移植机构中有精神科联络会诊团队的情况下，移植后并发精神疾病障碍与长期生存：一项多中心回顾性研究。
Comorbid psychiatric disorders and long-term survival after liver transplantation in transplant facilities with a psychiatric consultation-liaison team: a multicenter retrospective study.
机构信息
Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan.
Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita14, Nishi5, Kita-Ku, Sapporo, 060-8648, Japan.
出版信息
BMC Gastroenterol. 2023 Apr 5;23(1):106. doi: 10.1186/s12876-023-02735-1.
OBJECTIVE
Comorbid psychiatric disorders negatively affect the survival rate of patients with some physical disorders. In liver transplant recipients, various psychiatric disorders have been identified as worsening prognosis. However, little is known about how the presence of any comorbid (overall) disorders affect the survival rate of transplant recipients. In this study, we examined the effect of overall comorbid psychiatric disorders on survival rate in liver transplant recipients.
METHODS
A total of 1006 recipients who underwent liver transplantation between September 1997 and July 2017 across eight transplant facilities with a psychiatric consultation-liaison team were identified consecutively. Recipients were categorized into those with comorbid psychiatric disorders and those without comorbid psychiatric disorders. In the comorbid psychiatric disorder group, psychiatric disorder diagnosis and time of diagnosis were investigated retrospectively.
RESULTS
Of the 1006 recipients, 294 (29.2%) had comorbid psychiatric disorders. Comorbid psychiatric disorders in the 1006 recipients were insomnia (N = 107, 10.6%), delirium (N = 103, 10.2%), major depressive disorder (N = 41, 4.1%), adjustment disorder (N = 19, 1.9%), anxiety disorder (N = 17, 1.7%), intellectual disability (N = 11, 1.1%), autism spectrum disorder (N = 7, 0.7%), somatic symptom disorder (N = 4, 0.4%) schizophrenia (N = 4, 0.4%), substance use disorder (N = 24, 2.4%) and personality disorder (N = 2, 0.2%). The most common time of psychiatric disorder diagnosis was within the first 3 months after liver transplantation (51.6%). The final mortality in patients with comorbid psychiatric disorder diagnosis during the five periods (pretransplant, transplant to 3 months, months to 1 year, 1 to 3 years, and over 3 years posttransplant) was 16.2%, 18.8%, 39.1%, 28.6%, and 16.2% respectively, and there were no significant differences between the five periods (χ2 = 8.05, df = 4, p = 0.09). Overall comorbid psychiatric disorders were significantly associated with shorter survival time (log-rank test: p = 0.01, hazard ratio: 1.59 [95% confidence interval: 1.14-2.21], survival rate at the endpoint [%]: 62.0 vs. 83.3). However, after adjusting for confounding variables using Cox proportional hazards regression, there was no significant effect of overall comorbid psychiatric disorders on prognosis.
CONCLUSION
Comorbid psychiatric disorders did not affect the survival rate of liver transplant recipients in this study.
目的
合并精神疾病会降低某些躯体疾病患者的生存率。在肝移植受者中，各种精神疾病已被确定为预后恶化的因素。然而，对于合并（总体）精神疾病如何影响移植受者的生存率，我们知之甚少。在本研究中，我们研究了总体合并精神疾病对肝移植受者生存率的影响。
方法
连续纳入 1997 年 9 月至 2017 年 7 月在 8 家具有精神科联络会诊小组的移植中心接受肝移植的 1006 例受者。将受者分为合并有合并有精神疾病和无合并有精神疾病的两组。在合并有精神疾病的组中，回顾性调查精神疾病的诊断和诊断时间。
结果
在 1006 例受者中，294 例（29.2%）合并有精神疾病。1006 例受者的合并精神疾病包括失眠症（107 例，10.6%）、谵妄（103 例，10.2%）、重度抑郁障碍（41 例，4.1%）、适应障碍（19 例，1.9%）、焦虑障碍（17 例，1.7%）、智力障碍（11 例，1.1%）、自闭症谱系障碍（7 例，0.7%）、躯体症状障碍（4 例，0.4%）、精神分裂症（4 例，0.4%）、物质使用障碍（24 例，2.4%）和人格障碍（2 例，0.2%）。精神疾病诊断最常见的时间是肝移植后 3 个月内（51.6%）。在 5 个时间段（移植前、移植后 3 个月内、移植后 1 至 1 年内、移植后 1 至 3 年内和移植后 3 年以上）合并有精神疾病诊断的患者的最终死亡率分别为 16.2%、18.8%、39.1%、28.6%和 16.2%，5 个时间段之间无显著差异（χ2=8.05，df=4，p=0.09）。总体合并精神疾病与较短的生存时间显著相关（对数秩检验：p=0.01，风险比：1.59[95%置信区间：1.14-2.21]，终点时的生存率[%]：62.0 与 83.3）。然而，在校正了使用 Cox 比例风险回归的混杂变量后，总体合并精神疾病对预后没有显著影响。
结论
在本研究中，合并精神疾病并未影响肝移植受者的生存率。
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