成人肝移植术后早期胆红素变化规律

Regularity of early postoperative bilirubin changes after adult liver transplantation

目的探讨肝移植术后早期总胆红素(TB)变化规律及其临床意义。方法对42例成人肝移植术后胆红素进行对比分析,将其分为肿瘤组与非肿瘤组、并发症组与无并发症组。结果肿瘤组与非肿瘤组TB曲线在术后似呈反“S”曲线,即先降后升再降,但具有差别显著的峰谷值;肿瘤组与非肿瘤组的前4个时间点不同(P<0.005),余时间差异无统计学意义(P>0.05)。结论(1)由基础肝病所致的术前TB将影响术后7天内的TB值,但7天后此影响将很小,提示原肝病与移植肝是否出现近期肝并发症可能无明显关系。(2)31天的TB仍高于正常,提示肝移植术后1个月仍属多种原因导致的肝损伤恢复期。(3)初步揭示了肝移植术后有无肿瘤的患者TB变化规律曲线。

Objective To investigate the trend and clinical roles of early postoperative bilirubin changes after liver transplantation. Methods The data of total bilirubin （TB） in 42 patients undergoing liver transplantation were retrospectively analyzed by comparing the cancer and non-cancer group; complication and noncomplication group on day 1,2,3,7,11,1S,19,23,27,and 31 after operation. Results The curves of TBaverage in all groups were similar to the invert S curve, that is, descending-ascending-descending. However the kurtosis in all groups was different remarkably. The TB in cancer or non-cancer group at first 4 time points（day 1,2,3,7 after operation） and the complication or noncomplication group at last 4 time points （day 19,23,27,31 after operation） was significantly different （P〈0. 05）, but the values at other time points were similar（P〉0.05）. Conclusion TB values of pre-operation produced by primary liver disease will affect the values in 7 days after operation, and the effect will become tiny after that, which may indicate that there is no definitely relationship between primary liver diseases and liver complications of recipient. The fact that TB in non-complication group is higher than normal values after day 31 reveals 1 month after operation is recovery phase for impaired liver. The change regularity of TB in the recipients who have a normal recovery was preliminarily revealed.