肝移植术后患者血清胆汁酸的变化及临床意义

Clinical significance of serum level of bile acid in patients after liver transplantation

目的探讨肝移植术后患者血清血清胆汁酸水平的变化及其临床应用价值。方法选择本院收治的肝移植术后患者78例,以及同期于本院体检健康者30例。检测并比较受试者血清胆汁酸、门冬氨酸氨基转移酶等肝功能指标的水平。结果 Child-Pugh分级为A、B、C级的肝移植患者血清胆汁酸水平分别为(1.41±0.28)、(1.91±0.19)、(2.04±0.08)mol/L,均高于健康者[(0.79±0.09)mol/L,P<0.05]。Child-Pugh分级为B级和C级患者,血清胆汁酸水平均高于A级患者(P<0.05)。在术后第5、7天,出现排异反应的患者血清胆汁酸水平高于未出现排异反应的患者。出现排异反应的患者血清胆酸/鹅脱氧胆酸比值低于术前水平,且术后第5、7天水平均低于未出现排异反应的患者(P<0.05)。结论血清胆汁酸、胆酸/鹅脱氧胆酸比值能够敏感地反映肝细胞损伤程度,是早期诊断肝移植术后排异反应的良好指标,能够为临床诊断和治疗提供重要参考。

Objective To explore the clinical significance of serum bile acid in patients after liver transplantation.Methods A total of 78 patients receiving liver transplantation in this hospital and 30 healthy subjects were enrolled.Concentration of serum bile acid and other indicators were detected and compared.Results Postoperative serum levels of bile acid in patients of Child-Pugh class A,B and C were（1.41±0.28）,（1.91±0.19）and（2.04±0.08）mol/L,which were all higher than the（0.79±0.09）mol/L of healthy subjects（P〈0.05）.Serum levels of bile acid in patients of Child-Pugh class B and C were significantly higher than patients of Child-Pugh class A（P〈0.05）.At the fifth and seventh day after operation,serum levels of bile acid in patients with rejection were higher than patients without rejection.Ratio of serum cholic acid to chenodeoxycholic acid in patients with rejection decreased,compared with levels detected before operation,and levels detected at the fifth and seventh day after operation were lower than patients without rejection（P〈0.05）.Conclusion Serum bile acid and the ratio of cholic acid to chenodeoxycholic acid could sensitively reflect damages of liver cells,which might be good indicators of early diagnosis of rejection after liver transplantation,and could provide important references for clinical diagnosis and treatment.