双重血浆分子吸附系统模式人工肝治疗中低血压发生的影响因素分析

胡东燕; 王红; 李文渊; 宁玲; 韩华; 沈强; 江守伟; 李磊

doi:10.3969/j.issn.1001-5256.2022.09.024

双重血浆分子吸附系统模式人工肝治疗中低血压发生的影响因素分析

DOI: 10.3969/j.issn.1001-5256.2022.09.024

中国科学技术大学附属第一医院感染病科，合肥 230001

基金项目:

安徽省自然科学基金资助项目 (1208085QH147);

北京肝胆相照公益基金会人工肝专项基金课题 (RGGJJ-2021-002)

伦理学声明：本研究方案由中国科学技术大学附属第一医院伦理委员会审批，批号为2022-RE-044，所有患者在人工肝术前均签署知情同意书。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：李磊、江守伟对研究的思路或设计有关键贡献；胡东燕、王红、李文渊、宁玲、韩华、沈强参与了研究数据的获取分析解释过程；胡东燕、王红、江守伟参与了论文的撰写及修改。

详细信息

通信作者:
江守伟，61747533@qq.com

李磊，lilei0403@163.com

作者说明：胡东燕和王红对本文贡献等同，同为第一作者

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出版历程
- 收稿日期: 2022-02-04
- 录用日期: 2022-03-30
- 出版日期: 2022-09-20

Influencing factors for hypotension in patients undergoing double plasma molecular adsorption system artificial liver support therapy

Department of Infectious Diseases, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China

Research funding:

Natural Science Foundation of Anhui Province (1208085QH147);

Artificial Liver Support System Special Fund Project of Beijing Hepatology Charity Foundation (RGGJJ-2021-002)

More Information

Corresponding author: JIANG Shouwei, 61747533@qq.com(ORCID: 0000-0002-3024-7368); LI Lei, lilei0403@163.com(ORCID: 0000-0002-5330-429X)

摘要

摘要: 目的探讨双重血浆分子吸附系统(DPMAS)模式人工肝治疗过程中患者发生低血压(IOH)的相关危险因素。方法收集2017年10月1日-2020年12月31日中国科学技术大学附属第一医院肝病中心行DPMAS人工肝治疗的181例患者(共计670例次)的临床资料, 根据人工肝治疗过程中是否发生低血压, 分为IOH组(70例)和非IOH组(111例)。比较两组患者各项临床指标, 并分析其与IOH发生的相关性以及12周、24周预后。符合正态分布的计量资料两组间比较采用独立样本t检验, 非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ²检验。IOH相关危险因素采用单因素及多因素Logistic回归分析。Kaplan-Meier法绘制受试者工作特征曲线(ROC曲线), 独立危险因素的ROC曲线下面积(AUC)比较采用Z检验。结果单因素Logistic回归分析显示, 女性、年龄≥50岁、正常及低BMI (≤24 kg/m²)者发生IOH的风险更高(P值均 < 0.05);多因素分析显示, 正常及低BMI (OR=3.290, 95% CI: 1.523~7.108, P=0.002)、女性(OR=5.146, 95% CI: 2.316~11.432, P < 0.001)是DPMAS人工肝患者出现IOH的独立危险因素。女性+BMI≤24 kg/m²联合进行ROC曲线分析, 其预测IOH的AUC为0.639(P=0.002)。IOH组与非IOH组12周(76.53% vs 55.77%, χ²=6.887, P=0.009)和24周(74.49% vs 50.00%, χ²=9.080, P=0.003)的生存率比较差异均有统计学意义。结论女性、正常或低BMI值患者行DPMAS模式人工肝治疗中发生低血压风险大; 发生IOH者24周生存预后差。
- 肝, 人工 /
- 低血压 /
- 预后
Abstract: Objective To investigate the risk factors for intraoperative hypotension (IOH) in patients undergoing double plasma molecular adsorption system (DPMAS) artificial liver support therapy. Methods Clinical data were collected from 181 patients (670 cases in total) who underwent DPMAS artificial liver support therapy in Liver Disease Center of The First Affiliated Hospital of University of Science and Technology of China from October 1, 2017 to December 31, 2020, and according to the presence or absence of IOH during DPMAS therapy, they were divided into IOH group with 70 patients and non-IOH group with 111 patients.Clinical indicators were compared between the two groups and their association with IOH was analyzed; prognosis was analyzed at 12 and 24 weeks.The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups.Univariate and multivariate Logistic regression analyses were used to investigate the risk factors for IOH.The Kaplan-Meier method was used to plot receiver operating characteristic (ROC) curves, and the Z test was used for comparison of the area under the ROC curve (AUC) of independent risk factors. Results The univariate Logistic regression analysis showed that female individuals, individuals aged ≥50 years, and individuals with normal or low body mass index (BMI) tended to have a higher risk of IOH (all P < 0.05), and the multivariate analysis showed that normal or low BMI (odds ratio [OR]=3.290, 95% confidence interval [CI]: 1.523-7.108, P=0.002) and female sex (OR=5.146, 95% CI: 2.316-11.432, P < 0.001) were independent risk factor for IOH in patients undergoing DPMAS artificial liver support therapy.The ROC curve analysis of female sex+BMI ≤24 kg/m² showed that it had an AUC of 0.639 in predicting IOH (P=0.002).The patients experiencing IOH had a 12-week survival rate of 55.77%(29/52) and a 24-week survival rate of 50%(26/52), and there were significant differences between the two groups in 12-and 24-week survival rates (12-week: 76.53% vs 55.77%, χ²=6.887, P=0.009;24-week: 74.49% vs 50.00%, χ²=9.080, P=0.003). Conclusion The risk of hypotension was higher in female patients and that with normal or low BMI during DPMAS artificial liver therapy.Patients with IOH had poor survival prognosis at 24 weeks after DPMAS therapy.
- Liver, Artificial /
- Hypotension /
- Prognosis

