摘要
目的了解肝移植患者术后急性肾损伤（AKI）的发生情况，以及AKI与预后的关系。方法回顾性分析2004年至2006年在上海仁济医院行原位经典肝移植手术成人患者的临床资料。用急性肾损伤网络（AKIN）定义的AKI诊断和分期标准观察肝移植患者术后AKI的发生情况。应用Kaplan—Meier生存曲线分析患者术后28d和1年的肾脏和患者预后。分析AKI对患者预后的影响。结果符合入选标准的共193例，平均年龄（48．07-＋10．02）岁，男女比例4：1。术后共有116例（60．1％）患者发生了118例次AKI，1、2、3期分别占50．0％、21．6％和28．4％。10例患者术后需行肾替代治疗，占术后AKI患者的8．6％。AKI患者术后28d（15．5％比0）和1年（25．9％比3．9％）的病死率显著高于术后非AKI患者（均P〈0．05）。Kaplan．Meier生存分析显示，术后AKI1、2、3期和非AKI患者1年存活率分别为84．0％、81．0％、42．4％和90．9％，后者显著高于前3者；AKI3期的1年存活率显著低于1、2期患者；而AKI 1期和2期的1年存活率差异无统计学意义。患者术后1年的Scr显著高于基础Scr【（88．35±7．15）比（73．70±33．88）μmol／L，P〈0．05】。1年前后Scr差值在AKI和非AKI组间差异无统计学意义，但AKI2期和3期患者的上述差值显著高于1期患者。结论AKI在肝移植患者术后常见，且与患者的近期和长期预后有关。肝移植术后患者肾功能逐渐减退，术后AKI发生的程度与术后长期肾功能减退有关。
Objective To investigate the incidence of acute kidney injury （AKI） postorthotopie liver transplant （ OLT ） and its association with prognosis. Methods Data of 28 patients received single OLT in our hospital from 2004 to 2006 were retrospectively analyzed. The incidence of AKI was investigated by new acute kidney injury network （AKIN） criteria. The follow- up was over one year. The prognosis of AKI patients at day 28 and 1 ）rear was evaluated by Kaplan-Meier survival analysis. The association between AKI anti prognosis was examined. Results A total of 193 patients were enrolled. The average age was （48.07±10.02） years old. The ratio of male to female was 4：1. One hundred and sixteen （60.1%） patients of post-OLT AKI were found, whose AKI stage 1, 2 and 3 were 50.0%, 21.6% and 28.4% respectively. Ten （8.6%） patients required renal replacement therapy （RRT） after OLT. In AKI post-OLT patients, day 28 and 1 year mortality were significantly higher than those in non-AKI patients （15.5% vs 0, 25.9% vs 3.9%, respectively, both P〈0.05）. Kaplan-Meier survival analysis showed the 1-year survival rates of AKI stage 1, 2, 3 post-OLT and non-AKI were 84.0%, 81.0%, 42.4% and 90.9%, respectively. The 1-year survival rate of non-AKI was significantly higher than that of AKI stage 1, 2, 3. The 1-year survival rate of AKI stage 3 was significantly lower than that of stage 1 and 2. There was no significant difference between AKI stage 1 and 2. Scr at 1 year post-OLT was significantly higher than that of baseline [（88.35±37.15） vs （73.70±33.88） Ixmol/L, P〈0.05）. The change of Scr value at 1 year compared to baseline in AKI patients was similar to non-AKI patients. However such change in AKI stage 2 and 3 was higher than that in stage 1. Conclusions The incidence of AKI post-OLT is quite high and associated to the poor prognosis in short and long periods. Renal function may decrease gradually which is associated to the AKI stage post-OLTI.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2009年第2期86-92,共7页
Chinese Journal of Nephrology
基金
基金项目：上海市医学发展基金重点研究课题（2003ZD001）
上海市医药卫生基金（2007-135）
关键词
肾功能不全
急性
肝移植
发生率
病死率
Renal insufficiency, acute
Liver transplantation
Incidence
Mortality
