肾移植术后受者血清中肝肾功能指标动态监测的临床意义

Clinical significance of monitoring parameters in serum of the recipients after renal transplantations

目的探讨肾移植术后受者肝、肾功能各指标的动态变化及其临床意义。方法应用日立7600生化全自动分析仪对受者术后1、3、5、7 d,1、2、3周血清中的肝肾功能指标进行动态监测,比较肾功能恢复稳定组(A组)与肾功能恢复不良组(B组)各指标的差异。结果 (1)B组术后1 d尿素氮(BUN)水平高于A组(P<0.05),A组在5 d后持续下降,B组在2周内下降,3周反弹时水平约为A组的两倍(P<0.01);(2)术后1 d B组肌酐(CR)水平约为A组1.5倍,A组呈递减趋势;B组水平出现反弹,3周时B组水平约为A组的3倍(P<0.01);(3)两组术后胱抑素C(CYSC)水平在1 d时无统计学差异,A组呈下降趋势,B组在3 d后出现持续反弹,到3周时超过术后1 d的水平,约为A组的2.5倍(P<0.01);(4)两组转氨酶水平均在正常参考范围内,同组谷草转氨酶(AST)、谷丙转氨酶(ALT)变化极其相似,A组总胆汁酸(TBA)呈缓慢上升趋势,B组的改变无规律;(5)超敏C反应蛋白(HS-CRP)3周内两组水平无统计学差异(P>0.05)。结论为正确评估受者肾功能,建议以CYSC替代BUN、CR,联合检测受者血清中TBA、CRP更能全面地反映肝功能的状态。

Objective To study the clinical significance of monitoring parameters in serum of the recipients after renal transplantations. Methods Hitachi 7600 blood biochemical analyzer was used to measure all parameters of different times, and these parameters were compared between two groups. Results After operations, the level of BUN in group B was higher than in group A on 1th day （P〈0.05）,the level in group A kept on decreasing, but the level in group B rebounded on 3 w when the level in group B was as twice as in group A（P〈0.01）. 2）On 1st day the level of CR in group B was as 1.5 times as in group A, in group A the level of CR obviously decreased, but it rebounced in group B. On W3 the level in group B was as 3 times as in group A（P〈0.01）. 3）On 1st day, the level of CYSC was not significantly different between the two groups, but on 3 w the level in group B was as 2.5 times as in group A（P〈0.01）. 4）The levels of ALT and AST were in the normal limit, the change of AST was similar with ALT in the same group. The level of TBA in group A rose slowly, the change in group B was irregular. 5）On the 3th week there were no significant difference in the level of high-sensitivity C reactive protein （HS-CRP） between the two groups（P〉0.05）. Conclusions It is suggested to use CYSC to replace BUN and CR to evaluate renal function. Combined measurement of TBA and HS-CRP may be more valuable to evaluate liver function.