肝移植患者术后巨细胞病毒感染的危险因素分析

doi:10.3969/j.issn.1006-7795.2021.04.025

摘要/Abstract

摘要： 目的通过分析肝移植患者住院期间的不同特征以寻找巨细胞病毒(cytomegalovirus, CMV)感染的危险因素。方法对2016年12月至2019年2月在首都医科大学附属北京朝阳医院肝胆胰脾外科行肝移植手术并具有CMV实验室检查结果的134例患者的临床资料进行回顾性分析,其中男性113例,女性21例,平均年龄(52±10)岁。根据术后3个月内是否有CMV感染分为感染组(n=24)和对照组(n=110)。应用独立样本t检验、Mann-Whitney U秩和检验对定量资料进行单因素分析,应用卡方检验对定性资料进行单因素分析,应用Logistic回归分析进行多因素分析,探讨肝移植患者术后CMV感染的危险因素。结果单因素分析结果显示,年龄(P=0.005)、终末期肝病模型(model for end-stage liver disease, MELD)评分(P=0.001)、Child-Pugh评分(P=0.048)、总胆红素(P=0.002)、国际标准化比值(international normalized ratio, INR)(P=0.002)、血氨(P=0.040)、腹水(P=0.042);术中术式(P=0.023)、失血量(P=0.006)、输血量(P=0.004);术后入住重症监护室(intensive care unit, ICU)时间(P=0.016)等因素是肝移植术后CMV感染的危险因素。多因素分析结果提示,MELD评分(P=0.007,95% CI:1.027~1.187)可能为肝移植术后CMV感染的独立危险因素。钙调磷酸酶抑制剂(calcineurin inhibitor, CNI)、霉酚酸酯(mycophenolate mofetil, MMF)、糖皮质激素等免疫抑制剂以及多克隆抗体的使用与肝移植患者术后早期CMV感染不相关。结论 MELD评分高可能是肝移植术后患者CMV感染的独立危险因素。免疫抑制剂不是肝移植患者术后早期CMV感染的危险因素。

关键词: 肝移植, 巨细胞病毒, 免疫抑制剂, 危险因素

Abstract: Objective To look for the risk factors of cytomegalovirus (CMV) infection by analyzing the characteristics of hospitalized liver transplantation patients. Methods Retrospective analysis was conducted on the clinical data of 134 patients with CMV laboratory test results who received liver transplantation in Department of Hepatobiliary and Pancreaticosplenic Surgery of Beijing Chaoyang Hospital between December 2016 to February 2019, including 113 males and 21 females, with an average age of (52±10) years. The patients were divided into the CMV infection group (n=24) and the control group (n=110) according to the presence of CMV infection within 3 months after surgery. T test, Mann-Whitney U test and Chi-square test were used for single factor analysis, and Logistic regression analysis was used for multivariate analysis to determine the risk factors of CMV infection in patients after liver transplantation. Results The results of univariate analysis showed that the history of age (P=0.005), model for end-stage liver disease (MELD) score (P=0.001), Child-Pugh score (P=0.048), total bilirubin (P=0.002), international normalized ratio (INR) (P=0.002), blood ammonia (P=0.040) and ascites(P=0.042), operation method (P=0.023), intraoperative bleeding volume (P=0.006), blood transfusion volume (P=0.004) and postoperative intensive care unit (ICU) monitoring time (P=0.016) were risk factors of CMV infection. The results of multivariate analysis suggested that MELD score (P=0.007, 95% CI: 1.027-1.187) may be an independent risk factor of CMV infection. The use of immunosuppressive agents, including calcineurin inhibitors (CNI), mycophenolate mofetils (MMF), glucocorticoids, and polyclonal antibodies were not associated with early postoperative CMV infection in patients with liver transplantation. Conclusion High MELD score may be an independent risk factor for CMV infection after liver transplantation. Immunosuppressive agents are not risk factors for early postoperative CMV infection in patients after liver transplantation.

Key words: liver transplantation, cytomegalovirus, immunosuppressive agents, risk factors

中图分类号:

孙熙木, 王华光, 赵昕, 吕少诚, 贺强, 刘丽宏. 肝移植患者术后巨细胞病毒感染的危险因素分析[J]. 首都医科大学学报, 2021, 42(4): 664-671.

Sun Ximu, Wang Huaguang, Zhao Xin, Lyu Shaocheng, He Qiang, Liu Lihong. Risk factors of cytomegalovirus infection in patients undergoing liver transplantation[J]. Journal of Capital Medical University, 2021, 42(4): 664-671.

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