终末期良性肝病肝移植术后顽固性脾亢影响因素及预测模型构建

doi:10.3877/cma.j.issn.2095-3232.2026.04.015

目的

探讨终末期良性肝病肝移植术后顽固性脾功能亢进（脾亢）影响因素，并建立肝移植术后顽固性脾亢预测模型。

方法

回顾性分析2013年1月至2023年12月在首都医科大学附属北京朝阳医院行肝移植术的97例终末期良性肝病合并脾亢患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男70例，女27例；平均年龄（52±9）岁。术前肝功能Child-Pugh分级A级7例，B级30例，C级60例。改良背驮式肝移植63例，经典原位肝移植术34例。根据术后6个月脾亢恢复情况，将患者分为脾亢缓解组和顽固性脾亢组。肝移植术后顽固性脾亢发生相关因素分析采用t检验、秩和检验等。采用Logistic多因素回归分析筛选顽固性脾亢发生独立危险因素。基于独立危险构建预测模型，ROC曲线分析独立危险因素的预测效能。

结果

单因素分析显示，术前Plt（Z=3.201）、TB（Z=2.036）、DB（Z=2.085）、脾上下径（t=3.291）、脾厚径（t=4.441）、脾长径（Z=3.309）、脾动脉直径（t=3.634）、脾静脉直径（Z=3.494）、门静脉直径（t=3.379）与顽固性脾亢发生有关（P<0.05）。较低的术前Plt（OR=0.971，95%CI：0.945~0.997），更长的术前脾厚径（OR=1.080，95%CI：1.014~1.151）和术前脾动脉直径（OR=1.472，95%CI：1.010~2.145）是患者术后顽固性脾亢的独立危险因素（P<0.05）。基于术前Plt、术前脾厚径、术前脾动脉直径构建预测模型，该预测模型对患者术后顽固性脾亢具有较强预测效能（ROC AUC=0.888，95%CI：0.823~0.953，P<0.001），预测术后顽固性脾亢的灵敏度为0.771，特异度为0.855。

结论

对于终末期良性肝病肝移植术后顽固性脾亢患者，可以通过评估患者术前Plt、脾厚径、脾动脉直径来预测脾脏功能恢复情况。

关键词: 终末期良性肝病, 肝硬化, 肝移植, 脾功能亢进

Objective

To investigate the influencing factors and to construct a prediction model for refractory hypersplenism after liver transplantation for benign end-stage liver diseases.

Methods

Clinical data of 97 patients with benign end-stage liver diseases complicated with hypersplenism who underwent liver transplantation in Beijing Chaoyang Hospital, Capital Medical University from January 2013 to December 2023 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 27 female, aged (52±9) years on average. Before operation, 7 patients were classified with Child-Pugh A, 30 cases of Child-Pugh B and 60 cases of Child-Pugh C. 63 patients underwent modified piggyback liver transplantation and 34 cases of classic orthotopic liver transplantation. According to the recovery of hypersplenism at postoperative 6 months, all patients were divided into the remission group and refractory hypersplenism group. The risk factors of refractory hypersplenism after liver transplantation were analyzed by t-test and rank-sum test. The independent risk factors for refractory hypersplenism were identified by Logistic multivariate regression analysis. Based on the independent risk factors, the prediction model was constructed. The prediction efficiency of these independent risk factors was determined by the ROC curve.

Results

Univariate analysis showed that preoperative Plt (Z=3.201), TB (Z=2.036), DB (Z=2.085), bipolar spleen diameter (t=3.291), thick spleen diameter (t=4.441), long spleen diameter (Z=3.309) and splenic artery diameter (t=3.634), splenic vein diameter (Z=3.494) and portal vein diameter (t=3.379) were associated with the incidence of refractory hypersplenism (all P<0.05).Lower preoperative Plt (OR=0.971, 95%CI: 0.945-0.997), longer preoperative thick spleen diameter (OR=1.080, 95%CI: 1.014-1.151) and preoperative splenic artery diameter (OR=1.472, 95%CI: 1.010-2.145) were the independent risk factors for patients with postoperative refractory hypersplenism (all P<0.05). Based on preoperative Plt, preoperative thick spleen diameter and preoperative splenic artery diameter, a prediction model was constructed. The prediction model yielded a high prediction efficiency for patients with postoperative refractory hypersplenism (ROC AUC=0.888, 95%CI: 0.823-0.953, P<0.001), with a sensitivity of 0.771 and a specificity of 0.855.

