肝脏
肝髒
간장
CHINESE HEPATOLOGY
2015年
8期
571-575
,共5页
骨髓间充质干细胞%乙型肝炎肝硬化%预后%生存期
骨髓間充質榦細胞%乙型肝炎肝硬化%預後%生存期
골수간충질간세포%을형간염간경화%예후%생존기
Bone marrow-derived mesenchymal stem cells%Hepatitis B liver cirrhosis%Prognosis%Survival rate
目的：了解影响骨髓间充质干细胞（BM-MSC）移植治疗乙型肝炎肝硬化（HBV-LC）患者的预后因素。方法HBV-LC 患者158例，根据终末期肝病模型（MELD）评分、年龄、性别进行1∶1配对，将患者分为治疗组79例，对照组79例。治疗组在抗病毒、保肝等基础治疗上行 BM-MSC 移植术，对照组仅给予抗病毒、保肝等治疗。记录治疗组术前并发症、生化、凝血功能等指标，随访3年。结果治疗组的患者中存活与死亡亚组上消化道出血和肝肾综合征发生率差异有统计学意义（χ2分别为9．278和8．365，均 P ＜0．05），但自发性腹膜炎无明显差异（χ2＝0．633，P ＞0．05）。治疗组的 Child-Pugh 评分（CPS）B 级和 C 级的3年生存率与对照组相比差异均有统计学意义，进一步分析发现 CPS 为 B 级的患者生存率优于 C 级。治疗组术后死亡与否的单因素分析发现 TBil、MELD 评分、国际标准化比值（INR）、肌酐（Cr）差异显著，作多因素 Logistic 回归和 ROC 曲线分析发现，血清白蛋白低于23．4 g／L、MLED 评分高于18．37分、TBil 高于96．4μmol／L 和INR 高于1．97为治疗组患者死亡的高危因素。结论 BM-MSC 移植能够提高 HBV-LC 患者3年生存率，术前合并上消化道出血和肝肾综合征及低 Alb 和高 TBil、MELD 评分、INR 为 BM-MSC 移植术后死亡的高危因素。
目的：瞭解影響骨髓間充質榦細胞（BM-MSC）移植治療乙型肝炎肝硬化（HBV-LC）患者的預後因素。方法HBV-LC 患者158例，根據終末期肝病模型（MELD）評分、年齡、性彆進行1∶1配對，將患者分為治療組79例，對照組79例。治療組在抗病毒、保肝等基礎治療上行 BM-MSC 移植術，對照組僅給予抗病毒、保肝等治療。記錄治療組術前併髮癥、生化、凝血功能等指標，隨訪3年。結果治療組的患者中存活與死亡亞組上消化道齣血和肝腎綜閤徵髮生率差異有統計學意義（χ2分彆為9．278和8．365，均 P ＜0．05），但自髮性腹膜炎無明顯差異（χ2＝0．633，P ＞0．05）。治療組的 Child-Pugh 評分（CPS）B 級和 C 級的3年生存率與對照組相比差異均有統計學意義，進一步分析髮現 CPS 為 B 級的患者生存率優于 C 級。治療組術後死亡與否的單因素分析髮現 TBil、MELD 評分、國際標準化比值（INR）、肌酐（Cr）差異顯著，作多因素 Logistic 迴歸和 ROC 麯線分析髮現，血清白蛋白低于23．4 g／L、MLED 評分高于18．37分、TBil 高于96．4μmol／L 和INR 高于1．97為治療組患者死亡的高危因素。結論 BM-MSC 移植能夠提高 HBV-LC 患者3年生存率，術前閤併上消化道齣血和肝腎綜閤徵及低 Alb 和高 TBil、MELD 評分、INR 為 BM-MSC 移植術後死亡的高危因素。
목적：료해영향골수간충질간세포（BM-MSC）이식치료을형간염간경화（HBV-LC）환자적예후인소。방법HBV-LC 환자158례，근거종말기간병모형（MELD）평분、년령、성별진행1∶1배대，장환자분위치료조79례，대조조79례。치료조재항병독、보간등기출치료상행 BM-MSC 이식술，대조조부급여항병독、보간등치료。기록치료조술전병발증、생화、응혈공능등지표，수방3년。결과치료조적환자중존활여사망아조상소화도출혈화간신종합정발생솔차이유통계학의의（χ2분별위9．278화8．365，균 P ＜0．05），단자발성복막염무명현차이（χ2＝0．633，P ＞0．05）。치료조적 Child-Pugh 평분（CPS）B 급화 C 급적3년생존솔여대조조상비차이균유통계학의의，진일보분석발현 CPS 위 B 급적환자생존솔우우 C 급。치료조술후사망여부적단인소분석발현 TBil、MELD 평분、국제표준화비치（INR）、기항（Cr）차이현저，작다인소 Logistic 회귀화 ROC 곡선분석발현，혈청백단백저우23．4 g／L、MLED 평분고우18．37분、TBil 고우96．4μmol／L 화INR 고우1．97위치료조환자사망적고위인소。결론 BM-MSC 이식능구제고 HBV-LC 환자3년생존솔，술전합병상소화도출혈화간신종합정급저 Alb 화고 TBil、MELD 평분、INR 위 BM-MSC 이식술후사망적고위인소。
Objective To investigate the prognostic factors for hepatitis B liver cirrhosis (HBV-LC)patients treated with bone marrow-derived mesenchymal stem cells (BM-MSC)transplantation.Methods Seventy-nine patients with HBV-LC were enrolled as treatment group to accept BM-MSC transplantation combined with anti-viral and liver protection therapy,while control group only received anti-viral and liver protection therapy.Then treatment and control group were matched 1 ∶ 1 on the bases of the model for end-stage liver diseases (MELD)score,age and gender.Complications, biochemistry and coagulation function in treatment group were recorded before and after transplantation,follow-up of which was conducted for 3 years.Results The incidences of preoperative complications of upper gastrointestinal hemorrhage (UGH)and hepatorenal syndrome (HRS)were significantly different between the subgroups of survival and death in treatment group (χ2 were 9.278 and 8.365,respectively ,P < 0.05 ),while the incidence of spontaneous bacterial peritonitis in the two subgroups was not significantly different(χ2 =0.633,P >0.05).Compared with control group,the 3-year survival rate of patients evaluated as Child-Pugh class B and C in treatment group was significantly different.In addition,further research showed that class B subgroup had a higher 3-year survival rate than class C group.The differences of total bilirubin (TBil),MELD score,international normalized ratio (INR)and creatinine (Cr)were significant between the subgroups of survival and death in treatment group.Then these indicators were analyzed with logistic regression analysis and receiver operating characteristic curve analysis,which showed that cases with serum albumin lower than 23.4 g/L,MELD score higher than 18.37,TBil higher than 96.4 μmol/L and INR higher than 1 .97 had a high risk of death.Conclusion BM-MSC transplantation in treatment of HBV-LC can improve the 3-year survival rate.Preoperative UGH and HRS complications,low serum albumin (Alb)level,and high levels of MELD score,TBil and INR carry high risk of death after BM-MSC transplantation.
