终末期肝病患者肝移植同手术期肾功能指标的变化

Changes of perioperative renal function indicators in patients with end-stage liver diseases during liver transplantation

目的观察重型肝炎和肝癌肝硬化患者在原位肝移植围手术期肾功能指标的变化及差异。方法52例终末期肝病的原位肝移植术患者，分为重型肝炎组（24例）和肝癌肝硬化组（28例）。在不同时间点测定两组患者血β2微球蛋白（β2-MG）含量和异常率、尿β2—MG和N-乙酰-β-D-葡萄糖苷酶（NAG）含量和异常率及血肌酐（Scr）、尿素氮（BUN）和总胆红素（TBIL）含量，并进行组内和组间的比较。结果重型肝炎组术前尿β2—MG异常率及术前、新肝60min、术后30min的尿NAG异常率均高于肝癌肝硬化组（均P〈0．01）.在无肝前、无肝30min、新肝60min、术后30min重型肝炎组血β2-MG水平均明显高于相应的时段肝癌肝硬化组[（2．50±1．59）mg／L比（1．79±0．38）mg／L，（2．58±1．12）mg／L比（1．81±0．40）mg／L，（2．46±0．01）mg／L比（1．84±0．46）mg／L，（2．57±0．82）mg／L比（1．97±0．59）mg／L，均P〈0．05]。术前、新肝60min及术后30min重型肝炎组尿β2—MG和NAG水平均高于肝癌肝硬化组（均P〈0．05）。新肝60min及术后30min两组患者尿β2-MG和NAG水平均高于术前（均P〈0．05）。重型肝炎组术前血TBIL高于肝癌肝硬化组（P〈0．05）：重型肝炎组术后24h、术后1周血Scr、BUN和TBIL均明显高于肝癌肝硬化组（均P〈0．05）。结论重型肝炎患者在肝移植围手术期肾功能损伤较肝癌肝硬化组严重，肝移植围手术期应注意保护重型肝炎患者的肾功能。

Objective To investigate the changes and difference of perioperative renal function indicators in patients with end-stage liver diseases （including severe viral hepatitis and hepatocareinoma with hepatic cirrhosis） during orthotopic liver transplantation （OLT）. Methods Fifty-Two patients with OLT were divided into severe viral hepatitis group （SVH group, n=24） and hepatocarcinoma with hepatic cirrhosis group （HCH group, n=28）. The levels and the abnormal rates of serum β2-microglobulin （β2- MG） and urine N-acetyl-β-D-glucosamlnidase （NAG）, the levels of serum creatinine （Scr）, urea nitrogen （BUN）, total bilirubin （TBIL） were measured in 2 groups at different time points, and the intra-group comparison and inter-group comparison were performed then. Results The abnormal rates of preoperative urine β2-MG and NAG at the time points of preoperation, 60 min after new liver transplantation and 30 min postoperation in SVH group were significantly higher than those in HCH group （all P〈0.01 ）. The levels of serum β2-MG in SVH group at the time points of 0 and 30 min after surgical removal of liver, 60 min after new liver transplantation and 30 rain postoperation were significantly higher than those of HCH group [ （2.50±1.59 ） mg/L vs （1.79±0.38） mg/L, （2.58±1.12） mg/L vs （1.81±0.40） mg/L, （2.46±0.01） mg/L vs （1.84± 0.46） mg/L, （2.57±0.82） mg/L vs （1.97±0.59） mg/L,all P〈0.05]. The levels of urine β2-MG and NAG in SVH group at the time points of preoperation, 60 min after new liver transplantation and 30 min postoperation were significantly higher than those of HCH group （all P〈0.05）. During 60min after new liver transplantation and 30 min postoperation, the levels of urine β2-MG and NAG were significantly higher comparing with the preoperative levels in both groups （all P〈0.05）. The preoperative level of serum TBIL in SVH group was significantly higher than that in HCH group （P〈0.05）.The levels of serum BUN, Ser and TBIL in SVH group at the time points of 24 h and 1 week postoperation were significantly higher than those in HCH group （all P〈0.05）. Conclusions The degree of perioperative renal dysfunction is more serious in patients with SVH than that in patients with HCH during liver transplantation. It is important to protect the perioperative renal function for patients with SVH during liver transplantation.