Conclusions

For benign end-stage liver disease patients with refractory hypersplenism after liver transplantation, the recovery of spleen function can be predicted by evaluating preoperative Plt, thick spleen diameter and splenic artery diameter.

Key words: End-stage benign liver disease, Liver cirrhosis, Liver transplantation, Hypersplenism

表1 肝移植术后顽固性脾亢相关因素分析

因素	脾亢缓解组	顽固性脾亢组	统计值	P值
术前Plt[×10⁹/L, M(Q₁, Q₃)]	60(45, 72)	43(25, 64)	Z=3.201	0.001
术前TB[μmol/L, M(Q₁, Q₃)]	125(35, 257)	58(24, 188)	Z=2.036	0.042
术前DB[μmol/L, M(Q₁, Q₃)]	67(16, 183)	22(10, 87)	Z=2.085	0.037
术前脾上下径(mm, $x ¯$ ±s)	157±35	181±36	t=3.291	0.001
术前脾厚径 (mm, $x ¯$ ±s)	44±10	54±11	t=4.441	<0.001
术前脾长径[mm, M(Q₁, Q₃)]	135(128, 156)	165(144, 179)	Z=3.309	0.001
术前脾动脉直径 (mm, $x ¯$ ±s)	6.4±1.5	7.6±1.7	t=3.634	<0.001
术前脾静脉直径[mm, M(Q₁, Q₃)]	10(8, 12)	13(11, 15)	Z=3.494	<0.001
术前门静脉直径 (mm, $x ¯$ ±s)	12.2±3.1	14.6±3.8	t=3.379	0.001

表1 肝移植术后顽固性脾亢相关因素分析

因素	脾亢缓解组	顽固性脾亢组	统计值	P值
术前Plt[×10⁹/L, M(Q₁, Q₃)]	60(45, 72)	43(25, 64)	Z=3.201	0.001
术前TB[μmol/L, M(Q₁, Q₃)]	125(35, 257)	58(24, 188)	Z=2.036	0.042
术前DB[μmol/L, M(Q₁, Q₃)]	67(16, 183)	22(10, 87)	Z=2.085	0.037
术前脾上下径(mm, $x ¯$ ±s)	157±35	181±36	t=3.291	0.001
术前脾厚径 (mm, $x ¯$ ±s)	44±10	54±11	t=4.441	<0.001
术前脾长径[mm, M(Q₁, Q₃)]	135(128, 156)	165(144, 179)	Z=3.309	0.001
术前脾动脉直径 (mm, $x ¯$ ±s)	6.4±1.5	7.6±1.7	t=3.634	<0.001
术前脾静脉直径[mm, M(Q₁, Q₃)]	10(8, 12)	13(11, 15)	Z=3.494	<0.001
术前门静脉直径 (mm, $x ¯$ ±s)	12.2±3.1	14.6±3.8	t=3.379	0.001

表2 肝移植术后顽固性脾亢影响因素的多因素Logistic分析

因素	b	SE(b)	OR	95%CI	P值
术前Plt	-0.030	0.014	0.971	0.945~0.997	0.029
术前TB	-0.012	0.010	0.988	0.968~1.007	0.220
术前DB	0.016	0.013	1.017	0.991~1.043	0.210
术前脾长径	0.001	0.013	1.001	0.975~1.027	0.956
术前脾厚径	0.077	0.032	1.080	1.014~1.151	0.017
术前脾上下径	0.000	0.010	1.000	0.980~1.019	0.969
术前脾动脉直径	0.387	0.192	1.472	1.010~2.145	0.044
术前脾静脉直径	0.043	0.087	1.044	0.879~1.238	0.625
术前门静脉直径	0.055	0.090	1.056	0.885~1.260	0.545

