供体血钠、供受体血钠差值对肝移植患者术后的影响

Influence of donor blood sodium and donor-recipient blood sodium difference on patients after liver transplantation

摘要:

目的：探讨肝移植供体血钠、供受体血钠差值对肝移植患者术后的影响。方法：回顾性分析2016年7月至2018年5月我院行供体器官维护并行肝移植术的供体及肝移植患者分别20例，记录临床资料进行分析。结果：①供体最高血钠Na>155 mmol/L与Na<155 mmol/L两组肝移植患者术后最高总胆红素、最高丙氨酸氨基转移酶（alanine transaminase，ALT）、门冬氨酸氨基转移酶（aspartate transaminase，AST）、肝功能恢复时间、重症监护病房（intensive care unit，ICU）住院时间、总住院时间差异无统计学意义。②供体移植时血钠分为Na>155 mmol/L与Na<155 mmol/L 2组，其中Na<155 mmol/L组术后最高ALT更高[（747.17±375.34） U/L vs. （357.00±190.50） U/L，t=-2.700，P=0.015]。③供受体血钠差值ΔNa<10 mmol/L、ΔNa=10~20 mmol/L、ΔNa>20 mmol/L 3组肝移植患者术后最高ALT有差异[（805.00±332.90） U/L、（329.75±237.43） U/L、（329.60±186.21） U/L，F=6.714，P=0.007]；两两分析示ΔNa<10 mmol/L组肝移植术后最高ALT比其他2组更高（P=0.012，P=0.007），ΔNa=10~20 mmol/L与ΔNa >20 mmol/L组无统计学差异（P=0.999）。④供受体血钠差值ΔNa与肝移植患者术后最高ALT两者存在线性负相关（相关系数R=-0.579，P=0.007），ΔNa越小，术后最高ALT越大。⑤回归分析示肝移植患者术前终末期肝病模型评分（model for end-stage liver disease，MELD）是移植术后感染并发症发生独立危险因素。结论：供体移植时血钠低于155 mmol/L肝移植患者术后最高ALT更高；供受体血钠差值ΔNa越小，术后最高ALT更高；MELD评分是肝移植患者术后感染并发症的独立危险因素。

Abstract:

Objective：To investigate the effect of donor blood sodium and donor-recipient blood sodium difference on patients after liver transplantation. Methods：A retrospective analysis was performed for the clinical data of 20 donors who underwent donor organ main－tenance and 20 patients who underwent liver transplantation in our hospital from July 2016 to May 2018. Related clinical data were analyzed. Results：There were no significant differences in the highest levels of total bilirubin，alanine aminotransferase（ALT），and aspartate aminotransferase（AST），recovery time of liver function，length of stay in the intensive care unit，and length of hospital stay after liver transplantation between the blood sodium >155 mmol/L donor group and the blood sodium <155 mmol/L donor group. According to donor blood sodium at the time of transplantation，the patients were divided into donor blood sodium >155 mmol/L group and donor blood sodium <155 mmol/L group，and the highest ALT level after surgery in the donor blood sodium <155 mmol/L group was significantly higher than that in the donor blood sodium >155 mmol/L group（747.17±375.34 U/L vs. 357.00±190.50 U/L，t=-2.700，P=0.015）. According to donor-recipient blood sodium difference（ΔNa），the patients were divided into ΔNa <10 mmol/L，ΔNa=10-20 mmol/L，and ΔNa >20 mmol/L groups，and there was a significant difference in the highest ALT level after liver transplantation between the three groups（805.00±332.90 U/L vs. 329.75±237.43 U/L vs. 329.60±186.21 U/L，F= 6.714，P=0.007）；the highest ALT level after liver transplantation in the ΔNa<10 mmol/L group was significantly higher than that in the other two groups（P=0.012 and 0.007），and there was no significant difference between the ΔNa=10-20 mmol/L group and the ΔNa>20 mmol/L group（P=0.999）. ΔNa was nega－tively correlated with the highest ALT level after liver trans－plantation（r=-0.579，P=0.007），and the highest ALT level after liver transplantation increased with the reduction in ΔNa. The linear regression analysis showed that model for end-stage liver disease（MELD） score was an independent risk factor for infec－tion after liver transplantation. Conclusion：Donor blood sodium <155 mmol/L may result in an increase in the highest ALT level after liver transplantation. The highest ALT level after liver transplantation increases with the reduction in ΔNa. MELD score is an inde－pendent risk factor for infection after liver transplantation.