缺血再灌注损伤对肝移植受者术后早期胆红素代谢影响的临床及病理分析

Clinical and pathological analysis on the effect of ischemic-reperfusion injury on bilirubin metabolism in patients at the early stage after liver transplantation

目的分析缺血再灌注损伤对同种异体原位肝移植后受者胆红素变化的影响。方法30例入选患者监测术前及术后15天内肝功能数据进行统计学分析,同时在手术中获取冷缺血时及再灌注后供体肝脏组织进行光学显微镜及电子显微镜检查。结果肝移植术后存在一过性高胆红素血症(术后11天内),血总胆红素术后第1天(78.84±34.59)mmol/L,较术前(21.60±8.03)mmol/L明显升高(P<0.05),碱性磷酸酶术前中位数40.46IU/L,术后第1天中位数19.27IU/L,术后1天较术前降低(P<0.05)。胆汁酸术前中位数32.93μmmol/L,术后第1天中位数20.85μmmol/L,术后1天较术前降低(P<0.05)。γ-谷氨酰转肽酶术前中位数28.81IU/L,术后第1天中位数29.17IU/L,术后1天γ-谷氨酰转肽酶较术前升高没有显著差异(P>0.05)。术前直接胆红素/总胆红素比值为(39.85%±12.51%),术后1天比值为(54.25%±7.6%),术后较术前升高(P<0.05)。同时,光学显微镜及电子显微镜检查没有发现肝细胞外胆汁瘀积,胆红素主要瘀积于肝细胞内。结论缺血再灌注损伤导致患者肝移植术后早期出现以直接胆红素升高为主的一过性高胆红素血症,并在术后11天左右降至术前水平。胆汁瘀积主要发生于肝细胞水平。

Objective To analyze the influence of ischemic- reperfusion injury to the bilirubin's metabolism of paitients in the early stage after orthotopic liver transplantation. Method 30 patients are included in the test. Datas of liver function are monitored before and after transplantation. Statistics analysis is done to evaluate the tendency of these datas. Biopsy of donors' livers are done before and after reperfusion. Results The concentration of bilirubin after liver transplantation is increased(p<0.05), while the concentration of glutamyltranspeptidase is not increased, even the concentration of alkaline phosphatase and bile acid is degrade. The concentration of direct bilirubin is increased predominantly(p<0.05). Meanwhile , there is no jaundice detected in biliary tract by light microscope and electron microscope test. Conclusions Hyperbilirubinemia is induced by ischemic- reperfusion injury within 11 days after liver transplantation. Cholestasis developes within cellular level, which manifests hepatocyte's transport function of direct bilirubin is damaged during ischemia-reperfusion.