原位肝移植术后耐激素性急性排斥反应的临床诊治分析

发布时间：2018-06-27 12:13

本文选题：原位肝移植 + 耐激素性急性排斥反应　；参考：《广东医学》2017年12期

【摘要】：目的探讨原位肝移植术后耐激素性急性排斥反应(SRAR)的临床诊治方法与预后,分析SRAR发生的危险因素。方法采用回顾性研究方法,选择成人原位肝移植98例患者作为研究对象,记录与调查患者的一般资料、肝功能、临床诊治情况与预后情况。结果在98例患者中,术后SRAR发生18例,发生率为18.4%;16例SRAR发生在术后第1天,2例发生在术后第2~6天。排斥组与对照组患者在年龄、性别、体质指数、病因等方面没有明显差异(P0.05),术前气管插管、使用升压药、血液透析在排斥组与对照组之间对比差异有统计学意义(P0.05)。排斥组术前ALT、AST、TBIL与ALP浓度都明显高于对照组,差异有统计学意义(P0.05)。多因素logistic分析结果表明,影响肝移植术后SRAR发生的因素主要为术前气管插管、使用升压药与TBIL浓度(OR=2.216、2.062和1.022,P0.05)。相对于对照组,排斥组的6个月与1年死亡率明显增加,术后机械通气时间、住院时间明显延长,再移植率、感染率明显升高,对比差异均有统计学意义(P0.05)。结论原位肝移植术后SRAR比较常见,多发生于术后第1天,患者术前气管插管、使用升压药与TBIL浓度为主要的发病因素,可增加患者的死亡率、再移植率和感染率,延长术后机械通气时间和住院时间。
[Abstract]:Objective to investigate the clinical diagnosis, treatment and prognosis of steroid-resistant acute rejection (SRAR) after orthotopic liver transplantation (OLT), and to analyze the risk factors of SRAR. Methods 98 adult orthotopic liver transplantation (OLT) patients were studied retrospectively. The general data, liver function, clinical diagnosis and treatment and prognosis of the patients were recorded and investigated. Results among 98 patients, 18 cases had SRAR, 16 cases had SRAR on the first day after operation and 2 cases occurred on the second day after operation. There was no significant difference in age sex body mass index and etiology between the rejection group and the control group (P0.05). There was significant difference between the rejection group and the control group in preoperative tracheal intubation the use of blood pressure booster and hemodialysis (P0.05). The concentrations of TBIL and ALP in the rejection group were significantly higher than those in the control group before operation (P0.05). Multivariate logistic analysis showed that the main factors affecting the occurrence of SRAR after liver transplantation were tracheal intubation before operation and the concentration of BP and TBIL (OR2. 2162.062 and 1.022? P 0.05). Compared with the control group, the mortality of 6 months and 1 year in the rejection group was significantly increased, the time of postoperative mechanical ventilation and hospital stay was significantly prolonged, the rate of retransplantation and the infection rate were significantly increased, and the difference was statistically significant (P0.05). Conclusion SRAR is more common after orthotopic liver transplantation (OLT), most of which occur on the first day after operation. Preoperative tracheal intubation, blood pressure booster and TBIL concentration are the main risk factors, which can increase the mortality, retransplantation rate and infection rate of the patients. The duration of mechanical ventilation and hospital stay were prolonged.
【作者单位】：首都医科大学附属北京朝阳医院肝胆胰脾外科;空军总医院肝胆外科;
【基金】：北京市科技计划课题项目(编号:Z131100006813010)
【分类号】：R657.3

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