肝移植急性排斥反应临床化学诊断特点

Clinical chemical markers of acute rejection in liver transplantation

目的:筛选与肝移植急性排斥反应有关的临床化学项目,探讨它们的规律、特点及其对诊断急性排斥反应的价值。方法:7例肝移植术后急性排斥反应为观察组;5例胆道感染、4例胆道狭窄/梗阻和6例抗排异药物毒性反应分别为对照组。测定14项临床化学指标,分析它们在各组的消长和变化规律,找出有特征性意义的指标。结果:急性排斥反应ALT、GGT、ALP、TB、DB 5项指标的变化有特异性,在术后7～14 d急剧升高,或没有降低反而逐渐升高趋势。GGT升高时间较早,TB、DB升高时间较晚,临床化学指标改变时间比病理学诊断时间早3～5 d。胆道感染ALT、GGT,胆道狭窄/梗阻TB、DB,抗排异药物毒性反应ALT、AST、TB、DB变化最明显。急性排斥反应5项组合指标的特点不同于对照组。结论:用ALT、GGT、ALP、TB、DB 5项组合指标的变化,对急性排斥反应可做出初步判断。比组织学诊断时间早,对中、重度急性排斥反应的治疗可提早3～5 d。

Objective：To investigate the clinical chemical markers of the acute rejection （AR） and analyze their pattern and character and the value for diagnosis. Methods：Seven AR cases served as subjects, five biliary tract infection cases, four biliary tract obstruction cases and six anti -rejection drug side -function cases as controls. Fourteen clinical chemical indexes were ana- lyzed and selected for the diagnosis of AR. Results：Plasma ALT, GGT, ALP, TB and DB were observed the character for the diag- nosis of AR. Their levels were rapidly or gradually increasing at 7 - 14 ds after transplantation. GGT rising was earlier and TB and DB was later. The diagnosis days of clinical chemistry marker were early 3 ～ 5 d than biopsy. ALT and GGT in biliary tract infec- tion, TB and DB in biliary tract obstruction and ALT, AST,TB, DB in anti -rejection drug side -function were found their characters. Five chemical markers of AR were different from controls. Conclusion：The distinguishing of AR may be done by using the groups of ALT,GGT,ALP,TB and DB levels and earlier than histology. It is of practical value for treatment.