zheng Weiping;Zhang Fubo;Han Chao;Qin Hong;Yang Yang;Zhang Guofeng;Xu Min;Jiao Lijun;Gao Wei(Department of Children's Organ Transplantation,First Central Municipal Hospital,Tianjin 300192,Tianjin)
出处
《临床小儿外科杂志》
CAS
CSCD
2022年第5期420-424,共5页
Journal of Clinical Pediatric Surgery
基金
天津市重点学科(专科)建设项目。
关键词
肝移植
移植物排斥
嗜酸细胞
影响因素分析
预测
Liver transplantation
Graft rejection
Eosinophil
Root cause analysis
Forecasting
