本文選題：肝移植　切入點(diǎn)：高鈉血癥　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:一直以來,供肝的數(shù)量遠(yuǎn)遠(yuǎn)無法滿足肝移植的需要。為此,臨床工作中促使了擴(kuò)大供肝標(biāo)準(zhǔn)的概念,包括本文的高鈉血癥供肝。目前尚沒有足夠的證據(jù)表明高鈉血癥供肝對(duì)肝移植預(yù)后有顯著影響。目的:研究供體獲取前高鈉血癥對(duì)肝移植術(shù)后患者短期及長期生存率的影響方法:統(tǒng)計(jì)移植受者科學(xué)登記處數(shù)據(jù)庫中(2004-2008年)23494例第一次接受單純肝移植的患者。本研究高鈉血癥定義為160μmol/L。其中1645例屬于高鈉血癥供體。受體及供體基線資料中分類變量采用了卡方檢驗(yàn),連續(xù)變量采用了 t檢驗(yàn)。對(duì)于患者的生存率及移植物的生存率,我們采用了 Kaplan-Meier法繪制生存曲線,同時(shí)采用Cox回歸模型分析。結(jié)果:Kaplan-Meier分析表明在移植物和患者的總體生存率上供體高鈉血癥組顯著低于供體非高鈉血癥組,且供體高鈉血癥組在肝移植術(shù)后1、3、5年移植物生存率(78.1%,70.4%,60.1%)顯著低于非高鈉血癥組(79.8%,71.8%,65.6%)。供體高鈉血癥組在肝移植術(shù)后1、3、5年患者生存率(74.6%,68.4%,58.5%)也顯著低于非高鈉血癥組(76.2%,70.1%,61.7%)。Cox回歸分析表明供體獲取前高鈉血癥對(duì)移植后移植物生存率的多因素危險(xiǎn)比例為HR 1.164,95%CI 1.054-1.511;供體獲取前高鈉血癥對(duì)移植后患者的生存率的多因素危險(xiǎn)比例為HR 1.212,95%CI 1.034-1.389。結(jié)論:使用供體高鈉血癥的供肝會(huì)顯著降低移植物及病人的生存率,并且是肝移植預(yù)后的獨(dú)立危險(xiǎn)因素。
[Abstract]:Background: the number of liver donors has been far from meeting the needs of liver transplantation. For this reason, clinical work has led to the concept of expanding the standard of donor liver. At present, there is not enough evidence that hypernatremia donor liver has a significant effect on the prognosis of liver transplantation. Objective: to study the effect of hypernatremia before donor acquisition on short-term and long-term birth of patients after liver transplantation. Methods: a total of 23, 494 patients received liver transplantation for the first time from 2004 to 2008 in the scientific registry database of transplant recipients. Hypernatremia was defined as 160 渭 mol / L in this study. Of these, 1 645 belonged to hypernatremia donors, receptors and donors. The classification variables in the baseline data are chi-square test. T test was used for the continuous variables. For the survival rate of the patients and the survival rate of the grafts, we used the Kaplan-Meier method to draw the survival curve. Results the overall survival rate of grafts and patients was significantly lower in donor hypernatremia group than in donor non-hypernatremia group. The survival rate of donor hypernatremia group was significantly lower than that of non-hypernatremia group (79.8%). The survival rate of donor hypernatremia group was 74.68.48.48.58.54.64.68.48.55.The survival rate of donor hypernatremia group was significantly lower than that of non-hypernatremia group (76.270.1 + 61.70.41% vs 71.70.41%, P < 0.05), and the 5-year survival rate of donor hypernatremia group was 74.68.48.58.5), which was significantly lower than that of non-hypernatremia group (79.78% vs 71.70.1%). The multivariate risk ratio of hypernatremia before donor acquisition to graft survival was 1.16495 CI 1.054-1.511, and the multivariate risk ratio of hypernatremia before donor acquisition was 1.212995 CI 1.034-1.389.Conclusion:. The donor liver with hypernatremia significantly reduced the survival rate of both the graft and the patient. It is an independent risk factor for the prognosis of liver transplantation.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.3
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本文編號(hào)：1590338