肝移植术后早期肝组织葡萄糖及乳酸代谢的相关性研究

Research on the correlation between glucose and lactate metabolism of liver cells in early phase following liver transplantation

目的利用微透析技术观察移植肝早期肝组织代谢（葡萄糖、乳酸、乳酸／丙酮酸）的变化和它们之间的相关性。方法收集我院2007～03～2009—12肝移植患者20例，在新肝镰状韧带植入微透析导管进行透析，每隔1h，测定透析液中葡萄糖、乳酸、乳酸／丙酮酸的浓度，常规监测5～7d。结果原位肝移植患者术后，葡萄糖和乳酸在第1个24h显著下降，差异有统计学意义（P〈0．05）；且乳酸升高期问乳酸／丙酮酸比值并不升高，肝组织乳酸和葡萄糖的决定系数（r）=0．575，回归系数（b）=0．252，回归方程：Y=0．278＋0．227x，差异有统计学意义（P〈0．001），两变量呈正相关。结论原位肝移植术后患者早期肝组织乳酸升高的主要原因是高血糖，而并非肝组织缺血、缺氧。

Objective To assess liver cell metabolism （glucose, lactic acid and the ratio of lactate to pyruvic acid ） and their correlation in early phase following liver transplantation by using microdialysis technique. Methods Twenty patients with whole - organ orthotropic liver transplantation （OLT） were studied. At the end of the operation, a microdialysis catheter was intrahepatically implanted in falciform ligament. Consecutive samples were collected at intervals of an hour for 5 - 7 days. Glucose, lactic acid, and the ratio of lactic acid to pyruvic acid were measured. Results During the first 24 h after the operation, glucose and lactic acid in liver significantly decreased, and the ratio of lactic acid to pyruvic acid did not change when lactic acid concentration increased. The determination coefficient of glucose and lactic acid in liver （r） was 0. 575. The regression coefficient （b） was 0. 252. The regression equation showed positive correlation： Hyperglycemia, but not hypoxia- isehemia in liver, phase following liver transplantation. y = 0. 278 ＋ 0. 227x （ P 〈0. 001 ）. Conclusion is the main reason for lactate development in early