肝移植术后高脂血症的危险因素分析： 一项单中心回顾性研究

Analysis of Risk Factors for Hyperlipidemia after Liver Transplantation: A Single-Center Retrospective Study

摘要: 目的：基于单中心真实世界数据，分析成人肝移植受者术后1年内新发高脂血症的危险因素，并构建风险预测模型。方法：回顾性纳入单中心成人肝移植受者251例，按术后1年内是否发生高脂血症分为高脂血症组(84例)与非高脂血症组(167例)。比较两组一般资料、术前检验及围术期相关指标差异，并采用逐步法二元Logistic回归筛选独立危险因素，评价模型拟合与预测效能。结果：术后1年内高脂血症发生率为33.47% (84/251)。多因素Logistic回归显示：原发性高血压病史(OR = 2.546, 95%CI: 1.135~5.710, P = 0.023)、原发病为肝原发恶性肿瘤(OR = 1.957, 95%CI: 1.095~3.499, P = 0.023)及术前血小板升高(OR = 1.005, 95%CI: 1.001~1.009, P = 0.013)与高脂血症发生风险增加独立相关；术前eGFR升高为保护因素(OR = 0.984, 95%CI: 0.969~1.000, P = 0.045)。ROC曲线分析显示模型AUC为0.691 (95%CI: 0.621~0.761, P < 0.001)，Hosmer-Lemeshow检验提示拟合良好(χ² = 5.290, P = 0.726)。结论：肝移植术后1年内高脂血症发生率较高；高血压、肝原发恶性肿瘤及血小板升高为独立危险因素，较高eGFR具有保护作用。基于上述因素构建的预测模型具有良好的区分度和校准度，可用于术后早期风险分层。

Abstract: Objective: To analyze the risk factors for new-onset hyperlipidemia within one year after transplantation in adult liver transplant recipients based on single-center real-world data, and to construct a risk prediction model. Methods: A total of 251 adult liver transplant recipients from a single center were retrospectively enrolled and divided into a hyperlipidemia group (84 cases) and a non-hyperlipidemia group (167 cases) according to the occurrence of hyperlipidemia within one year postoperatively. General characteristics, preoperative laboratory parameters, and perioperative indicators were compared between the two groups. Independent risk factors were identified using stepwise binary logistic regression analysis, and model fitting and predictive performance were evaluated. Results: The incidence of hyperlipidemia within one year after surgery was 33.47% (84/251). Multivariate logistic regression analysis showed that history of essential hypertension (OR = 2.546, 95%CI: 1.135~5.710, P = 0.023), primary hepatic malignancy as the underlying disease (OR = 1.957, 95%CI: 1.095~3.499, P = 0.023), and elevated preoperative platelet count (OR = 1.005, 95%CI: 1.001~1.009, P = 0.013) were independently associated with increased risk of hyperlipidemia. Preoperative elevated estimated glomerular filtration rate (eGFR) was identified as a protective factor (OR = 0.984, 95%CI: 0.969~1.000, P = 0.045). Receiver operating characteristic (ROC) curve analysis demonstrated that the model achieved an area under the curve (AUC) of 0.691 (95%CI: 0.621~0.761, P < 0.001). The Hosmer-Lemeshow test indicated good calibration (χ² = 5.290, P = 0.726). Conclusion: The incidence of hyperlipidemia within one year after liver transplantation is relatively high. Essential hypertension, primary hepatic malignancy, and elevated platelet count are independent risk factors, whereas higher eGFR exerts a protective effect. The prediction model constructed based on these factors demonstrates good discrimination and calibration, and may be useful for early postoperative risk stratification.