外科理论与实践 ›› 2022, Vol. 27 ›› Issue (02): 158-164.doi: 10.16139/j.1007-9610.2022.02.014
收稿日期:
2022-01-17
出版日期:
2022-05-25
发布日期:
2022-06-16
通讯作者:
滕飞,孙克彦
E-mail:188025796@qq.com;tengfei@smmu.edu.cn
基金资助:
ZHANG Lei1, MAO Jiaxi2, LI Tao1, TENG Fei2(), SUN Keyan1()
Received:
2022-01-17
Online:
2022-05-25
Published:
2022-06-16
Contact:
TENG Fei,SUN Keyan
E-mail:188025796@qq.com;tengfei@smmu.edu.cn
摘要:
目的: 观察肝移植治疗原发性胆汁性胆管炎(primary biliary cholangitis, PBC)的疗效及预后。方法: 回顾性分析上海交通大学医学院附属瑞金医院和上海长征医院2001年1月至2020年12月收治肝移植治疗PBC病人的临床资料。术前免疫炎症反应采用10个免疫炎症指标,包括全身免疫炎症指数、纤维蛋白原以及中性粒细胞、淋巴细胞、单核细胞、血小板、天冬氨酸转氨酶、CD4、CD8之间的比值。根据单核细胞与淋巴细胞的比值以及纤维蛋白原计算、得到评分。评分≥-0.12为高危组,<-0.12为低危组。生存率分析采用寿命表法。多因素分析采用二元Logistic回归模型和COX 回归分析。结果: 82例纳入研究。术后随访至2021年12月31日,时间4.54年(2 d~17.06年)。全部PBC肝移植病人的1、3、5、10、15年生存率为85%、79%、79%、79%、47%。中位生存期为12.92年。多因素分析显示,术前天冬氨酸转氨酶与血小板比值是影响PBC肝移植病人90 d生存的独立危险因素(P=0.013);术前单核细胞与淋巴细胞比值和术前纤维蛋白原是影响PBC病人肝移植术后住院时间的独立危险因素(P=0.002;P=0.007)。高危组总住院时间和住院费用都较低危组明显升高。结论: 术前免疫炎症反应可能影响PBC肝移植病人的近期预后。
中图分类号:
张磊, 毛家玺, 李涛, 滕飞, 孙克彦. 术前免疫炎症反应对原发性胆汁性胆管炎肝移植病人预后影响的双中心回顾性研究[J]. 外科理论与实践, 2022, 27(02): 158-164.
ZHANG Lei, MAO Jiaxi, LI Tao, TENG Fei, SUN Keyan. Effect of preoperative immunoinflammatory response on prognosis in patients undergoing liver transplantation for primary biliary cholangitis: a two-center retrospective study[J]. Journal of Surgery Concepts & Practice, 2022, 27(02): 158-164.
表1
影响PBC肝移植病人长期生存的COX分析(n=82)
项目 | 单因素分析 | ||
---|---|---|---|
HR | 95%CI | P值 | |
年龄(岁) | 0.984 | (0.950,1.019) | 0.370 |
性别(男/女) | 0.506 | (0.188,1.361) | 0.177 |
术前MELD评分(分) | 1.041 | (0.980,1.106) | 0.195 |
术前Child-Pugh评分(分) | 1.104 | (0.864,1.410) | 0.428 |
术前免疫炎症指标 | |||
SII | 0.998 | (0.996,1.000) | 0.067 |
NLR | 0.981 | (0.804,1.198) | 0.853 |
MLR | 0.822 | (0.126,5.381) | 0.838 |
PLR | 0.987 | (0.975,1.000) | 0.054 |
SIRI | 1.072 | (0.873,1.318) | 0.507 |
ANRI | 1.000 | (0.993,1.007) | 0.944 |
ALRI | 0.998 | (0.993,1.003) | 0.388 |
APRI | 1.120 | (0.822,1.525) | 0.472 |
FIB | 0.958 | (0.659,1.390) | 0.820 |
CD4/CD8 | 0.461 | (0.181,1.175) | 0.105 |
术后胆道并发症(有/无) | 0.039 | (0.000,18.665) | 0.304 |
术后AR(有/无) | 0.734 | (0.230,2.344) | 0.602 |
术后PBC复发(有/无) | 0.035 | (0.000,7.673) | 0.222 |
表2
影响PBC肝移植病人90 d生存状态的Logistic分析(n=82)
项目 | 单因素分析 | 多因素分析 | |||||
---|---|---|---|---|---|---|---|
RR | 95%CI | P值 | RR | 95%CI | P值 | ||
年龄(岁) | 0.985 | (0.933,1.040) | 0.579 | ||||
性别(男/女) | 0.176 | (0.040,0.774) | 0.021 | ||||
术前MELD评分(分) | 1.076 | (0.988,1.172) | 0.094 | ||||
术前Child-Pugh评分(分) | 1.271 | (0.885,1.827) | 0.195 | ||||
术前免疫炎症指标 | |||||||
SII | 0.997 | (0.994,1.001) | 0.178 | ||||
NLR | 1.174 | (0.948,1.453) | 0.141 | ||||
MLR | 1.893 | (0.184,19.440) | 0.591 | ||||
PLR | 0.975 | (0.949,1.001) | 0.056 | ||||
SIRI | 1.175 | (0.910,1.518) | 0.216 | ||||
ANRI | 1.000 | (0.991,1.010) | 0.940 | ||||
ALRI | 1.001 | (0.996,1.006) | 0.673 | ||||
APRI | 1.802 | (1.133,2.866) | 0.013 | 1.802 | (1.133,2.866) | 0.013 | |
