基于术前血清胱抑素C的肝脏移植预后风险分析

发布时间：2018-11-02 06:54

【摘要】：背景:在终末期肝病患者中,相较于基于血清肌酐浓度,基于血清胱抑素C浓度评估的肾小球滤过率(glomerular filtration rate,GFR)更为准确。肝脏移植术前肾功能不全对术后受者的生存率有重要影响。本研究旨在进行基于术前血清胱抑素C的肝脏移植预后风险分析,探究肝脏移植术前血清胱抑素C浓度与移植后受者生存情况的关系。对象和方法:本研究共回顾性收集了 250例于2014年1月至2016年1月期间在浙江大学附属第一医院行心脏死亡供体(donation after cardiac death,DCD)来源肝脏移植手术的病例数据。分别使用基于血清肌酐浓度的CKD-EPI-Pcr公式、MDRD-4公式、MDRD-6公式,基于血清胱抑素C浓度的Hoek公式、CKD-EPI-CysC公式,以及同时基于血清胱抑素C和血清肌酐浓度的CKD-EPI-Pcr-Cys C公式计算受者的术前肾小球滤过率。采用KDIGO 2012 CKD分期诊断标准,按不同公式计算的肾小球滤过率结果分为以下4组:CKD1期,GFR≥90mL/min/1.73m2;CKD2期,60≤GFR90mL/min/1.73m2;CKD3 期,30≤GFR60mL/min/1.73m2;CKD4-5期,GFR30mL/min/1.73m2。使用SPSS 22.0统计学软件对数据进行分析。用平均数±标准差或中位数(四分位间距)描述连续变量,用数字和百分比描述非连续变量。进行单因素分析计算风险比(hazard ratio,HR)和95%置信区间,如P0.1则将该因素纳入Cox比例风险模型进行多因素分析。用Kaplan-Meier法分析各组患者的累积生存率,用Log Rank检验比较组间差异。结果:本研究250例受者平均年龄是48.5(25-69)岁,平均随访时间为17.82±10.01月。采用KDIGO 2012CKD分期,根据CDK-EPI-CysC公式的术前肾小球滤过率结果进行分组,共有57.6%的受者术前肾功能为CKD 1期,22.4%为CKD 2期,15.2%为 CKD 3 期,5.2%为 CKD 4-5 期。MELD 评分(HR = 1.048,P0.001,95%置信区间1.024-1.072)升高和CDK-EPI-CysC公式计算的肾小球滤过率(HR= 0.991,P = 0.020,95%置信区间0.984-0.999)降低是肝脏移植受者术后死亡的独立风险因素。全样本6个月、1年、2年累积生存率分别为82.8%、80.0%、75.7%。分别基于CKD-EPI-Pcr公式、MDRD-4公式、MDRD-6公式、Hoek公式、CKD-EPI-CysC公式、CKD-EPI-Pcr-CysC公式的术前肾小球滤过率结果进行分组并作Kaplan-Meier生存曲线,其中基于CKD-EPI-Cys C公式的组间生存时间存在显著性差异(P=0.033),而基于CKD-EPI-Pcr公式(P=0.517)、MDRD-4公式(P=0.387)、MDRD-6 公式(P=0.400)、Hoek 公式(P=0.235)、CKD-EPI-Pcr-Cys C公式(P=0.500)的组间生存时间没有显著性差异。结论:MELD评分升高和基于CKD-EPI-Cys C公式的术前肾小球滤过率降低是肝脏移植术后生存情况的独立风险因素,且基于CKD-EPI-Cys C公式的肾功能分期对术后生存情况存在显著影响,因此血清胱抑素C可作为术前评估肝脏移植预后的工具,而术前血清肌酐浓度则无法预测肝脏移植术后受者生存情况。
[Abstract]:Background: glomerular filtration rate (glomerular filtration rate,GFR) is more accurate in patients with end-stage liver disease than in patients based on serum creatinine concentration and serum cystatin C concentration. Renal insufficiency before liver transplantation plays an important role in the survival rate of recipients after liver transplantation. The purpose of this study was to analyze the prognostic risk of liver transplantation based on preoperative serum cystatin C, and to explore the relationship between serum cystatin C concentration before liver transplantation and the survival of recipients after liver transplantation. Participants and methods: a total of 250 cases of liver transplantation with cardiac death donor (donation after cardiac death,DCD from January 2014 to January 2016 in the first affiliated Hospital of Zhejiang University were retrospectively collected. CKD-EPI-Pcr formula, MDRD-4 formula, MDRD-6 formula based on serum creatinine concentration, Hoek formula based on serum cystatin C concentration, CKD-EPI-CysC formula were used, respectively. The preoperative glomerular filtration rate was calculated by CKD-EPI-Pcr-Cys C formula based on serum cystatin C and serum creatinine concentration. According to KDIGO 2012 CKD staging criteria, the results of glomerular filtration rate calculated by different formulas were divided into the following four groups: CKD1 stage, GFR 鈮，

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