肝移植治疗酒精性肝病的回顾性分析

摘要

Objective To evaluate the outcome of patients with alcoholic liver disease (ALD) after orthotopic liver transplantation (OLT) and to study the prognostic factors.Methods The data of 17 patients who underwent OLT for ALD from January 2010 to March 2013 were analyzed retrospectively.The data on age,gender,history of gastrointestinal bleeding,history of splenectomy,Child-Pugh score,Maddrey' s discriminant function and MELD score were evaluated using the Kaplan-Meier method for univariate analysis.The log-rank test was applied to compare the survival rates.Results The overall survival rate at 100 weeks in patients less than 55 years old was 90％ (9/10),while that in patients more than 55 years old was 28.57％ (2/7).There was a significant difference between the two groups (P ＜ 0.05).There were no statistically significant differences between female and male patients,between patients with or without a history of gastrointestinal bleeding or splenectomy (P ＞ 0.05).There was no significant difference on survival rates after liver transplantation between patients with Child-Pugh B and Child-Pugh C,patients with Maddrey' s scores ＜ 70 and ≥70,and patients with a MELD score ＜ 30 and ≥ 30 (P ＞ 0.05).Conclusions Better survival rates were observed in ALD patients who were ＜ 55 years old after liver transplantation.The Child-Pugh score,Maddrey' s discriminant function and MELD score were of no prognostic significance.These findings still need to be verified by prospective large-scale studies.%目的 探讨原位肝移植治疗酒精性肝病的疗效和预后影响因素.方法 回顾性分析郑州人民医院肝移植科2010年1月至2013年3月收治的17例接受原位肝移植的酒精性肝病患者的临床资料.分析肝移植后并发症的发生情况和预后,分别对年龄、性别、消化道出血史、脾切除史、Child-Pugh评分、Maddrey辨别函数、MELD评分用Kaplan-Meier法进行单因素分析,采用log-rank检验比较生存率.结果 年龄小于55岁的酒精性肝病患者肝移植后100周生存者有9例(90％,9/10),大于55岁的患者术后100周生存2例(28.6％,2/7),差异有统计学意义(P＜0.05).分析显示不同性别、有无消化道出血史、脾切除史与术后生存率无显著关联(P＞0.05);Child-Pugh评分B级组与C级组、Maddrey评分＜70组与 ≥70组以及MELD评分＜30组与≥30组肝移植术后生存率差异亦均无统计学意义(P＞0.05).结论 酒精性肝病患者肝移植术后25周、50周、100周存活率较为理想,尤其是在年龄小于55岁者.研究未发现Child-Pugh评分、Maddrey评分和MELD评分对酒精性肝病患者肝移植预后判断有何指导意义,但该结论仍需进一步的大样本前瞻性研究予以明确.