表2 肝移植术后顽固性脾亢影响因素的多因素Logistic分析

因素	b	SE(b)	OR	95%CI	P值
术前Plt	-0.030	0.014	0.971	0.945~0.997	0.029
术前TB	-0.012	0.010	0.988	0.968~1.007	0.220
术前DB	0.016	0.013	1.017	0.991~1.043	0.210
术前脾长径	0.001	0.013	1.001	0.975~1.027	0.956
术前脾厚径	0.077	0.032	1.080	1.014~1.151	0.017
术前脾上下径	0.000	0.010	1.000	0.980~1.019	0.969
术前脾动脉直径	0.387	0.192	1.472	1.010~2.145	0.044
术前脾静脉直径	0.043	0.087	1.044	0.879~1.238	0.625
术前门静脉直径	0.055	0.090	1.056	0.885~1.260	0.545

图1 术前Plt、脾厚径、脾动脉直径预测肝移植术后顽固性脾亢ROC曲线

图2 预测模型预测肝移植术后顽固性脾亢ROC曲线

[1]	Zhu Q, Chen D, Lou Y, et al. Baseline ALBI grade predicts benefits after splenectomy for cirrhotic patients with hypersplenism[J]. J Gastrointest Surg, 2023, 27(6): 1130-1140. DOI: 10.1007/s11605-023-05610-2.
[2]	王孟龙. 门静脉高压症肝脏血供改变对肝移植的影响与对策[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(5): 687-692. DOI: 10.3877/cma.j.issn.2095-3232.2025.05.005.
[3]	Nam NH, Taura K, Yao S, et al. Pretransplantation splenomegaly frequently persists after liver transplantation and can manifest as hypersplenism and graft fibrosis-a retrospective study[J]. Transpl Int, 2020, 33(12): 1807-1820. DOI: 10.1111/tri.13761.
[4]	Chen TY, Chen CL, Huang TL, et al. Predictive factors for persistent splenomegaly and hypersplenism after adult living donor liver transplantation[J]. Transplant Proc, 2012, 44(3): 752-754. DOI: 10.1016/j.transproceed.2012.01.044.
[5]	Jiang WT, Yang J, Xie Y, et al. Simultaneous partial splenectomy during liver transplantation for advanced cirrhosis patients combined with severe splenomegaly and hypersplenism[J]. World J Gastroenterol, 2021, 27(7): 654-665. DOI: 10.3748/wjg.v27.i7.654.
[6]	Lee CY, Lim WX, Chen CL, et al. Efficacy and safety of splenic artery embolization for intractable ascites using Amplatzer vascular plug versus coil after living donor liver transplantation[J]. Diagn Interv Radiol, 2022, 28(5): 478-485. DOI: 10.5152/dir.2022.21027.
[7]	Zhang ZG, Li Z, Yang Y, et al. Hemodynamic effect through a novel endoscopic intervention in management of varices and hypersplenism (with video)[J]. Gastrointest Endosc, 2022, 95(1): 172-183. e2. DOI: 10.1016/j.gie.2021.06.029.
[8]	Talwar A, Gabr A, Riaz A, et al. Adverse events related to partial splenic embolization for the treatment of hypersplenism: a systematic review[J]. J Vasc Interv Radiol, 2020, 31(7): 1118-1131. e6. DOI: 10.1016/j.jvir.2019.08.015.
[9]	苏日顺, 卢逸, 庄宝鼎, 等. 肝硬化脾亢脾切除术后门静脉血栓形成影响因素[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(1): 39-44. DOI: 10.3877/cma.j.issn.2095-3232.2024.01.008.
[10]	党晓卫, 张中杰, 李路豪. 门静脉高压症性脾功能亢进的处理方式选择[J/OL]. 中华肝脏外科手术学电子杂志, 2019, 8(3): 276-278. DOI: 10.3877/cma.j.issn.2095-3232.2019.03.022.
[11]	Wei L, Zhou GP, Qu W, et al. Is simultaneous partial splenectomy during pediatric liver transplantation safe and effective for severe hypersplenism? A prospective cohort study[J]. Int J Surg, 2021, 88: 105926. DOI: 10.1016/j.ijsu.2021.105926.
[12]	Zhao HC, Chen CZ, Song HQ, et al. Single-cell RNA sequencing analysis reveals new immune disorder complexities in hypersplenism[J]. Front Immunol, 2022, 13: 921900. DOI: 10.3389/fimmu.2022.921900.
[13]	黄孟修, 汪京, 吕少诚, 等. 肝硬化肝移植术后脾功能亢进转归的研究进展[J]. 中华肝胆外科杂志, 2021, 27(12): 957-960. DOI: 10.3760/cma.j.cn113884-20210706-00221.
