目的 应用逐步判别分析法对成人首次肝移植术后早期(术后90 d内)预后进行判断,筛选出预后的主要影响因素.方法 回顾性分析2004年8月至2011年2月南方医科大学南方医院施行的221例肝移植患者的临床资料,将符合研究条件的218例患者分为训练样本(2004年8月至2010年6月,188例)和验证样本(2010年7月至2011年2月,30例).根据术后患者的生存情况,将患者分为死亡组(术后生存时间≤90 d,34例)和生存组(术后生存时间＞90 d,184例).用逐步判别分析法对单因素分析有统计学意义的相关因素进行研究,建立早期预后的判断函数并分析主要影响因素.计量资料采用t检验或秩和检验,计数资料采用RxC表的x2检验或Fisher确切概率法.结果 死亡组与生存组受者平均年龄分别为(54±11)岁和(51±11)岁,两组比较,差异无统计学意义(t =-1.681,P＞0.05)；术前平均Hb分别为106.7 g/L和119.2 g/L,两组比较,差异有统计学意义(t=2.809,P＜0.05).两组患者的肌酐、尿素氮、Alb、TBil、IBil、Na+、PT、活化部分凝血活酶时间、国际标准化比值、纤维蛋白原、凝血酶原活动度、PLT、营养危险指数、终末期肝病模型评分、术前肝性脑病、术前肝肾综合征、术前消化道出血、术前感染、术前糖尿病、Child-Turcotte-Pugh肝功能分级、心功能分级、麻醉危险度分级、手术时间、无肝期时间、术中输血量、腹腔积液量以及术中尿量比较,差异有统计学意义(Z=-2.277,-2.595,-3.290,-3.486,-2.562,-2.577,-3.670,-3.882,-3.625,-3.557.-3.837,-1.974,-3.693,-3.815,x2=19.632,9.756,28.143,Z=-4.175,-3.905,-4.865,-3.564,-5.822,P＜0.05).影响成人首次肝移植术后早期预后的主要因素为术前肝性脑病、术前肝肾综合征、手术时间、术中输血量和术中尿量.其标准偏回归系数分别为0.146、0.188、0.257、0.181、-0.340.用判别函数对训练样本进行回顾性考核判断正确率为89.9％ (169/188),验证样本前瞻性考核判别正确率为90.0％(27/30).结论 根据患者手术时间、术中输血量、术中尿量以及术前是否合并肝性脑病和肝肾综合征,可在很大程度上预测成人首次肝移植早期预后.
目的 應用逐步判彆分析法對成人首次肝移植術後早期(術後90 d內)預後進行判斷,篩選齣預後的主要影響因素.方法 迴顧性分析2004年8月至2011年2月南方醫科大學南方醫院施行的221例肝移植患者的臨床資料,將符閤研究條件的218例患者分為訓練樣本(2004年8月至2010年6月,188例)和驗證樣本(2010年7月至2011年2月,30例).根據術後患者的生存情況,將患者分為死亡組(術後生存時間≤90 d,34例)和生存組(術後生存時間＞90 d,184例).用逐步判彆分析法對單因素分析有統計學意義的相關因素進行研究,建立早期預後的判斷函數併分析主要影響因素.計量資料採用t檢驗或秩和檢驗,計數資料採用RxC錶的x2檢驗或Fisher確切概率法.結果 死亡組與生存組受者平均年齡分彆為(54±11)歲和(51±11)歲,兩組比較,差異無統計學意義(t =-1.681,P＞0.05)；術前平均Hb分彆為106.7 g/L和119.2 g/L,兩組比較,差異有統計學意義(t=2.809,P＜0.05).兩組患者的肌酐、尿素氮、Alb、TBil、IBil、Na+、PT、活化部分凝血活酶時間、國際標準化比值、纖維蛋白原、凝血酶原活動度、PLT、營養危險指數、終末期肝病模型評分、術前肝性腦病、術前肝腎綜閤徵、術前消化道齣血、術前感染、術前糖尿病、Child-Turcotte-Pugh肝功能分級、心功能分級、痳醉危險度分級、手術時間、無肝期時間、術中輸血量、腹腔積液量以及術中尿量比較,差異有統計學意義(Z=-2.277,-2.595,-3.290,-3.486,-2.562,-2.577,-3.670,-3.882,-3.625,-3.557.-3.837,-1.974,-3.693,-3.815,x2=19.632,9.756,28.143,Z=-4.175,-3.905,-4.865,-3.564,-5.822,P＜0.05).影響成人首次肝移植術後早期預後的主要因素為術前肝性腦病、術前肝腎綜閤徵、手術時間、術中輸血量和術中尿量.其標準偏迴歸繫數分彆為0.146、0.188、0.257、0.181、-0.340.用判彆函數對訓練樣本進行迴顧性攷覈判斷正確率為89.9％ (169/188),驗證樣本前瞻性攷覈判彆正確率為90.0％(27/30).結論 根據患者手術時間、術中輸血量、術中尿量以及術前是否閤併肝性腦病和肝腎綜閤徵,可在很大程度上預測成人首次肝移植早期預後.
