| 吴迪,谷化剑,肖晶晶,等.公民逝世后器官捐献肝移植术后早期感染的危险因素分析[J].安徽医药,2025,29(7):1446-1453. |
| 公民逝世后器官捐献肝移植术后早期感染的危险因素分析 |
| Risk factors of early infection in liver transplant patients from organ donation after citizen's death |
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| DOI：10.3969/j.issn.1009-6469.2025.07.037 |
| 中文关键词: 肝移植 危险因素 早期感染 器官捐献 革兰阴性菌 |
| 英文关键词: Liver transplantation Risk factors Early infection Organ donation Gram-negative bacteria |
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| 摘要点击次数: 869 |
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| 中文摘要: |
| 目的探讨公民逝世后器官捐献肝脏移植受者术后早期感染( 1个月)的危险因素，为临床治疗提供参考意见。方法回顾性分析贵州医科大学附属医院 2019年 1月至 2022年 1月 74例公民逝世后器官捐献肝移植病人的临床资料，根据术后早期是否发生感染分为感染组和非感染组，采用单因素及多因素 logistic回归分析，探讨影响公民逝世后器官捐献肝脏移植受者术后早期感染的危险因素，并建立相关预测模型，使用 ROC曲线下面积评价模型的预测效果。结果 74例肝移植病人中共有 20例发生感染，肝移植术后早期感染发生率为 27.03%。从 20例发生感染病人中共培养出病原体 31株，其中革兰阴性菌处于优势( 13/31，41.94%)，革兰阳性菌次之( 10/31，32.26%)。革兰阴性菌中最常见者为鲍曼不动杆菌( 4/31，12.9%)，革兰阳性菌中最常见者为屎肠球菌( 4/31，12.9%)。主要感染部位为肺部( 13/29，44.83%)及腹腔( 7/29，24.14%)。单因素分析显示受体术前肝功能 Child-Pugh评分 C级、终末期肝病模型( MELD)评分 >30分、血清白蛋白 <30 g/L、术中输注红细胞量 ≥8 U、术后机械通气时间 ≥2 d与术后早期感染发生相关( P<0.05)；多因素 logistic回归分析显示受体术前血清白蛋白 <30 g/L、MELD评分 >30分是肝移植术后早期感染并发症的独立危险因素。预测模型的 ROC曲线结果显示 AUC及其 95%CI为 0.72(0.57，0.86)，提示模型对术后早期感染预测有一定准确度。结论公民逝世后器官捐献肝移植术后早期感染发生率为 27.03%，最常见感染部位是肺部，最常见病原菌为革兰阴性菌。受体术前血清白蛋白 <30 g/L、MELD评分 >30分是公民逝世后器官捐献肝移植术后早期感染的独立危险因素，术后早期感染预测模型可为临床提供一定的参考。 |
| 英文摘要: |
| Objective To explore the risk factors of postoperative early infection (1 month) in liver transplant recipients with organdonation after citizen's death, and to provide reference for clinical treatment.Methods Retrospective analysis was made of the clini-cal data of 74 cases of liver transplantation from organ donation after citizen's death in The Affiliated Hospital of Guizhou MedicalUniversity from January 2019 to January 2022, and they were assigned into infected group and non-infected group according to wheth-er postoperative infection occurred. Univariate and multivariate logistic regression analyses were conducted to explore the risk factorsfor postoperative early infection in liver transplant patients from organ donation after citizen's death, and a predictive model was estab-lished. And then the prediction effect of the model was evaluated by ROC curve.Results Postoperative early infection occurred in 20of 74 patients with liver transplantation, and the incidence of early infection was 27.03%. A total of 31 strains of pathogens were cul-tured from 20 infected patients, among which Gram-negative bacteria were dominant (13/31, 41.94%), followed by Gram-positive bacte-ria (10/31, 32.26%). The most common Gram-negative bacterium was Acinetobacter baumannii (4/31,12.9%), and the most common Gram-positive bacterium was Enterococcus faecium (4/31, 12.9%). The main sites of infection were the lungs (13/29, 44.83%) and ab-dominal cavity (7/29, 24.14%). The results of the univariate analysis showed that five factors, including C grade Child-Pugh score of re-cipient liver function, MELD (model for end-stage liver disease) score > 30 points, serum albumin level < 30 g/L, intraoperative transfu-sion of red blood cell volume ≥ 8 U and postoperative mechanical ventilation time ≥ 2 d, were associated with the occurrence of early in-fection after organ-donation liver transplantation (P<0.05). Multivariate logistic regression analysis results showed that preoperative se-rum albumin <30 g/L and MELD score >30 were independent risk factors for early infection complications after liver transplantation.The ROC curve results of the prediction model showed that the AUC value was 0.72 and 95%CI was 0.57-0.86, suggesting that the model had a certain accuracy in predicting postoperative early infection.Conclusions The incidence of early infection in liver trans-plant patients from organ donation after citizen's death is 27.03%. The most common infection is respiratory infection, and the domi-nant pathogens are Gram-negative bacteria. Preoperative serum albumin <30 g/L and MELD score >30 are independent risk factors forpostoperative infection after liver transplantation. The prediction model of postoperative early infection can provide reference for clini-cal practice. |
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