新型凝血标记物在肝移植术后早期并发症中的应用价值

张雪; 陈思敏; 郭军; 张中伟; 胡海; 杨家印; 康焰

doi:10.12182/20230960105

新型凝血标记物在肝移植术后早期并发症中的应用价值

Application Value of Novel Coagulation Markers in Predicting Postoperarative Complications in the Early Stage After Liver Transplantation

摘要

摘要:
目的探讨凝血酶-抗凝血酶复合物（thrombin-antithrombin complex, TAT）、纤溶酶-α₂抗纤溶酶复合物（plasmin-α₂-plasmin inhibitor complex, PIC）、可溶性血栓调节蛋白（soluble thrombomodulin, sTM）和组织型纤溶酶原激活剂-抑制剂复合物（tissue plasminogen activator-inhibitor complex, tPAIC）与肝移植术后早期并发症的关系。
方法分析 2021年12月–2022年11月四川大学华西医院重症医学科（intensive care unit, ICU）收治的130例肝移植术后患者围手术期的临床资料（包括血浆TAT、PIC、sTM和tPAIC）。根据患者术后30 d内是否发生Clavien-Dindo (CD) Ⅲb级及以上并发症，将患者分为并发症组和无并发症组。单因素分析及二元多因素logistic回归模型确定肝移植术后30 d内并发症的危险因素。
结果肝移植术后30 d内CDⅢb级及以上并发症的发生率为33.1%（43/130）。并发症组患者MELD评分、手术时间、术中红细胞用量、术中血浆用量以及术后ICU入院时血浆TAT、PIC、sTM和tPAIC均高于无并发症组（P<0.05）。logistic回归显示移植期间每输注1 U红细胞，肝移植术后30 d内并发症概率增加15.1%〔95%置信区间（confidence interval, CI）：1.070～1.239，P<0.001 〕，术后ICU入院时血浆sTM每增加1 TU/mL，肝移植术后30 d内并发症概率增加13.7%（95%CI：1.060～1.220，P<0.001）。
结论肝移植术后ICU入院时血浆sTM是肝移植术后30 d内并发症的重要危险因素，对sTM的额外评估可能有助于预测肝移植术后早期的并发症。

Abstract:
Objective To investigate the relationship between thrombin-antithrombin complex (TAT), plasmin-α₂-plasmininhibitor complex (PIC), soluble thrombomodulin (sTM), and tissue plasminogen activator-inhibitor complex (tPAIC) and postoperative complications in the early stage after liver transplantation (LT).
Methods We analyzed the perioperative clinical data, including plasma TAT, PIC, sTM, and tPAIC, of 130 post-LT patients admitted to the intensive care unit (ICU), West China Hospital, Sichuan University between December 2021 and November 2022. Patients were divided into two groups, a complication group and a non-complication group, according to whether they experienced complications of Clavien-Dindo (CD) grade Ⅲb and above within 30 days after the surgery. Univariate analysis and binary multivariate logistic regression models were used to determine the risk factors for complications within 30 days post-LT.
Results The incidence of complications of CD grade Ⅲb and above within 30 days post-LT was 33.1% (43/130). Patients in the complication group had significantly higher scores for the Model for End-Stage Liver Disease (MELD), operative time, intraoperative red blood cell transfusion volume, intraoperative plasma transfusion volume, and plasma TAT, PIC, sTM and tPAIC measured at the time of admission to ICU after the operation than those in the non-complication group did (all P<0.05). Logistic regression showed that for every single U of red blood cells transfused during the transplant surgery, the probabilities of complications within 30 days post-LT increased by 15.1% (95% confidence interval CI: 1.070-1.239, P<0.001) and for the increase of every single TU/mL of plasma sTM measured upon post-LT admission to ICU, the probabilities of complications increased by 13.7% (95% CI: 1.060-1.220, P<0.001).
Conclusion Plasma sTM measured upon admission to ICU after LT is an independent risk factor for complications within 30 days post-LT, and additional assessment of sTM may help predict complications in the early stage post-LT.

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