摘要
目的探讨肝移植供体供肝获取术前的炎症相关指标和受体术后早期临床指标对受体术后生存的影响及供体进行器官维护的意义。方法 2015年2月至2016年7月中山大学附属第一医院实施66例肝移植手术。供体入院时和器官维护后均检测炎症因子外周血肿瘤坏死因子(TNF)、白细胞介素6(IL-6)、白细胞介素10(IL-10)、脑钠肽(BNP)、降钙素原(PCT)、乳酸(Lac)等浓度。术后早期检测受体总胆红素(TBIL)、碱性磷酸酶(ALT)浓度及国际标准化比值(INR)。采用配对t检验比较器官维护前后供体炎症因子浓度差异;采用χ~2检验进行影响受体术后生存的单因素分析;采用COX比例风险回归模型筛选受体术后生存的独立危险因素。结果供体维护后,供体血清TNF、IL-6浓度均较入院时下降[(13.13±8.27)ng/L vs(20.91±18.80)ng/L,(141.58±272.55)ng/L vs(387.20±404.33)ng/L,且差异均有统计学意义(t=-3.715、-4.052,P均<0.001);供体术前TNF、PCT浓度,受体术后早期INR、ALT浓度是受体生存预后的单因素影响因素(χ~2=6.176,P=0.029;χ~2=0.010,P=0.339;χ~2=0.971,P=0.346;χ~2=1.277,P=0.283)。COX多因素回归分析结果显示,供体器官获取前TNF浓度是肝移植受体术后短期生存率的独立影响因素(相对危险度1.138,95%置信区间为0.000-0.309,P=0.001)。结论供体术前TNF浓度升高为肝移植受体术后生存的独立危险因素;供体器官维护可降低TNF浓度并改善受体预后。
Objective To investigate the effect of inflammatory factors of donors before liver harvest and early postoperative clinical parameters of recipientson the survival of recipients and the meaning of donor maintenance in liver transplantation.Methods Retrospective analysis clinical data of 66 patients who received hepatic allografts in the First Affiliated Hospital of Sun Yat-sen University from 2015 February to 2016 July. Tumor necrosis factor （TNF）, interleukin-6 （IL-6）, interleukin-10 （IL-10）, brain natriuretic peptide （BNP）, procalcitonin （PCT）, lactic acid （Lac） of donors before and after the donor maintenance and total bilirubin （TBIL）, alkaline phosphatase （ALT）, international normalized ratio （INR） of recipients was measured. Paired t-test was performed to analyse the difference of donor inflammatory factors before and after the donor maintenance. Chi square test and Cox regression model were performed to analyze the risk factors of recipients survival after transplantation.Results After donor maintenance, The level of TNF and IL-6 were significantly reduced [ （13.13±8.27） ng/L vs （20.91±18.80） ng/L, （141.58±272.55） ng/L vs （387.20±404.33） ng/L, t=-3.715, -4.052, both P〈0.001]. The univariate analysis revealed that the level of TNF, PCT of donors, and the level of INR, ALT of recipients were the independent risk factors of short-term survival in liver transplantation patients （χ^2=6.176, P=0.029; χ^2=0.010, P=0.339; χ^2=0.971, P=0.346; χ^2=1.277, P=0.283）. However, the COX multivariate regression analysis revealed that only the level of TNF before donor liver harvest was the independent risk factor of short-term survival in liver transplantation patients （RR 1.138, 95% CI 0.000-0.309, P=0.001）.Conclusions Increased level of TNF of donors before harvest was associated with the survival of recipients. Donor maintenance could reduce the TNF level and further improve the survival of recipients.
出处
《中华重症医学电子杂志》
2017年第2期111-115,共5页
Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)
基金
广东省器官捐献与移植免疫重点实验室建设项目(2013A061401007)
关键词
肝移植
器官维护
肿瘤坏死因子
受体生存
Liver transplantation
Donor maintenance
Tumor Necrosis Factor
Recipient survival
