胆道闭锁儿童肝移植术后90天再入院危险因素分析

doi:10.12372/jcp.2023.22e0452

摘要/Abstract

摘要：

目的调查胆道闭锁儿童在肝移植术后90天再入院率及危险因素。方法回顾性分析上海交通大学医学院附属新华医院、仁济医院和上海儿童医学中心确诊为胆道闭锁，2019年1月1日至2019年12月31日首次接受肝移植手术治疗患儿的临床资料。比较再入院组和未再入院组间临床特征，分析再入院的危险因素。结果共纳入264例患儿，男124例、女140例，中位年龄6.9（5.6~9.4）月。儿童肝移植术后90天再入院率为22.0%（58/264）。与未再入院组相比，再入院组患儿PELD评分、血清总胆汁酸水平、INR较高，住院时间较长，血小板计数、腰肌面积较低，差异均有统计学意义（P<0.05）。二元logistic回归分析示血小板减少症(OR=2.347,95%CI：1.154~4.776)、血清总胆汁酸水平(OR=1.058,95%CI：1.011~1.106)、腰肌面积(OR=0.615,95%CI：0.301~0.989)、住院时间(OR=1.069, 95%CI：1.031~1.109)是肝移植术后再入院的影响因素（P均<0.05）。结论血小板减少症、血清总胆汁酸水平升高、腰肌面积减少和住院时间长的儿童，肝移植术后90天再入院的风险更高，建议早期筛查。

关键词: 再入院, 胆道闭锁, 肝移植, 儿童

Abstract:

Objective To investigate the 90-day readmission rate and risk factors of children with biliary atresia (BA) after liver transplantation (LT). Methods This retrospective cohort study was conducted in Xinhua Hospital, Renji Hospital and Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine from January 1 to December 31, 2019. Data of children with BA who received LT for the first time were retrospectively analyzed. Patients were divided into readmission group and non-readmission group according to whether they were readmitted within 90 days after LT. The differences between the two groups were compared. Logistic regression was used to analyze the risk factors of 90-day readmission. Results A total of 264 children (female 53.0%) were included, with a median age of 6.9 (5.6-9.4) months. The 90-day readmission rate was 22.0% (58 / 264). Compared with the non-readmission group, the readmission group had higher pediatric end-stage liver disease (PELD) score, higher serum total bile acid level (TBA), higher international normalized ratio (INR), longer length of hospital stays (LOS), lower platelet count and lower psoas muscle area (PMA), and all the difference were statistically significant (P<0.05). Binary logistic regression analysis showed that thrombocytopenia (OR =2.347, 95%CI: 1.154-4.776), TBA (OR =1.058, 95% CI: 1.011-1.106), PMA (OR = 0.615, 95% CI: 0.301-0.989), and LOS (OR= 1.069, 95% CI: 1.031-1.109) were the influencing factors of 90-day readmission after pediatric LT, with statistical significance (P<0.05).Conclusions Children with thrombocytopenia, elevated TBA, lower PMA and long LOS had a higher risk of 90-day readmission after LT.

Key words: readmission, biliary atresia, liver transplantation

万双双, 徐仁应, 钱永兵, 洪莉, 冯一. 胆道闭锁儿童肝移植术后90天再入院危险因素分析[J]. 临床儿科杂志, 2023, 41(2): 134-139.

WAN Shuangshuang, XU Renying, QIAN Yongbing, HONG Li, FENG Yi. Risk factors of 90-day readmission after liver transplantation in children with biliary atresia[J]. Journal of Clinical Pediatrics, 2023, 41(2): 134-139.

