肝移植术后早期肝功能的动态变化及其对预后的价值

Early dynamic changes of liver function and its prognostic implications after lepatic transplantation

目的动态观察肝移植术后1周内肝功能的变化,明确变化规律及术式对其的影响,以筛选对判断预后有价值的指标。方法回顾性分析149例肝移植受者术前、术后1、3、7d时ALT、AST、总胆红素(TB)、直接胆红素(DB)及凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原的变化情况,采用logistic回归筛选与预后有关的指标。结果肝移植术后1个月内生存的患者在术后1周内肝功能呈单峰变化。术后1d,纤维蛋白原恢复;术后3d,PT、APTT恢复;术后7d,ALT、AST下降至正常值附近。术后1个月内死亡的患者胆红素出现双峰,PT、APTT高峰前移,各项指标恢复时间延迟。背驮式肝移植受者前期恢复慢于经典式受者,但在术后1周内两组均可恢复,且术式与预后无关。术后7d的AST水平,术前及术后1、3、7d的TB水平,术后1、3d的DB水平及术后1d的PT值与预后相关。结论肝移植术后1周内肝功能出现单峰改变,术后7d基本可恢复正常;肝移植术后1周内AST、TB、PT与术后早期预后相关。术后高峰形状及位置改变提示并发症的出现,对术后管理和判断预后有积极意义。

Objective To detect the rule of hepatocyte-function change with 1 week following liver transplantation and to select useful parameter to forecast prognosis, we investigated the function of hepatocytes dynamically of patients within 1week following surgery.Methods A retrospective study was undertaken. Data was collected form 149 patients in our hospital from December 1994 to August 2003. AST, ALT, total bilirubin (TB), direct bilirubin (DB), prothrombin time(PT), activated partial thromboplastin time(APTT) and fibrinogen (FIB) were examined in the day before operation, 1, 3 and 7 d following surgery. Results Single peak of all values occurred with 1 week in patients who lived more than 1 month following surgery. The level of FIB, PT and APTT, AST and ALT descended to normal level in 1, 3 and 7 d after liver transplantation respectively. However, double peaks of bilirubin and altered peak of APTT and PT were observed in patients lived less than 1 month after surgery. Furthermore, descents of these values were delayed. Compared with the reversion of patients received classic liver transplantation, that of patients who received piggy back-on liver transplantation showed a slow recovery trend in earlier period after surgery. However, at 7 d following surgery, both can went near to normal level. The level of AST 7 d, DB 1 d and 3 d, PT 1 d following surgery and TB were related closely to the prognosis of patients who underwent liver transplantation. Conclusions The levels of ALT, AST, TB, DB, PT, APTT and FIB become normal on the whole within 1 week after liver transplantation. During this period, Single peak of all values occur. Alteration of the hump indicated the occurrence of complications. The shape of hepatic function hump and the level of AST, DB and PT and TB postoperation were useful value to forecast prognosis.