血清谷氨酸脱氢酶对肝移植患者的预后评价

Prognostic value of glutamate dehydrogenase activity in clinical liver transplantation

目的探讨血清谷氨酸脱氢酶(glutamate dehydrogenase,GLD)与肝移植患者预后的关系。方法应用德国临床化学学会推荐的速率法测定30例肝移植患者血清GLD活性并动态观察其变化的规律。结果对30例肝移植术中及术后早期患者血清GLD、ALT、AST、LDH活性进行连续监测。在术中供肝血流再灌注后,患者血清中此4种肝酶的活性开始明显上升。患者的预后与GLD升高的幅度及恢复至正常的时间的长短有关。预后不良的患者术后GLD峰值(均值5898.52 U/L)明显高于预后良好的患者(均值285.08 U/L)。分别以肝移植术后GLD、ALT的峰值800 U/L、1400 U/L为临界值预测肝移植术后预后。肝移植术后GLD峰、ALT峰预测准确率分别为86.7%、90%。将肝移植术后GLD恢复正常值天数以14天为界预测肝移植预后。其动态变化对预后的预测准确率为100%。结论肝移植术后早期血清GLD水平与预后有密切关系,GLD是预测肝移植预后的一个有价值的酶学指标。

Objective To investigate the relationship between serum glutamate dehydrogenase（GLD） and the prognosis of clinical liver transplantation. Methods The serum GLD in 30 patients with liver transplantation was measured with double agent, double wave rate method on the Olympus AU 2700 chemistry analyzer and thus the dynamic release patterns were monitored. Results Serum liver enzymes GLD, ALT, AST, LDH were assayed in during- and pnst-transplant until 30 day in 30 patients with liver transplantation. Patients with poorer prognosis had significantly higher peak GLD values compared with those with better prognosis （5898.52 U/L vs 285.08 U/L）. There was a marked difference in the release of serum GLD between the 2 groups. As a whole, the prognosis was poor in 12/12 of patients with continuously increased GLD values compared with 18/18 of those with GLD value quickly decreased in 4 d- 13 d after liver transplantation. Conclusion Serum GLD is closely related to the prognosis in patients with liver transplantation and as a specific enzyme of liver mitochondria, it is of value in the prognosis of liver transplantation.