[14]	Peck-Radosavljevic M. Thrombocytopenia in chronic liver disease[J]. Liver Int, 2017, 37(6): 778-793. DOI: 10.1111/liv.13317.
[15]	Dogan GM, Dogan SM, Okut G, et al. Comprehensive analysis of long-term splenic volume changes in pediatric liver transplant patients: does it correlate with adverse graft outcomes?[J]. Transplant Proc, 2021, 53(1): 104-110. DOI: 10.1016/j.transproceed.2020.08.031.
[16]	Mukhtar A. Modulation of splanchnic circulation: role in perioperative management of liver transplant patients[J]. World J Gastroenterol, 2016, 22(4): 1582. DOI: 10.3748/wjg.v22.i4.1582.
[17]	Yao S, Kaido T, Yagi S, et al. Impact of imbalanced graft-to-spleen volume ratio on outcomes following living donor liver transplantation in an era when simultaneous splenectomy is not typically indicated[J]. Am J Transplant, 2019, 19(10): 2783-2794. DOI: 10.1111/ajt.15337.
[18]	Yoshida H, Shimizu T, Yoshioka M, et al. The role of the spleen in portal hypertension[J]. J Nippon Med Sch, 2023, 90(1): 20-25.
[19]	Kawano F, Ishizaki Y, Yoshimoto J, et al. Factors affecting persistent splenomegaly after adult-to-adult living donor liver transplantation using a left lobe[J]. Transplant Proc, 2019, 51(6): 1946-1949. DOI: 10.1016/j.transproceed.2019.02.033.
[20]	Hori T, Ogura Y, Onishi Y, et al. Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation[J]. World J Hepatol, 2016, 8(25): 1047. DOI: 10.4254/wjh.v8.i25.1047.
[21]	Tal N, Waisbourd-Zinman O, Kaplan E, et al. Early post-liver transplant thrombocytopenia in children: Clinical characteristics and significance[J]. Pediatr Transplant, 2022, 26(6): e14326. DOI: 10.1111/petr.14326.
[22]	Liu ZR, Zhang YM, Cui ZL, et al. Effects of thrombopoietin pre-treatment on peri-liver transplantation thrombocytopenia in a mouse model of cirrhosis with hypersplenism[J]. World J Gastrointest Surg, 2023, 15(10): 2115-2122. DOI: 10.4240/wjgs.v15.i10.2115.
[23]	贺健, 张骊, 王洪海, 等. 肝移植术后脾功能亢进转归及治疗研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(5): 310-314. DOI: 10.3877/cma.j.issn.1674-3903.2024.05.010.
[24]	Sockrider CS, Boykin KN, Green J, et al. Partial splenic embolization for hypersplenism before and after liver transplantation[J]. Clin Transplant, 2002, 16(s7): 59-61. DOI: 10.1034/j.1399-0012.16.s7.9.x.
[25]	Patel MS, Egawa H, Kwon YK, et al. The role of graft to recipient weight ratio on enhanced recovery of the recipient after living donor liver transplantation: a systematic review of the literature and expert panel recommendations[J]. Clin Transplant, 2022, 36(10): e14630. DOI: 10.1111/ctr.14630.
[26]	Subramaniyam R, Jamir I, Kumar N, et al. Implementation of intraoperative distal splenic artery ligation for portal inflow modulation in adult living donor liver transplantation[J]. Liver Transplant, 2025, 31(10): 1238-1249. DOI: 10.1097/lvt.0000000000000635.
[27]	Kumar N, Chaudhary A. Comment on “graft inflow modulation by splenic artery ligation for portal hyper perfusion does not decrease rates of early allograft dysfunction in adult live donor liver transplantation: a randomized control trial”: can we really write off graft inflow modulation[J]. Ann Surg Open, 2024, 5(3): e464. DOI: 10.1097/as9.0000000000000474.