FIB | 0.499 | (0.187,1.330) | 0.165 | ||||
CD4/CD8 | 0.560 | (0.172,1.824) | 0.336 |
表3
影响PBC病人肝移植术后总住院时间的Logistic分析(n=74)
项目 | 单因素分析 | 多因素分析 | |||||
---|---|---|---|---|---|---|---|
RR | 95%CI | P值 | RR | 95%CI | P值 | ||
年龄(岁) | 1.003 | (0.966,1.040) | 0.895 | ||||
性别(男/女) | 0.929 | (0.333,2.591) | 0.887 | ||||
术前MELD评分(分) | 1.016 | (0.954,1.081) | 0.626 | ||||
术前Child-Pugh评分(分) | 1.090 | (0.866,1.371) | 0.465 | ||||
术前免疫炎症指标 | |||||||
SII | 1.001 | (0.999,1.003) | 0.242 | ||||
NLR | 1.387 | (1.097,1.752) | 0.006 | ||||
MLR | 54.275 | (3.713,793.323) | 0.004 | 128.462 | (6.127,2 693.461) | 0.002 | |
PLR | 1.007 | (0.998,1.016) | 0.149 | ||||
SIRI | 1.446 | (1.068,1.958) | 0.017 | ||||
ANRI | 0.995 | (0.987,1.004) | 0.272 | ||||
ALRI | 1.002 | (0.998,1.006) | 0.371 | ||||
APRI | 1.174 | (0.813,1.696) | 0.392 | ||||
FIB | 0.425 | (0.226,0.797) | 0.008 | 0.343 | (0.158,0.744) | 0.007 | |
CD4/CD8 | 1.024 | (0.621,1.687) | 0.927 |
表4
MF评分高危组与低危组病人的比较[$\bar{x}\pm s$/中位数(最小值~最大值)/n]
项目 | 高危组(n=38) | 低危组(n=36) | Z/t/χ2值 | P值 |
---|---|---|---|---|
年龄(岁) | 49±11 | 48±14 | 0.167 | 0.868 |
性别(男/女) | 10/28 | 10/26 | 0.020 | 0.887 |
术前MELD评分(分) | 23(12~35) | 18(8~36) | 1.791 | 0.003 |
术前Child-Pugh评分(分) | 10±2 | 9±2 | 2.476 | 0.016 |
术前免疫炎症指标 | ||||
SII | 344.37(80.57~1 343.95) | 121.16(28.62~1 036.10) | 2.056 | <0.001 |
NLR | 4.83(1.58~14.36) | 2.45(0.53~6.48) | 2.426 | <0.001 |
MLR | 0.52(0.21~1.43) | 0.23(0.11~0.60) | 3.156 | <0.001 |
PLR | 86.16(38.95~277.08) | 78.72(21.13~309.38) | 0.899 | 0.394 |
SIRI | 1.83(0.26~8.76) | 0.39(0.13~3.64) | 2.546 | <0.001 |
ANRI | 26.02(2.51~467.74) | 36.46(11.06~185.27) | 1.402 | 0.039 |
ALRI | 152.55(12.33~737.29) | 97.95(10.90~251.58) | 1.345 | 0.054 |
APRI | 1.27(0.16~6.64) | 1.10(0.22~3.57) | 1.685 | 0.007 |
FIB | 1.63(0.51~3.78) | 2.04(1.45~5.89) | 2.037 | <0.001 |
CD4/CD8 | 1.75(0.82~5.08) | 1.88(0.83~4.53) | 0.603 | 0.860 |
术后总住院时间(d) | 47(13~158) | 32(18~84) | 1.515 | 0.020 |
术后ICU住院时间(d) | 8(2~73) | 7(5~34) | 0.937 | 0.344 |
术后住院费用(万元) | 20.90(12.34~57.90) | 18.33(11.38~32.09) | 1.490 | 0.024 |
术后胆道并发症(有/无) | 6/32 | 4/32 | 0.062 | 0.804 |
术后AR(有/无) | 11/27 | 5/31 | 2.474 | 0.116 |
术后PBC复发(有/无) | 4/34 | 6/30 | 0.187 | 0.666 |
表5
2001—2020年前、后10年病人的比较[$\bar{x}\pm s$/中位数(最小值~最大值)/n]
项目 | 前10年组(n=32) | 后10年组(n=50) | Z/t/χ2值 | P值 |
---|---|---|---|---|
年龄(岁) | 50(6~62) | 52(7~72) | 0.745 | 0.635 |
性别(男/女) | 12/20 | 13/37 | 1.218 | 0.270 |
术前MELD评分(分) | 22(11~38) | 19(8~36) | 1.137 | 0.150 |
术前Child-Pugh评分(分) | 10±2 | 9±2 | 2.367 | 0.020 |
术后总住院时间(d) | 38(2~80) | 34(13~158) | 0.541 | 0.931 |
术后ICU住院时间(d) | 7(2~17) | 8(4~73) | 0.701 | 0.709 |
术后住院费用(万元) | 20.04(10.12~57.90) | 18.95(10.67~42.68) | 1.115 | 0.166 |
术后胆道并发症(有/无) | 4/28 | 6/44 | 0.000 | 1.000 |
术后AR(有/无) | 10/22 | 8/42 | 2.649 | 0.104 |
术后PBC复发(有/无) | 6/26 | 4/46 | 1.222 | 0.269 |
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