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图 1 在DPMAS治疗中IOH发生的时间分布

Figure 1. The time distribution of the occurrence of IOH in DPMAS therapy

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图 2 独立危险因素预测IOH的ROC曲线

Figure 2. ROC curve analysis for independent risk factors of IOH

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表 1 IOH组和非IOH组患者的一般临床资料

Table 1. General information of patients in IOH and non-IOH groups

指标	非IOH组(n=111)	IOH组(n=70)	统计值	P值
性别[例(%)]			χ²=16.424	＜0.001
男	98(88.29)	44(62.86)
女	13(11.71)	26(37.14)
心血管疾病[例(%)]	1(0.90)	0	χ²=0.634	0.426
年龄(岁)	46.38±12.52	51.59±11.61	t=-2.848	0.005
BMI(kg/m²)	22.89±4.15	21.42±3.10	t=2.709	0.007
血红蛋白(g/L)	120.63±21.93	110.91±21.96	t=2.902	0.004
白蛋白(g/L)	32.77±4.03	32.91±4.65	t=-0.210	0.834
总胆红素(μmol/L)	375.88±130.50	391.66±138.15	t=-0.774	0.440
凝血酶原活动度(%)	50.49±32.13	44.35±26.94	t=1.331	0.185
血钠(mmol/L)	136(132~137)	135(130~137)	Z=-2.039	0.041
肌酐(μmol/L)	61(49~78)	63(54~86)	Z=-0.855	0.392
血糖(mmol/L)	5.13(4.29~7.51)	5.02(4.29~6.63)	Z=-0.424	0.672

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表 2 IOH发生的单因素Logistic回归分析

Table 2. Univariate Logistic regression analysis of IOH ocurrence

参数	β值	SE	Wald χ²值	P值	OR
年龄(≥50岁)	0.688	0.311	4.912	0.027	1.990
BMI(≤24 kg/m²)	1.020	0.364	7.853	0.005	2.773
女性	1.494	0.385	15.048	＜0.001	4.455

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表 3 IOH发生的多因素Logistic回归分析

Table 3. Multivariate Logistic regression analysis of IOH ocurrence

参数	β值	SE	Wald χ²值	P值	OR	95%CI
BMI(≤24 kg/m²)	1.191	0.393	9.183	0.002	3.290	1.523~7.108
女性	1.638	0.407	16.179	＜0.001	5.146	2.316~11.432

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