原位肝移植后胆管铸型组肝功能分析及预警指标筛选

Analysis of liver function test and screening of early warning indicators for biliary cast group after orthotopic liver transplantation

背景:当肝移植胆管铸型诊断明确时移植肝因为胆道梗阻和反复感染已经受到不同程度的损伤,因此早期发现胆管铸型显得尤为重要。目的:检测原位肝移植后发生胆管铸型胆道并发症患者的肝功能,从中筛选出可供早期诊断胆管铸型的预警指标。方法:回顾性分析经胆道内镜诊治或胆道造影已经确定发生肝移植后胆道并发症患者25例的肝功能指标,其中胆管铸型组7例,胆管吻合口狭窄5例,胆管铸型并吻合口狭窄13例;以胆道内镜检查肝移植后胆道正常的18例患者为对照组。结果与结论:肝移植后1周,正常组与胆道并发症各分组受者血清肝功能指标差异均无显著性意义(P>0.05)。肝移植后1个月胆管铸型组、胆管铸型并吻合口狭窄组血清γ-谷氨酰转肽酶水平显著高于胆道正常组(P<0.01),胆管吻合口狭窄组血清γ-谷氨酰转肽酶水平显著低于胆管铸型组(P<0.05)。提示胆管铸型是原位肝移植后潜在的并发症,γ-谷氨酰转肽酶可作为原位肝移植后胆管铸型组的预警指标,也是肝移植后鉴别黄疸原因的重要参考指标和胆道镜检查和外科治疗的指征。

BACKGROUND：When biliary cast syndrome in liver transplantation is identified, the transplanted liver has been injured to different extents because of obstruction of biliary tract and repeated infection, therefore, it is extremely important to detect biliary cast syndrome. OBJECTIVE：To detect the liver function of patients who underwent orthotopic liver transplantation and exhibited biliary cast complications and to screen the warning indicators for early diagnosis of biliary casts. METHODS：We retrospectively analyzed the liver function indices of 25 patients with biliary tract complications after liver transplantation, which have been confirmed by endoscopic or radiographic cholangiography. The 25 patients were assigned to four groups according to the syndromes：biliary cast （n =7）, biliary duct anastomotic stricture （n =5）, biliary cast ＋ anastomotic biliary stricture （n = 13） and normal biliary duct （n =18）. RESULTS AND CONCLUSION：At 1 week after liver transplantation, there was no significant difference in liver function indices between normal biliary duct and other groups （P 0.05）. At 1 months after liver transplantation, serumγ-glutamyl transpeptidase was significantly higher in the biliary cast group, biliary cast ＋ anastomotic biliary stricture group than in the normal biliary duct group （P 0.01）, and it was significantly lower in the biliary duct anastomotic stricture group than in the biliary cast group （P 0.05）. The results showed that biliary cast is the potential complication of orthotopic liver transplantation;serumγ-glutamyl transpeptidase can be used as an warning indicator of biliary cast group after orthotopic liver transplantation and it is also an important reference indicator for identification of jaundice causes following surgery and an indication for choledochoscopy and surgical treatment.