术前血浆β_2-微球蛋白增高与肝移植术后发生急性肾衰竭的关系

Relationship between preoperative raised plasma β_2-microglobulin and acute renal failure after liver transplantation

目的探讨β2-微球蛋白(β2-microglobulin,β2-MG)水平与肝移植术后急性肾衰竭(acute renal failure,ARF)发生率的关系。方法研究对象为2004年3月至2006年11月在中山大学附属第三医院由同一手术小组进行下腔静脉全阻断改良背驮式肝移植的80例终末期肝病患者,术前血清肌酐(Scr)、血尿素氮(BUN)检测均在正常范围,术中未采用体外静脉-静脉转流术。术前采用散射比浊法测定两组患者桡动脉血β2-MG值。根据术前血β2-MG值正常与否将患者分为两组:术前血β2-MG值异常组(Ⅰ组),术前血β2-MG值正常组(Ⅱ组)。术后按有否发生重度ARF分为重度ARF组和非重度ARF组。全部患者术后进行至少随访3年,以随访结束日或死亡为研究终点。记录并比较Ⅰ组与Ⅱ组患者术后ARF的发生率及术后30d、术后1年、2年及3年的生存率;记录并比较重度ARF组和非重度ARF组术后30d、术后1年、2年及3年的生存率。结果根据术前血β2-MG值分组,Ⅰ组32例,Ⅱ组48例,术前血β2-MG值增高异常率为40%。Ⅰ组32例患者中11例(34%)发生轻度ARF,6例(19%)发生重度ARF;Ⅱ组48例患者中12例(25%)发生轻度ARF,1例(2%)重度ARF。两组的轻度和重度ARF发生率比较差异有统计学意义(均为P<0.05)。Ⅰ组与Ⅱ组相比较,术后30d及术后1年生存率差异无统计学意义(均为P>0.05);术后2年及3年生存率比较差异有统计学意义(均为P<0.05)。重度ARF组的术后30d、术后1年、2年、3年生存率远低于非重度ARF组患者(均为P<0.01)。结论肝移植患者术前肾功能异常与术后ARF发生率有关,与Scr比较,血浆β2-MG是反映早期肾损害更灵敏的指标,并且具有预测术后ARF的能力。

Objective To investigate the relationship between plasma β2- microglobulin （β2-MG） level and the incidence of acute renal failure （ARF） after liver transplantation. Methods The objects of this study were 80 patients underwent modified piggyback liver transplantation with total cava exclusion, who were performed by the same surgery team in the Third Affiliated Hospital of Sun Yat-sen University from March 2004 to November 2006. The levels of serum creatinine （Scr） and blood urea nitrogen （BUN） were both normal before the operation. No veno-veno bypass in vitro was applied in the operation. Before the operation, the β2- MG level was detected by nephelometry. The patients were divided into 2 groups according to the normal or abnormal β2-MG level before the operation： the abnormal β2-MG group （group I ） and the normal [52-MG group （group II ）. After the operation, the patients were divided into the severe ARF group and non-severe ARF group according to whether severe ARF happened. All the patients were followed up at least 3 years after liver transplantation with the follow-up deadline or death as the end of research. Results There were 32 cases in group I and 48 cases in group II , according to the β2-MG level before the operation. The abnormal rate with increased β2-MG was 40%. Eleven cases （34%） suffered mild ARF and 6 cases （ 19% ） suffered severe ARF in 32 patients of group I. Twelve cases （25%） suffered mild ARF and 1 case （2%） suffered severe ARF in 48 patients of group II. There were significant differences in the incidences of mild and severe ARF between the two groups （ both in P 〈 0. 05 ）. No significant difference was observed in the postoperative 30-day, 1-year survival rates between the two groups （ all in P 〉 0. 05 ）. But there were significant differences in the postoperative 2-year, 3-year survival rates between the two groups （all in P 〈 0. 05 ）. The postoperative 30-day, 1-year, 2-year, 3-year survival rates of the patients in the severe ARF group were much lower than those in the non-severe ARF group （ all in P 〈 0. 01 ）. Conclusions The renal dysfunction before the liver transplantation is associated with the incidence of postoperative ARF. Compared with the Scr, plasma β2-MG can be regarded as a more sensitive index of early renal damage and it can also predict the incidence of postoperative ARF.