论文部分内容阅读
目的:分析影响脑死亡供者供肝移植术后受者早期移植物功能不良(early allograft dysfunction, EAD)的分子标志物及临床因素，建立将分子标志物和临床因素相结合的预测移植术后EAD的预警体系。方法:回顾性分析2017年7月至2018年8月在郑州大学第一附属医院肝脏移植中心接受同种异体原位肝移植的87例成年受者的临床资料以及对应的供者临床信息。通过单因素分析，找出EAD的潜在危险因素，并进行Logistic回归分析以找出独立危险因素；并从中选取肝移植术后8例发生EAD和8例未发生EAD的组织标本，进行转录组测序，寻找与EAD相关信号通路。结果:通过临床数据分析发现供者总胆红素、淋巴细胞以及受者术前总胆红素是脑死亡供者供肝移植术后受者EAD的独立危险因素。通过转录组测序发现EAD不良组与非EAD组之间有3 857个显著差异的mRNA，其中1 751个在发生EAD的供肝组织中表达上调，2 106个下调。通过基因本体论和京都基因与基因组百科全书分析发现炎症与代谢相关的信号通路与移植术后EAD有关。结论:早期移植物功能不良相关的炎症与代谢信号通路结合供者总胆红素、淋巴细胞以及受者术前总胆红素对预测肝移植受者早期移植物功能不良的发生具有潜在的诊断意义。“,”Objective:To establish an early warning system for predicting the post-transplantation occurrence of early allograft dysfunction (EAD) through molecular and clinical factors.Methods:From July 2017 to August 2018, retrospective analysis was performed for clinical data of 87 adult recipients of orthotopic liver transplantation. The potential risk factors of EAD were identified by univariate analysis and the independent risk factors screened by logistic regression analysis. The tissue samples from 8 EAD cases and 8 non-EAD cases after liver transplantation were selected for transcriptome sequencing to search for the signal pathway related to EAD.Results:Through clinical data analysis, total bilirubin, lymphocytes and preoperative bilirubin of donor were independent risk factors for EAD after liver transplantation. Transcriptome sequencing revealed 3857 significantly different mRNAs between EAD and non-EAD groups. And 1751 were up-regulated and 2106 down-regulated. GO/KEGG analysis indicated that the signaling pathways of inflammation and metabolism were correlated with EAD after transplantation.Conclusions:Along with donor total bilirubin, lymphocyte and recipient total bilirubin, inflammatory and metabolic signaling pathways associated with EAD have potential diagnostic significance for predicting the occurrence of EAD.