목적 응용축보판별분석법대성인수차간이식술후조기(술후90 d내)예후진행판단,사선출예후적주요영향인소.방법 회고성분석2004년8월지2011년2월남방의과대학남방의원시행적221례간이식환자적림상자료,장부합연구조건적218례환자분위훈련양본(2004년8월지2010년6월,188례)화험증양본(2010년7월지2011년2월,30례).근거술후환자적생존정황,장환자분위사망조(술후생존시간≤90 d,34례)화생존조(술후생존시간＞90 d,184례).용축보판별분석법대단인소분석유통계학의의적상관인소진행연구,건립조기예후적판단함수병분석주요영향인소.계량자료채용t검험혹질화검험,계수자료채용RxC표적x2검험혹Fisher학절개솔법.결과 사망조여생존조수자평균년령분별위(54±11)세화(51±11)세,량조비교,차이무통계학의의(t =-1.681,P＞0.05)；술전평균Hb분별위106.7 g/L화119.2 g/L,량조비교,차이유통계학의의(t=2.809,P＜0.05).량조환자적기항、뇨소담、Alb、TBil、IBil、Na+、PT、활화부분응혈활매시간、국제표준화비치、섬유단백원、응혈매원활동도、PLT、영양위험지수、종말기간병모형평분、술전간성뇌병、술전간신종합정、술전소화도출혈、술전감염、술전당뇨병、Child-Turcotte-Pugh간공능분급、심공능분급、마취위험도분급、수술시간、무간기시간、술중수혈량、복강적액량이급술중뇨량비교,차이유통계학의의(Z=-2.277,-2.595,-3.290,-3.486,-2.562,-2.577,-3.670,-3.882,-3.625,-3.557.-3.837,-1.974,-3.693,-3.815,x2=19.632,9.756,28.143,Z=-4.175,-3.905,-4.865,-3.564,-5.822,P＜0.05).영향성인수차간이식술후조기예후적주요인소위술전간성뇌병、술전간신종합정、수술시간、술중수혈량화술중뇨량.기표준편회귀계수분별위0.146、0.188、0.257、0.181、-0.340.용판별함수대훈련양본진행회고성고핵판단정학솔위89.9％ (169/188),험증양본전첨성고핵판별정학솔위90.0％(27/30).결론 근거환자수술시간、술중수혈량、술중뇨량이급술전시부합병간성뇌병화간신종합정,가재흔대정도상예측성인수차간이식조기예후.
Objective To judge the prognosis of adult recipients after first liver transplantation by stepwise discriminant analysis,and screen out the main influencing factors.Methods The clinical data of 221 patients who received liver transplantation at the Nanfang Hospital of Southern Medical University were retrospectively analyzed.A total of 218 patients who met the criteria were divided into the training samples (188 patients admitted from August 2004 to June 2010) and checking samples (30 patients admitted from July 2010 to February 2011),and then all patients were re-divided into dead group (survival time ≤ 90 days,34 patients) and surviving group (survival time ＞ 90 days,184 patients).Factors which had significant difference after the univariate analysis was further analyzed by the stepwise discriminant analysis method.All data were analyzed by the t test,rank sum test,chi-square test or Fisher exact probability test.Results The ages of the recipients in the dead group and the living group were (54 ± 11)years and (51 ± 11)years,respectively,with no significant difference between the 2 groups (t =-1.681,P ＞ 0.05).The preoperative levels of hemoglobin in the dead group and the living group were 106.7 g/L and 119.2 g/L,respectively,with a significant difference between the 2 groups (t =2.809,P ＜ 0.05).There were significant differences in the levels of serum creatinine,urea nitrogen,albumin,total bilirubin,indirect bilirubin,Na+,prothrombin time,activated partial thromboplastin time,international normalized ratio,fibrinogen,prothrombin activity,platelet,nutrition risk index,model for end-stage liver disease score,number of patients with preoperative hepatic encephalopathy (HE),preoperative hepatorenal syndrome (HRS),preoperative digestive tract bleeding,preoperative infection,preoperative diabetes,Child-Turcotte-Pugh score,cardiac function classification and anesthesia risk rating operation time,anhepatic time,volume of intraoperative blood transfusion,volume of peritoneal effusion ; intraoperative urine output,between the 2 groups (Z =-2.277,-2.595,-3.290,-3.486,-2.562,-2.577,-3.670,-3.882,-3.625,-3.557,-3.837,-1.974,-3.693,-3.815,x2 =19.632,9.756,28.143,Z =-4.175,-3.905,-4.865,-3.564,-5.822,P ＜ 0.05).Preoperative HE,preoperative HRS,duration of operation,intraoperative blood transfusion and intraoperative volume of urine were the independent influencing factors of early prognosis after liver transplantation.The standardized partial regression coefficients were 0.146,0.188,0.257,0.181,-0.340,89.9％ (169/188) of the training samples and 90.0％ (27/30) of the checking samples were correctly classified.Conclusion Based on factors including HRS,HE,intraoperative blood transfusion,intraoperative volume of urine and duration of operation,the early prognosis can be judged in adult recipients after first liver transplantation.
