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
Multitime-point monitoring and analysis of influencing factors of early postoperative blood glucose and lipid levels in pediatric liver transplantation
摘要
Abstract
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.关键词
肝移植/儿童/血糖/血脂/影响因素Key words
liver transplantation/pediatrics/blood glucose/blood lipids/impact factors分类
医药卫生引用本文复制引用
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):443-451,9.基金项目
上海交通大学医学院护理学科建设项目(SJTUHLXK2024) （SJTUHLXK2024）
上海市闵行区自然科学研究课题(2024MHZ034) （2024MHZ034）
上海交通大学护理学院重点学科团队项目([2024]6号) （[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) （SHDC2023 CRS013）
上海交通大学医学院护理学科建设项目([2022]1号). Nursing discipline construction project of Shanghai Jiao Tong University School of Medicine(SJTUHLXK2024) （[2022]1号）
Minhang District Natural Science Research Project(2024MHZ034) （2024MHZ034）
Key Discipline Team Project of Shanghai Jiao Tong University School of Nursing([2024]No.6) （[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) （SHDC2023 CRS013）
Shanghai Jiao Tong University School of Medicine:Nursing Development Program([2022]No.1). （[2022]No.1）
