儿童肝移植术后生长发育的临床研究

摘要

目的：探讨儿童肝移植术后的生长发育状况。方法选择2006年9月至2014年5月于北京友谊医院及天津市第一中心医院接受肝移植术的70例患儿为研究对象，分别计算每例患儿移植时和术后6个月、1年、2年、3年、4年和5年的身高 Z 评分（ZH ）、体重 Z 评分（ZW）。分析患儿 ZH、Zw 评分在各个时间点的变化趋势，并将其各个时间点的 ZH 和 ZW 评分与2005年中国九省／市儿童体格发育调查数据制定的生长标准均数0（标准均数）进行比较；按照移植时 ZH、ZW 评分将患儿分别分为 Z≥－2组和 Z ＜－2组，比较各组患儿 ZH、ZW 评分的变化趋势。结果肝移植时患儿 ZH和 ZW 评分均数分别为－1.63±1.35和－1.53±1.52。接受肝移植术后，ZH、Zw 评分逐渐提高。患儿的 ZH 和 ZW 评分在移植时和术后6个月的平均水平均明显低于标准均数（均为 P ＜0.01），其余术后时间段 ZH 和 ZW 评分与标准均数比较，差异无统计学意义（均为 P ＞0.05）。ZH 评分＜－2组和≥－2组患儿的 ZH 评分在移植时、术后6个月、术后 1年比较，差异有统计学意义（均为 P ＜0.05）。ZW 评分＜－2组和≥－2组患儿的 ZW 评分在移植时、术后6个月、术后 1年、术后 2年比较，差异均有统计学意义（均为 P ＜0.05）。结论儿童肝移植患儿在术后生长发育逐渐恢复，术后 1年出现明显快速增长。%[Abstract ] Objective To investigate the growth and development of children after liver transplantation.Methods Seventy children who underwent liver transplantation in Beijing Friendship Hospital and Tianjin First Central Hospital from September 2006 to May 2014 were included in the study.Height Z-scores (ZH )and weight Z-scores (ZW )of each child were respectively calculated at transplantation and 6 months,1 year,2 years,3 years,4 years and 5 years after transplantation.The change trends of ZH and ZW at each time point were analyzed.Moreover,ZH and ZW at each time point were compared with the standardized mean of growth 0 (standardized mean ) formulated according to the survey data of children's physical development in nine provinces and municipalities in 2005.Children were divided into Z≥ -2 group and Z <-2 group according to ZH and ZW at transplantation.And the change trend of ZH and ZW of each group was compared.Results The mean of ZH and ZW at the time of liver transplantation was -1.63 ± 1.35 and-1.53 ±1.52 respectively.After liver transplantation,ZH and ZW increased gradually.ZH and ZW of children before transplantation and 6 months after transplantation were significantly lower than standardized mean (all in P <0.01).ZH and ZW in other postoperative periods had no statistical significance with standardized mean (all in P >0.05).There were significant difference between ZH≥ -2 group and ZH <-2 group at transplantation and 6 months and 1 year after transplantation (both in P <0.05).Zw of Zw≥ -2 group and Zw <-2 group at transplantation and 6 months,1 year and 2 years after transplantation had difference with statistical significance (all in P <0.05).Conclusions The growth and development of children with liver transplantation recover gradually and increase significantly at 1 year after transplantation.