供体获取前高钠血症对肝移植预后的影响

发布时间：2018-03-09 21:41

  本文选题：肝移植　切入点：高钠血症　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:一直以来,供肝的数量远远无法满足肝移植的需要。为此,临床工作中促使了扩大供肝标准的概念,包括本文的高钠血症供肝。目前尚没有足够的证据表明高钠血症供肝对肝移植预后有显著影响。目的:研究供体获取前高钠血症对肝移植术后患者短期及长期生存率的影响方法:统计移植受者科学登记处数据库中(2004-2008年)23494例第一次接受单纯肝移植的患者。本研究高钠血症定义为160μmol/L。其中1645例属于高钠血症供体。受体及供体基线资料中分类变量采用了卡方检验,连续变量采用了 t检验。对于患者的生存率及移植物的生存率,我们采用了 Kaplan-Meier法绘制生存曲线,同时采用Cox回归模型分析。结果:Kaplan-Meier分析表明在移植物和患者的总体生存率上供体高钠血症组显著低于供体非高钠血症组,且供体高钠血症组在肝移植术后1、3、5年移植物生存率(78.1%,70.4%,60.1%)显著低于非高钠血症组(79.8%,71.8%,65.6%)。供体高钠血症组在肝移植术后1、3、5年患者生存率(74.6%,68.4%,58.5%)也显著低于非高钠血症组(76.2%,70.1%,61.7%)。Cox回归分析表明供体获取前高钠血症对移植后移植物生存率的多因素危险比例为HR 1.164,95%CI 1.054-1.511;供体获取前高钠血症对移植后患者的生存率的多因素危险比例为HR 1.212,95%CI 1.034-1.389。结论:使用供体高钠血症的供肝会显著降低移植物及病人的生存率,并且是肝移植预后的独立危险因素。
[Abstract]:Background: the number of liver donors has been far from meeting the needs of liver transplantation. For this reason, clinical work has led to the concept of expanding the standard of donor liver. At present, there is not enough evidence that hypernatremia donor liver has a significant effect on the prognosis of liver transplantation. Objective: to study the effect of hypernatremia before donor acquisition on short-term and long-term birth of patients after liver transplantation. Methods: a total of 23, 494 patients received liver transplantation for the first time from 2004 to 2008 in the scientific registry database of transplant recipients. Hypernatremia was defined as 160 渭 mol / L in this study. Of these, 1 645 belonged to hypernatremia donors, receptors and donors. The classification variables in the baseline data are chi-square test. T test was used for the continuous variables. For the survival rate of the patients and the survival rate of the grafts, we used the Kaplan-Meier method to draw the survival curve. Results the overall survival rate of grafts and patients was significantly lower in donor hypernatremia group than in donor non-hypernatremia group. The survival rate of donor hypernatremia group was significantly lower than that of non-hypernatremia group (79.8%). The survival rate of donor hypernatremia group was 74.68.48.48.58.54.64.68.48.55.The survival rate of donor hypernatremia group was significantly lower than that of non-hypernatremia group (76.270.1 + 61.70.41% vs 71.70.41%, P < 0.05), and the 5-year survival rate of donor hypernatremia group was 74.68.48.58.5), which was significantly lower than that of non-hypernatremia group (79.78% vs 71.70.1%). The multivariate risk ratio of hypernatremia before donor acquisition to graft survival was 1.16495 CI 1.054-1.511, and the multivariate risk ratio of hypernatremia before donor acquisition was 1.212995 CI 1.034-1.389.Conclusion:. The donor liver with hypernatremia significantly reduced the survival rate of both the graft and the patient. It is an independent risk factor for the prognosis of liver transplantation.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3
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本文编号：1590338