肝移植治疗慢加急性肝衰竭3级临床疗效初步分析

摘要

目的 分析肝移植治疗慢加急性肝衰竭3级患者的临床疗效和影响因素.方法 回顾性分析2015年1月至2017年12月天津市第一中心医院拟行肝移植的33例慢加急性肝衰竭3级患者资料,其中男性28例,女性5例,年龄(43.4±12.3)岁.33例患者中21例接受肝移植纳入肝移植组,12例未接受肝移植纳入对照组.收集所有患者住院资料和随访信息.Kaplan-Meier法分析两组生存情况.单因素和多因素Cox回归分析肝移植组术后死亡的危险因素.结果 肝移植组与对照组术前Child-Pugh评分、总胆红素、肌酐、感染等方面比较,差异无统计学意义(P＞0.05).肝移植组患者年龄大于对照组,差异有统计学意义(P＜0.05).Kaplan-Meier生存分析显示,肝移植组1年和3年累积生存率分别为61.9％和61.9％.对照组1年和3年累积生存率分别为8.3％和8.3％.两组患者生存率比较,差异有统计学意义(P＜0.05).肝移植组21例患者获得长期随访,其中13例存活,随访163～1 123 d,除1例术后肾功能不全合并肾性贫血外,其余12例肝功能正常;8例于肝移植术后2～54 d死亡.单因素和多因素Cox回归分析,术后休克(RR=15.257,95％CI:1.838～126.639)是慢加急性肝衰竭3级患者肝移植术后死亡的独立危险因素.结论 慢加急性肝衰竭3级是肝移植治疗适应证,术后休克是影响患者肝移植术后死亡的独立危险因素.%Objective To investigate the clinical efficacy and influencing factors in patients with acute-on-chronic liver failure grade 3 after liver transplantation.Methods 33 patients with acute-on-chronic grade 3 liver failure who were treated in Tianjin First Center Hospital from January 2015 to December 2017 was retrospectively analyzed,including 21 patients in liver transplantation group and 12 patients in control group.Among them,28 patients were males and 5 patients were females,aged (43.4± 12.3) years.The data and follow-up information of all patients were collected.The survival condition was analyzed by Kaplan-Meier.Univariate and multivariate Cox regression analysis was used to analyze the risk factors of death in patients after liver transplantation.Results There was no significant difference in Child-Pugh score,total bilirubin,creatinine and infection before operation between liver transplantation group and control group (P＞0.05).The age of patients in liver transplantation group was older than the control group,the difference was statistically significant (P＜0.05).The 1-year and 3-year cumulative survival rates in the liver transplantation group were 61.9％ and 61.9％ respectively and the rates in control group were 8.3％ and 8.3％ respectively by Kaplan-Meier survival analysis.There was significant difference between the two groups (P＜0.05).Twenty-one patients in the liver transplantation group were followed up for a long time,13 patients survived and followed up for 163～ 1 123 days.Except for renal insufficiency complicated with renal anemia in 1 case,the other 12 cases had normal liver function,and 8 cases died in 2～54 days after liver transplantation.Postoperative shock was an independent risk factor for death after liver transplantation by univariate and multivariate Cox regression analysis.Conclusion Acute-on-chronic grade 3 liver failure was indication for liver transplantation,postoperative shock was an independent risk factor for death after liver transplantation.