【摘要】：背景:在終末期肝病患者中,相較于基于血清肌酐濃度,基于血清胱抑素C濃度評(píng)估的腎小球?yàn)V過(guò)率(glomerular filtration rate,GFR)更為準(zhǔn)確。肝臟移植術(shù)前腎功能不全對(duì)術(shù)后受者的生存率有重要影響。本研究旨在進(jìn)行基于術(shù)前血清胱抑素C的肝臟移植預(yù)后風(fēng)險(xiǎn)分析,探究肝臟移植術(shù)前血清胱抑素C濃度與移植后受者生存情況的關(guān)系。對(duì)象和方法:本研究共回顧性收集了 250例于2014年1月至2016年1月期間在浙江大學(xué)附屬第一醫(yī)院行心臟死亡供體(donation after cardiac death,DCD)來(lái)源肝臟移植手術(shù)的病例數(shù)據(jù)。分別使用基于血清肌酐濃度的CKD-EPI-Pcr公式、MDRD-4公式、MDRD-6公式,基于血清胱抑素C濃度的Hoek公式、CKD-EPI-CysC公式,以及同時(shí)基于血清胱抑素C和血清肌酐濃度的CKD-EPI-Pcr-Cys C公式計(jì)算受者的術(shù)前腎小球?yàn)V過(guò)率。采用KDIGO 2012 CKD分期診斷標(biāo)準(zhǔn),按不同公式計(jì)算的腎小球?yàn)V過(guò)率結(jié)果分為以下4組:CKD1期,GFR≥90mL/min/1.73m2;CKD2期,60≤GFR90mL/min/1.73m2;CKD3 期,30≤GFR60mL/min/1.73m2;CKD4-5期,GFR30mL/min/1.73m2。使用SPSS 22.0統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行分析。用平均數(shù)±標(biāo)準(zhǔn)差或中位數(shù)(四分位間距)描述連續(xù)變量,用數(shù)字和百分比描述非連續(xù)變量。進(jìn)行單因素分析計(jì)算風(fēng)險(xiǎn)比(hazard ratio,HR)和95%置信區(qū)間,如P0.1則將該因素納入Cox比例風(fēng)險(xiǎn)模型進(jìn)行多因素分析。用Kaplan-Meier法分析各組患者的累積生存率,用Log Rank檢驗(yàn)比較組間差異。結(jié)果:本研究250例受者平均年齡是48.5(25-69)歲,平均隨訪時(shí)間為17.82±10.01月。采用KDIGO 2012CKD分期,根據(jù)CDK-EPI-CysC公式的術(shù)前腎小球?yàn)V過(guò)率結(jié)果進(jìn)行分組,共有57.6%的受者術(shù)前腎功能為CKD 1期,22.4%為CKD 2期,15.2%為 CKD 3 期,5.2%為 CKD 4-5 期。MELD 評(píng)分(HR = 1.048,P0.001,95%置信區(qū)間1.024-1.072)升高和CDK-EPI-CysC公式計(jì)算的腎小球?yàn)V過(guò)率(HR= 0.991,P = 0.020,95%置信區(qū)間0.984-0.999)降低是肝臟移植受者術(shù)后死亡的獨(dú)立風(fēng)險(xiǎn)因素。全樣本6個(gè)月、1年、2年累積生存率分別為82.8%、80.0%、75.7%。分別基于CKD-EPI-Pcr公式、MDRD-4公式、MDRD-6公式、Hoek公式、CKD-EPI-CysC公式、CKD-EPI-Pcr-CysC公式的術(shù)前腎小球?yàn)V過(guò)率結(jié)果進(jìn)行分組并作Kaplan-Meier生存曲線,其中基于CKD-EPI-Cys C公式的組間生存時(shí)間存在顯著性差異(P=0.033),而基于CKD-EPI-Pcr公式(P=0.517)、MDRD-4公式(P=0.387)、MDRD-6 公式(P=0.400)、Hoek 公式(P=0.235)、CKD-EPI-Pcr-Cys C公式(P=0.500)的組間生存時(shí)間沒(méi)有顯著性差異。結(jié)論:MELD評(píng)分升高和基于CKD-EPI-Cys C公式的術(shù)前腎小球?yàn)V過(guò)率降低是肝臟移植術(shù)后生存情況的獨(dú)立風(fēng)險(xiǎn)因素,且基于CKD-EPI-Cys C公式的腎功能分期對(duì)術(shù)后生存情況存在顯著影響,因此血清胱抑素C可作為術(shù)前評(píng)估肝臟移植預(yù)后的工具,而術(shù)前血清肌酐濃度則無(wú)法預(yù)測(cè)肝臟移植術(shù)后受者生存情況。
[Abstract]:Background: glomerular filtration rate (glomerular filtration rate,GFR) is more accurate in patients with end-stage liver disease than in patients based on serum creatinine concentration and serum cystatin C concentration. Renal insufficiency before liver transplantation plays an important role in the survival rate of recipients after liver transplantation. The purpose of this study was to analyze the prognostic risk of liver transplantation based on preoperative serum cystatin C, and to explore the relationship between serum cystatin C concentration before liver transplantation and the survival of recipients after liver transplantation. Participants and methods: a total of 250 cases of liver transplantation with cardiac death donor (donation after cardiac death,DCD from January 2014 to January 2016 in the first affiliated Hospital of Zhejiang University were retrospectively collected. CKD-EPI-Pcr formula, MDRD-4 formula, MDRD-6 formula based on serum creatinine concentration, Hoek formula based on serum cystatin C concentration, CKD-EPI-CysC formula were used, respectively. The preoperative glomerular filtration rate was calculated by CKD-EPI-Pcr-Cys C formula based on serum cystatin C and serum creatinine concentration. According to KDIGO 2012 CKD staging criteria, the results of glomerular filtration rate calculated by different formulas were divided into the following four groups: CKD1 stage, GFR 鈮，

本文編號(hào)：2305268