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项目	再入院组(n=58)	未再入院组(n=206)	统计量	P
女[n(%)]	29(50.0)	111(53.9)	χ²=0.27	0.601
年龄[M(P₂₅~P₇₅)]/月	7.4(6.1~10.0)	6.7(5.6~9.2)	Z=1.59	0.111
体质量(x±s)/kg	7.2±1.5	7.3±1.9	t=0.31	0.759
WAZ(x±s)	-1.5±1.3	-1.3±1.4	t=0.99	0.324
身高(x±s)/cm	67.5±5.3	67.6±7.1	t=0.13	0.899
HAZ(x±s)	-1.3±1.4	-1.1±1.7	t=1.02	0.309
生长发育落后[n(%)]	24(41.4)	72(35.0)	χ²=0.81	0.369
PELD评分[M(P₂₅~P₇₅)]	17.0(13.0~22.0)	14.0(11.0~19.0)	Z=2.40	0.017
PELD评分>15[n(%)]	34(58.6)	87(42.2)	χ²=4.90	0.027
WBC[M(P₂₅~P₇₅)]/×10⁹·L^-1	6.5 (4.2~9.0)	6.9 (4.7~ 10.1)	Z=0.67	0.501
Hb(x±s)/g·L^-1	84.2±17.1	86.6±14.9	t=1.05	0.296
PLT [M(P₂₅~P₇₅)]/×10⁹·L^-1	131.0(86.0~179.0)	148.0(104.0~211.0)	Z=2.04	0.041
PLT<100×10⁹·L^-1[n(%)]	22(37.9)	49(23.8)	χ²=4.61	0.032
白蛋白(x±s)/g·L^-1	32.4±7.3	33.7±6.6	t=1.22	0.224
总蛋白(x±s)/g·L^-1	48.2±6.4	48.3±7.1	t=0.084	0.933
ALT(x±s)/U·L^-1	151.3±31.3	145.1±34.2	t=1.24	0.217
AST(x±s)/U·L^-1	201.5±31.2	198.0±35.2	t=0.68	0.495
总胆红素[M(P₂₅~P₇₅)]/μmol·L^-1	104.0(75.0~136.0)	94.0(63.0~129.0)	Z=1.80	0.072
直接胆红素[M(P₂₅~P₇₅)]/μmol·L^-1	63.0(51.0~80.0)	60.0(39.0~76.0)	Z=1.52	0.128
血清总胆汁酸[M(P₂₅~P₇₅)]/μmol·L^-1	10.0(5.4~15.0)	8.0(4.9~11.0)	Z=2.18	0.030
碱性磷酸酶[M(P₂₅~P₇₅)]/U·L^-1	133.0(82.0~194.0)	141.0(88.0~198.0)	Z=0.79	0.432
γ-GT[M(P₂₅~P₇₅)]/U·L^-1	74.8(31.8~116.0)	77.0(41.0~124.0)	Z=0.72	0.474
尿素氮[M(P₂₅~P₇₅)]/mmol·L^-1	3.0(2.0~4.2)	2.5(1.8~3.3)	Z=1.30	0.194
血肌酐(x±s)/μmol·L^-1	17.7±4.8	16.4±4.3	t=1.96	0.051
INR(x±s)	2.0±0.4	1.8±0.4	t=2.02	0.045

项目	再入院组(n=58)	未再入院组(n=206)	统计量	P
CT人体成分分析（L₃）
腰肌面积(x±s)/cm²	2.4±0.6	2.6±0.9	t=2.00	0.048
棘旁肌肉面积(x±s)/cm²	5.1±1.2	5.2±1.6	t=0.28	0.778
总肌肉面积(x±s)/cm²	7.5±1.6	7.9±2.2	t=0.97	0.334
皮下脂肪面积[M(P₂₅~P₇₅)]/cm²	12.8(9.0~19.9)	13.4(9.6~18.5)	Z=0.06	0.950
内脏脂肪面积[M(P₂₅~P₇₅)]/cm²	4.9(3.0~6.7)	4.4(3.0~7.1)	Z=0.46	0.647
总脂肪面积[M(P₂₅~P₇₅)]/cm²	18.2(14.5~26.7)	19.4(12.8~26.2)	Z=0.45	0.656
临床结局
ICU时间[M(P₂₅~P₇₅)]/h	116.0(93.0~145.0)	116.0(92.0~139.0)	Z=1.27	0.203
住院时间[M(P₂₅~P₇₅)]/d	19.0(15.0~31.0)	16.0(14.0~20.0)	Z=3.54	<0.001
术后1年内死亡[n(%)]	2(3.4)	2(1.0)	-	0.211^1）

变量	偏回归系数	标准误	Wald χ²	OR	95%CI	P
常数项	?3.664	0.535	46.890	0.026	-	-
PLT<100×10⁹·L^-1	0.853	0.362	5.546	2.347	1.154~4.776	0.019
血清总胆汁酸/μmol·L^-1	0.056	0.023	6.032	1.058	1.011~1.106	0.014
腰肌面积/cm²	?0.499	0.270	3.432	0.615	0.301~0.989	0.048
住院时间/d	0.067	0.019	12.763	1.069	1.031~1.109	<0.001