收稿日期: 2024-09-11
录用日期: 2024-12-10
网络出版日期: 2025-04-28
基金资助
上海交通大学医学院护理学科建设项目(SJTUHLXK2024);上海市闵行区自然科学研究课题(2024MHZ034);上海交通大学护理学院重点学科团队项目([2024]6号);上海申康医院发展中心第二轮《促进市级医院临床技能与临床创新三年行动计划》2023年研究型医院创新转化能力培训项目(SHDC2023 CRS013);上海交通大学医学院护理学科建设项目([2022]1号)
Multitime-point monitoring and analysis of influencing factors of early postoperative blood glucose and lipid levels in pediatric liver transplantation
Received date: 2024-09-11
Accepted date: 2024-12-10
Online published: 2025-04-28
Supported by
Nursing discipline construction project of Shanghai Jiao Tong University School of Medicine(SJTUHLXK2024);Minhang District Natural Science Research Project(2024MHZ034);Key Discipline Team Project of Shanghai Jiao Tong University School of Nursing ([2024] No.6);Shanghai Shenkang Hospital Development Center's second round of the "Three-Year Action Plan to Promote Clinical Skills and Clinical Innovation in Municipal Hospitals" 2023 Research Hospital Innovation Transformation Capacity Training Project(SHDC2023 CRS013);Shanghai Jiao Tong University School of Medicine: Nursing Development Program ([2022] No.1)
目的·监测肝移植（liver transplantation，LT）患儿术后早期多时间点的血糖（blood glucose，BG）及血脂（blood lipids，BL）并分析影响因素。方法·采用观察性研究，纳入上海交通大学医学院附属仁济医院肝脏外科的LT患儿，选择术前1 d及术后1、7、14 d采集血样，记录患儿基本信息和实验室指标。实验室指标包括：血常规（complete blood count，CBC）、细胞色素P450氧化酶基因分型（cytochrome P450，CYP）、他克莫司剂量（tacrolimus dosage，TD）、他克莫司血清药物浓度（tacrolimus serum drug level，TSDL）、空腹血糖（fasting blood glucose，FBG）、餐后2 h血糖（2-hour postprandial blood glucose，PBG）、肝移植生化检测（biochemical testing for liver transplantation，BTLT）指标。BTLT指标包括：总蛋白（total protein，TP）、白蛋白（albumin，ALB）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、碱性磷酸酶（alkaline phosphatase，AKP）、谷氨酰胺转移酶（transglutaminase，GGT）、直接胆红素（direct bilirubin，DBil）、总胆红素（total bilirubin，TBil）、肌酐（creatinine，Cr）、甘油三酯（triglyceride，TAG）、总胆固醇（total cholesterol，TC）、凝血酶原时间（prothrombin time，PT）、国际标准化比值（international normalized ratio，INR）。采用t检验或Mann-Whitney U检验分析PBG的影响因素，采用Cox回归分析FBG的影响因素，采用Logistic回归分析TC的影响因素。结果·共纳入82名肝移植患儿，其中男性45人（54.9%），女性37人（45.1%）；平均月龄7个月，平均身高65.00 cm，平均体质量7.15 kg。FBG［（6.54±1.71）mmol/L］和PBG［（7.42±2.19）mmol/L］均在术后第1天达到最高值，后逐渐降至正常水平。TAG［（0.93±0.63）mmol/L］及TC［（1.91±1.08）mmol/L］在术后第1天降到最低值，后缓慢上升。正常组（FBG和PBG均正常）59人，异常组23人。t检验提示，AKP（P=0.020）、GGT（P=0.002）、TC（P=0.017）及TD（P=0.028）在PBG正常组与异常组间差异有统计学意义。Cox回归分析显示，性别（HR=0.501，95%CI 0.184~1.361）、年龄（HR=0.972，95%CI 0.876~1.079）、身高（HR=1.012，95%CI 0.903~1.135）、体质量（HR=1.067，95%CI 0.720~1.579）、血型（A型HR=1.294，95%CI 0.464~3.612；B型HR=1.303，95%CI 0.456~3.723；AB型HR=1.520，95%CI 0.310~7.441）等变量在血糖-时间变化过程中没有显著影响。Logistic回归分析显示，患儿的CYP 3×3型（OR=18.083，95%CI 1.414~231.219）是TC的影响因素。结论·TD是术后第1天PBG的影响因素，患儿的CYP是术后第1天TC的影响因素。
陆晔峰 , 高磊青 , 倪晓筱 , 富晶晶 . 儿童肝移植术后早期血糖及血脂的多时间点监测与影响因素分析[J]. 上海交通大学学报（医学版）, 2025 , 45(4) : 443 -451 . DOI: 10.3969/j.issn.1674-8115.2025.04.006
Objective ·To monitor postoperative blood glucose (BG) and blood lipids (BL) at multiple time points in pediatric patients undergoing liver transplantation (LT) and to analyze the influencing factors. Methods ·An observational study was conducted, including pediatric LT patients from the Hepatic Surgery Department of Renji Hospital, Shanghai Jiao Tong University School of Medicine. Blood samples were collected one day before surgery and on days 1, 7, and 14 after surgery. Basic patient information and laboratory indicators were recorded, including complete blood count (CBC), cytochrome P450 (CYP) genotyping, tacrolimus dosage (TD), tacrolimus serum drug level (TSDL), fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG), and biochemical testing for liver transplantation (BTLT). BTLT included the following indicators: total protein (TP), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), transglutaminase (GGT), direct bilirubin (DBil), total bilirubin (TBil), creatinine (Cr), triglyceride (TAG), total cholesterol (TC), prothrombin time (PT), and international normalized ratio (INR). The t-test or Mann-Whitney U test was used to analyze factors influencing PBG, Cox regression analysis was used to analyze factors influencing FBG, and logistic regression analysis was used to analyze factors influencing TC. Results ·A total of 82 pediatric LT patients were included, with 45 males (54.9%) and 37 females (45.1%). The average age was 7 months, average height was 65 cm, and average body weight was 7.15 kg. FBG [(6.54±1.71) mmol/L] and PBG [(7.42±2.19) mmol/L] reached their highest values on the first postoperative day and gradually decreased to normal levels. There were 59 patients in the normal FBG and PBG groups and 23 in the abnormal groups. TAG [(0.93±0.63) mmol/L] and TC [(1.91±1.08) mmol/L] reached their lowest values on the first postoperative day and then slowly increased. The t-test indicated that TP (P=0.050), AKP (P=0.020), GGT (P=0.002), TC (P=0.017), and TD (P=0.028) showed statistically significant differences between the normal and abnormal PBG groups. Cox regression analysis showed that gender (HR=0.501, 95% CI 0.184‒1.361), age (HR=0.972, 95% CI 0.876‒1.079), height (HR=1.012, 95% CI 0.903‒1.135), body weight (HR=1.067, 95% CI 0.720‒1.579), and blood type (A type HR=1.294, 95% CI 0.464‒3.612; B type HR=1.303, 95% CI 0.456‒3.723; AB type HR=1.520, 95% CI 0.310‒7.441) did not significantly affect the BG's time change process. Logistic regression analysis showed that the patient's CYP (1×3 OR=9.332, 95% CI 0.960‒90.719; 3×3 OR=18.083, 95% CI 1.414‒231.219) was a factor influencing TC. Conclusion ·TD is a factor influencing PBG on the first postoperative day, and the patient's CYP is a factor influencing TC on the same day.
Key words： liver transplantation; pediatrics; blood glucose; blood lipids; impact factors
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