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| 患儿活体肝移植术中再灌注综合征危险因素分析和列线图预测模型建立 |
| Risk factors and nomogram prediction model establishment for postreperfusion syndrome in children undergoing living donor liver transplantation |
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| DOI：10.12089/jca.2026.04.004 |
| 中文关键词: 再灌注综合征 小儿 肝移植 危险因素 列线图 |
| 英文关键词: Postreperfusion syndrome Child Liver transplantation Risk factors Nomograms |
| 基金项目:天津市卫生健康科技项目（TJWJ2024XK012）；天津市医学重点学科项目（TJYXZDXK-3-022C） |
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| 中文摘要: |
目的： 分析患儿活体肝移植（LDLT）术中发生再灌注综合征（PRS）的危险因素，并构建列线图预测模型。
方法： 回顾性收集2019年10月至2022年2月接受LDLT的患儿资料，包括一般资料、术前实验室检查、术中及预后指标。根据术中是否发生PRS将患儿分为两组：PRS组和非PRS组。将LASSO回归分析筛选的PRS影响因素变量纳入多因素Logistic回归分析，并构建列线图预测模型。通过绘制受试者工作特征（ROC）曲线、校准曲线、决策曲线分析（DCA）评估列线图模型预测效能。
结果： 共纳入患儿340例，其中有145例（42.6%）发生PRS。多因素Logistic回归分析结果显示，术前中性粒细胞/淋巴细胞比值（NLR）升高、再灌注前即刻体温<36 ℃、门静脉阻断时间≥52.5 min、移植肝冷缺血时间（CIT）≥92.5 min是术中发生PRS的危险因素，术前左心室射血分数（LVEF）升高是PRS的保护因素（P<0.05）。基于上述因素构建预测PRS的列线图模型，该模型曲线下面积（AUC）为0.833（95%CI 0.790～0.876），敏感性为0.821，特异性为0.708。校准曲线显示，列线图模型预测曲线与实测曲线基本吻合。DCA曲线显示，该列线图模型在预测患儿肝移植PRS方面能产生良好的临床获益。
结论： 术前NLR升高、再灌注前即刻体温<36 ℃、门静脉阻断时间延长、CIT延长是患儿活体肝移植术中PRS发生的危险因素，术前LVEF升高是PRS的保护因素，根据以上因素构建的列线图模型对PRS具有较好的预测效能及临床获益。 |
| 英文摘要: |
Objective: To analyze the risk factors for postreperfusion syndrome (PRS) during living donor liver transplantation (LDLT) in pediatric patients and to establish a nomogram prediction model.
Methods: Clinical data of pediatric patients who underwent LDLT between October 2019 and February 2022 were retrospectively collected, including baseline characteristics, preoperative laboratory examinations, intraoperative variables, and prognosis-related indicators. Children were divided into two groups according to the intraoperative occurrence of PRS: PRS group and non-PRS group. Variables screened by LASSO regression as potential risk factors for PRS were included in multivariate logistic regression analysis, and a nomogram model was constructed. The predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).
Results: A total of 340 pediatric patients were enrolled, among whom 145 (42.6%) developed PRS. Multivariate logistic regression analysis showed that elevated preoperative neutrophil-lymphocyte ratio (NLR), body temperature < 36 ℃ immediately before reperfusion, portal vein occlusion time ≥ 52.5 minutes, and cold ischemia time (CIT) of the graft ≥ 92.5 minutes were independent risk factors for PRS, while elevated preoperative left ventricular ejection fraction (LVEF) was a protective factor (P < 0.05). The nomogram model established based on these variables achieved an area under the ROC curve (AUC) of 0.833 (95% CI 0.790-0.876), with a sensitivity of 0.821 and a specificity of 0.708. The calibration curve revealed good consistency between the predicted probability and the actual observation. DCA demonstrated that the nomogram provided favorable clinical net benefit in predicting PRS in pediatric patients undergoing living donor liver transplantation.
Conclusion: Elevated preoperative NLR, body temperature < 36 ℃ immediately before reperfusion, prolonged portal vein occlusion time, and prolonged graft CIT are risk factors for intraoperative PRS in pediatric patients undergoing living donor liver transplantation, whereas elevated preoperative LVEF is a protective factor. The nomogram model constructed with these factors shows satisfactory predictive performance and clinical value for PRS. |
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