肝移植术后患者血清胆汁酸代谢的检测及临床意义

Determination of serum bile acid in patients after liver transplantation

目的:评价肝移植术后患者血清总胆汁酸水平、胆酸/鹅脱氧胆酸比值在肝移植术后发生排斥反应及肝功能延迟恢复时的变化规律。方法:选择2004-01/2004-12在大连医科大学器官移植中心进行肝移植手术的患者28例,同时收集大连医科大学附属二院门诊健康体检者和肝硬化患者血清学标本各12例作为对照,所有观察对象均知情同意。采用高效液相色谱检测肝移植术后患者血清中不同种类胆汁酸及总胆汁酸水平,也与常规肝功能监测指标谷草转氨酶和总胆红素加以比较,对肝移植术后患者血清指标与肝功能恢复之间的关系进行综合评价。结果:所有观察对象均进入结果分析,无脱落。①肝硬化组、肝移植组术前患者的血清总胆汁酸水平显著高于正常对照组(P<0.05)。②肝移植患者术后发生排斥反应或肝功能延迟恢复时,血清总胆汁酸水平较术前明显升高(P<0.05),胆酸/鹅脱氧胆酸比值明显降低(P<0.05),且比谷草转氨酶、总胆红素的变化提前发生,随着供肝功能的恢复它们将逐渐恢复正常。结论:总胆汁酸及胆酸/鹅脱氧胆酸比率可以作为肝移植术后发生排斥反应及肝功能延迟恢复的早期诊断指标,其对于肝移植术后急性排斥反应的早期诊断、早期治疗有重大意义。

AIM： To analyze the changes of the total bile acid （TBA） and the ratio of cholic acid/chenodeoxycholic acid （CA/CDCA） in serum of patients when rejection reaction and the transplanted liver functional recovery delay happen after liver transplantation. METHODS： Twenty-eight patients, who underwent liver transplantation in the Organ Transplant Center of Dalian Medical University from January to December in 2004, were adopted in the study, meanwhile 12 healthy examinees and 12 liver cirrhosis patients from the Second Affiliated Hospital of Dalian Medical University ware used for contrast. Informed consents were obtained from all the subjects. The patients ware detected by high efficiency liquid chromatography for the varied levels of bile acid and TBA after operation, which were compared with common liver function index： glutamic oxalacetic transaminase （AST） and total bilirubin （TBIL）, then the relationship between the serum indexes and liver functional recovery of the patients after liver transplantation was estimated comprehensively. RESULTS： All the subjects were involved in the result analysis. ①Compared with normal controls, the liver cirrhosis patients and preoperative patients had a significant higher level of serum TBA （P 〈 0.05）. ~When the rejection happened or liver functional recovery delayed, the serum TBA would step up obviously （P 〈 0.05）, but the CA/CDCA depressed obviously （P 〈 0.05）. These changes were ahead of the changes of AST and TBIL, and would anastate normal with the transplant liver function recovered gradually. CONCLUSION： TBA and the ratio of CNCDCA can be used as the e ady diagnosis indexes of the rejection reaction and liver functional recovery after liver transplantation. They are meaningful for the early diagnosis and treatment of acute rejection.