婴幼儿肝移植围手术期血清HO-1水平的变化及其临床意义

Serum HO-1 levels in perioperative period and its clinical significance in pediatric liver transplantation

目的探讨婴幼儿肝移植围手术期血清血红素氧化酶1（HO-1）水平的变化及其临床意义。方法连续选取2015年10月1日至2015年12月31日间因胆道闭锁接受亲属活体供肝移植的婴幼儿受者20例，分别于术前即刻及术后24h、72h、1周和2周采集受者外周静脉血，采用酶联免疫吸附试验法检测血HO-1的表达量。以术前直接胆红素占胆红素总量50％（胆红素总量升高）为截断值，将受者分成直接胆红素低占比组（A组）和高占比组（B组），比较两组受者肝移植前后血HO-1表达的动态变化，同时检测丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）及其他相关临床指标。选取5例健康同龄儿童作为对照组。结果儿童肝移植受者术前血HO-1测定值高于对照组（P〈0．001）；术前直接胆红素与HO-1呈正相关（相关系数R=0．576，P=0．008）；B组受者谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）和直接胆红素水平均明显高于A组（P=0．039），接受过葛西手术的受者比例低于A组（P=0．02）；术前即刻、术后24h、72h时血HO-1值呈逐渐降低趋势，术后1～2周呈升高趋势；术前即刻和术后24h时B组受者血HO-1值显著高于A组（P〈0．05），而两组间术后72h、1周和2周的血HO-1值差异无统计学意义（P〉0．05）。术后1周和2周受者的肝功能趋于正常，HO-1升高。结论胆道闭锁患儿血HO-1值升高与胆道梗阻程度相关，肝移植术后受者体内HO-1因子升高有助于肝功能的恢复。

Objective To investigate the serum HO-1 level in children with liver transplantation and its clinical significance. Methods We selected 20 children with biliary atresia undergoing pediatric living donor liver transplantation from October 1, 2015 to December 31, 2015 in Tianjin First Central Hospital. The vein blood was collected before and 24 h, 72 h, 1 week and 2 weeks after operation. The serum HO-1 levels were determined by by ELISA. The patients were divided into low direct bilirubin group （group A） and high direct bilirubin group （group B） according to the cut-out value of preoperative direct bilirubin. The dynamic changes of serum HO-1 level were compared between the two groups before and after operation. ALT, AfT and other clinical indicators were measured at the same time. Five healthy age-matched children were selected as the controls. Results The serum HO- 1 level preoperation in patients was significantly increased compared to those in the control group （P〈 0. 001）. Preoperative direct bilirubin was positively correlated with HO-1 （R = 0. 576, P = 0. 008）. The GGT, ALP and direct bilirubin levels in group B were significantly higher than those in the group A （P = 0. 039）, but the Kasai ratio was opposite （P = 0. 02）. The serum HO-1 level before and 24 h and 72 h after operation was decreased gradually, and increased 1 week and 2 weeks after operation. The serum HO-1 level in group B was higher than in group A before and 24 h after operation （P〈 0. 05）, and there was no significant difference between the two groups 72 h, 1 week and 2 weeks after operation （P〉0. 05）. The liver function was tended to be normal after operation. Conclusion The serum HO-1 level in children with biliary atresia was related to the degree of obstruction, and the increase of HO-1 postoperation is helpful for the recovery of liver function.