联合检测血清总胆红素与胆汁性状在鉴别肝移植术后早期高胆红素血症中的应用初探

Application of joint detection with serum total bilirubin and bile characteristics in discriminating etiology of early hyperbilirubinemia after liver transplantation

目的探讨联合检测血清总胆红素变化与胆汁性状在鉴别肝脏移植术后早期高胆红素血症病因中的意义。方法 对47例有病理结果或临床诊断明确的肝移植术后高胆红素血症患者的血清胆红素变化及胆汁引流情况进行总结分析。结果 本组47例患者中出现高胆红素血症68例次,其中缺血再灌注损伤32例次,术前高胆红素血症17例次,急性排斥反应9例次,胆道并发症4例次,药物性肝脏损害3例次,肝动脉血栓2例次,原发性移植肝无功能1例次。不同病因的血清总胆红素与胆汁形状各有鲜明特点。其中缺血再灌注损伤组肝移植术后血清总胆红素逐渐下降,7～10d左右出现轻度反弹,然后再次下降逐渐恢复至正常;胆汁颜色金黄,黏稠度高,量逐日增加。术前高胆红素组术后血清总胆红素即明显下降,术后2d又开始上升,3～4d左右达高峰后开始下降,7～10d左右轻度反弹,然后再次下降并逐渐恢复正常;胆汁颜色金黄,黏稠度高,量逐日增加。急性排斥反应组术后血清总胆红素日渐下降,之后出现较高幅度的反弹,同时胆汁颜色变浅,引流总量急剧下降,每小时引流量只有几毫升甚至无胆汁分泌。结论 对肝移植术后早期高胆红素血症患者进行血清总胆红素及胆汁形状的动态监测,分析其特点,可初步判断高胆红素血症的病因,有利于及时采取正确的诊疗措施。

Objective To investigate the value of joint detection with serum total bilirubin variation and bile characteristics in discriminating etiology of early hyperbilirubinemia after liver transplantation.Methods Among 47 cases undergoing liver transplantation,serum total bilirubin levels and the characteristics of drained bile after liver transplantation were monitored regularly and analyzed.Results Forty-seven patients experienced 68 times of hyperbilirubinemia.The etiology of hyperbilirubinemia among these patients included the following：ischemia-reperfusion injury（IRI group,32 cases）,initial hyperbilirubinemia of recipient before liver transplantation（IHB group,17 cases）,acute rejection（9 cases）,biliary tract complication（4 cases）.drug-induced liver injury（3 cases）,liver artery thrombosis（2 cases）,primary allograft nonfunction（1 case）.Serum total bilirubin and drained bile had distinct characteristics in different diseases.In IRI group,serum total bilirubin gradually declined after liver transplantation,7-10 d appeared mild bounce and then returned to normal level gradually.Bile showed golden yellow,thick,the volume of bile increased gradually.In IHB group,postoperative serum total bilirubin declined obviously,began to rise after 2 d,3-4 d reached peak and then began to drop,7-10 d appeared mild bounce and then down again and return to normal gradually.Bile showed golden yellow,thick,and the volume increased on a daily basis.The postoperative serum total bilirubin level of acute rejection group dropped with each passing day,and then appeared higher amplitude rebound,and bile color became shallow.The volume of bile fell severely,the each hour amount of bile drainage had a few millilitre and even without bile.Conclusion Bilirubinemia is a common complication after liver transplantation and may result from risk factors.The serum total bilirubin variation and the characteristics of drained bile may reflect different etiology.Monitoring serum total bilirubin levels and drained bile is helpful for discriminating the causes of hyperbilirubinemia and adopting correct treatments in time.