体重指数预测脑-心双死亡器官捐献供肝脂肪肝的价值

评价体重指数(BMI)预测脑-心双死亡器官捐献(donation after brain plus cardiac death,DBCD)供肝脂肪肝的价值.方法 回顾性分析2011年7月至2013年3月在广东省佛山市第一人民医院移植中心实施的22例DBCD供体的临床资料.根据供体BMI将22例供体和17例受体分为体重正常组(18.0~22.9 kg/m2)和体重过重组(≥23.0 kg/m2).比较两组供体的术前临床指标及供肝脂肪肝程度,比较两组受体术后7d肝酶学指标、凝血功能及并发症发生情况.采用Pearson法分析供体BMI和供肝脂肪肝程度的相关性,采用受试者工作特征(ROC)曲线分析BMI预测供肝脂肪肝的灵敏度和特异度,并计算最佳截点值及相应的灵敏度和特异度.结果 DBCD供体BMI为(22.5 ±1.3) kg/m2,其中体重正常组13例,体重过重组9例,所有捐献者BMI均未超过28.0 kg/m2.体重过重组的平均年龄及供肝脂肪肝程度高于体重正常组,两组比较差异有统计学意义(均为P

Value of body mass index on predicting fatty liver in donor with donation after brain plus cardiac death

Objective To assess the value of body mass index （BMI） on predicting fatty liver with donation after brain plus cardiac death （DBCD）. Methods Clinical data of 22 donors of DBCD in the First People＇s Hospital of Foshan from July 2011 to March 2013 were analyzed retrospectively. According to the donors＇ BMI, 22 donors and 17 recipients were divided into with normal weight group （ 18.0-22. 9 kg/m2 ） and overweight group （ ≥ 23.0 kg/m2 ） . The clinical indicators and the degree of fatty liver in donors were compared between two groups. The indicators of liver enzymology, coagulation function and complications in recipients were compared between two groups at 7 d after transplantation. Correlation between donors＇ BMI and the degree of fatty liver was analyzed by Pearson test. Sensitivity and specificity of BMI on predicting fatty liver were analyzed by receiver operation characteristic （ROC） curve. The appropriate cut-off value, sensitivity and specificity were calculated. Results The BMI was （22. 5 ± 1.3 ） kg/m2 in DBCD donors, with 13 donors innormal weight group and 9 donors in overweight group. No one＇s BMI was over 28.0 kg/m2. The mean of age and the degree of hepatic steatosis in overweight group were higher than those in normal weight group （ all in P 〈 0. 05 ）. Among the clinical indicators of recipients at 7 d after transplantation, peak level of alanine aminotransferase in overweight group was higher than that in normal weight group （ P 〈 0. 05 ）. No primary non- function, dysfunction or acute rejection occurred in recipients of two groups. The moderate correlation was identified between the donors＇ BMI and the degree of fatty liver （ r = 0. 572, P = 0. 005 ）. The ROC curve analysis showed that area under the curve of BMI predicting the rate of hepatic steatosis ≥ 30% was 0. 87 （95% confidence interval was 0. 68-1.00, P =0. 005）. The appropriate cut-off value of BMI was≥23.0 kg/m2, while the sensitivity was 0. 875 and specificity was 0. 643 with moderate predictive value. Conclusions The BMI of DBCD donor can predict the degree of fatty liver well, but its specificity is not very satisfying.