目的 了解肝移植术后血清肌红蛋白（Mb）水平变化，探讨其与患者新发急性肾损伤（AKI） 的关系。方法 2018年7月至2020年6 月，收治符合病例入选标准的191例肝移植患者。（1）收集入选患 者围手术期基线资料；（2）分别于术后 0、24、48、72 h 采集患者外周血，检测其血清 Mb 水平；（3）根据术后 72 h 内肾功能损伤情况，将患者分为 AKI 组 80 例与非 AKI 组 111 例，对两组数据行 t 检验、重复测量设计 方差分析或χ2 检验。对各项临床相关指标与患者新发AKI的关系采用单因素及多因素 logistic 回归分析，绘制受试者工作特征（ROC）曲线，评估其对新发 AKI 相关危险因素的预测效果。结果 （1）术后 0、24、48、 72 h，AKI 组血清 Mb 水平均显著高于非 AKI 组（P < 0.001）；（2）经单因素回归分析筛选及多因素 logistic 回归分析显示，术前 MELD 评分（OR = 1.083，95% CI：1.022～1.147，P =0.007）、术中出血量（OR = 1.001， 95% CI：1.000 ~ 1.002，P = 0.003）、术中液体总出量（OR = 1.015，95% CI：1.010 ~ 1.032，P = 0.008）及术后第 72 小时血清 Mb 水平（OR = 1.038，95% CI：1.026 ~ 1.050，P < 0.001）是影响患者新发 AKI 的独立危险因素； （3）对 80 例患者新发 AKI 预测的术前 MELD 评分、术中出血量、术中液体总出量及术后72 h血清Mb水平的 ROC 曲线下总面积分别为 0.655（95% CI：3.55 ~ 15.84，P < 0.01）、0.672（95% CI：4.83 ~ 17.17，P < 0.01）、 0.532（95% CI：2.52 ~ 12.88，P < 0.01）及 0.861（95% CI：5.17 ~ 19.42，P < 0.01）；最佳阈值分别为 16.7 分、 0.8 L、2.9 L、150 ng/mL；对 AKI 预测的敏感度分别为 58%、56%、46%、84%，特异度分别为 69%、70%、69%、 82%。结论 肝移植术后患者血清 Mb 水平升高与患者新发 AKI 密切相关，早期监测其动态变化有助于预 测肝移植患者术后肾脏损伤相关并发症的发生。

Objective To investigate the kinetic changes of myoglobin（Mb）levels in serum and evaluate its prognostic implication in patients who received liver transplantation and suffered from new acute renal injury （AKI）. Methods A total of 191 hospitalized patients after liver transplantation from July 2018 to June 2020 were recruited in this retrospective study.（1）The important clinical indexes related to liver and kidney function and related score results were recorded before，during and after operation；（2）Serum Mb levels of patients were deter⁃ mined on post⁃operation hrs 0，24，48，72，respectively；（3）These patients were divided into AKI group（n = 80） and non ⁃AKI group（n = 111）according to the clinical outcomes at 72h after operation. Data were processed by Student′s t⁃test，analysis of variance of repeated measurement design and χ2 ⁃test. Logistic regression was used to screen out risk factors related to AKI. The validity of predicting patients′ AKI within the 72 h period with some selected variables was verified by receiver operating characteristic （ROC）curves. Results （1）Among these patients，the mean levels of serum Mb in AKI group were significantly higher than those in non⁃AKI group on post operation hrs 0，24，48，and 72（P < 0.001）；（2）Logistic regression analysis showed that the level of preoperative MELD score（OR = 1.083，95%CI：1.022 ~ 1.147，P = 0.007），intraoperative amount of bleeding（OR = 1.001， 95%CI：1.000 ~ 1.002，P = 0.003），intraoperative total fluid output（OR = 1.015，95%CI：1.010 ~ 1.032，P = 0.008） and serum Mb level at 72 h after operation（OR = 1.038，95%CI：1.026 ~ 1.050，P < 0.001）were the independent risk factors related to AKI outcome in patients；（3）The total areas under ROC curve of preoperative MELD score， intraoperative amount of bleeding，intraoperative total fluid output andserum Mb level at 72 h after operation for predicting AKI for 80 patients with liver transplantation were respectively 0.655（95%CI：3.55 ~ 15.84，P < 0.01， 0.672），（95% CI：4.83 ~ 17.17，P < 0.01），0.532（95%CI：2.52 ~ 12.88，P < 0.01），0.861（95%CI：5.17 ~ 19.42， P < 0.01）. The optimal threshold values were respectively 16.7 points，0.8 L，2.9 L，150 ng/mL. The sensitivities were respectively 58% ，56% ，46% ，84% ，and the specificities were respectively 69% ，70% ，69% ，82%. Conclusion The increase ⁃ inserum Mb levels in liver transplantation patients are significantly correlated with their AKI outcome. Monitoring the dynamic changes inserum Mblevels during the early stage may be useful to predict the outcome of liver transplantation patients with new renal complications.