[1]	吴柔娜, 王珏涵, 范登煌, 鲍王筱, 毛琳, 王大明. 早期下床活动对ICU内肝移植患者术后康复的影响[J/OL]. 中华危重症医学杂志(电子版), 2026, 19(02): 131-138.
[2]	蔡轶伦, 陈燕, 董金玲. 人类Runt相关转录因子、E-钙黏蛋白和Ras相关区域家族1A基因甲基化对丙型肝炎病毒相关肝细胞癌的诊断价值[J/OL]. 中华实验和临床感染病杂志(电子版), 2026, 20(02): 106-113.
[3]	刘洵, 毕亮, 郎韧, 吴安石. 同种异体原位肝移植术后早期死亡的危险因素分析[J/OL]. 中华普通外科学文献(电子版), 2026, 20(03): 150-156.
[4]	李丁洋, 党晓卫. 脾动脉部分栓塞术治疗门静脉高压症合并脾功能亢进的精准实践与策略[J/OL]. 中华普通外科学文献(电子版), 2026, 20(02): 79-84.
[5]	刘建勇, 江艺. 免疫检查点抑制剂新辅助治疗在肝细胞癌肝移植中的应用[J/OL]. 中华普通外科学文献(电子版), 2026, 20(02): 127-132.
[6]	艾孜曼提·艾山江, 阿力木·土拉宏, 郭强, 张瑞青, 阿卜杜海外尔·阿卜杜合力力, 吐尔干艾力·阿吉. 成人肝移植中大肝综合征的诊疗进展[J/OL]. 中华普通外科学文献(电子版), 2026, 20(02): 133-137.
[7]	刘涛, 冯蓓, 李晓勇. 肝静脉压力梯度对TIPS与EVL治疗肝硬化食管胃底静脉曲张出血临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 331-336.
[8]	王孟龙. 门静脉高压症的治疗选择策略[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 523-528.
[9]	杨健良, 张爱玲, 王晓明, 代天星, 袁峰, 朱灿华, 蓝岚, 杨汉宇, 汪国营. 早期拔除气管插管快通道麻醉在肝移植中应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 398-404.
[10]	叶晓勇, 周林. 耐受性树突状细胞在肝移植免疫耐受中应用进展[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 420-425.
[11]	麦吾兰江·麦麦提, 阿力娅·图拉丁, 吐尔洪江·吐逊. ABO血型不相容肝移植免疫抑制策略[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 152-159.
[12]	王小振, 陈灿辉, 唐善华, 代浩嘉, 丰扬舸, 王恺, 李清平, 李川江. 基于不同机器学习技术构建肝移植术后早期严重并发症预测模型和效能比较[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 197-204.
[13]	刘海龙, 唐敏娟, 高悦. 肝血流超声参数联合血清内皮素1、核因子κB对肝硬化患者食管胃底静脉曲张破裂出血的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(03): 216-221.
[14]	魏子杰, 陈欣欣, 姚瑶, 闫振宇. 老年代偿期肝硬化患者膳食炎症指数、营养参数与衰弱发生风险的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 167-172.
[15]	宋学栋, 夏杰军, 庞宁东, 刘国珩, 韦树长. 经颈静脉肝内门体分流术治疗肝硬化门静脉高压患儿一例[J/OL]. 中华介入放射学电子杂志, 2026, 14(02): 216-218.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Influencing factors and prediction model construction for refractory hypersplenism after liver transplantation for benign end-stage liver diseases

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Influencing factors and prediction model construction for refractory hypersplenism after liver transplantation for benign end-stage liver diseases