肝移植患者血清肌酐和尿素氮的动态监测及其临床意义

Dynamic change surveillance of serum creatinine and urea nitrogen and its clinical significance in patients after orthotopic liver transplantation

目的研究肝移植患者术前及术后血清肌酐(Cr)和尿素氮(BUN)的变化规律,探讨其临床价值。方法采用日立7180全自动生化分析仪检测88例肝移植患者术前1 d、术后1 d、3 d、7 d、30 d及术后1年血清Cr和BUN的动态变化。根据Cr和BUN的正常参考值,将患者分为术前正常组和术前异常组,比较2组患者术后变化规律。结果术前正常组术后Cr第1 d显著升高,第3 d开始逐渐下降,1个月后降低至治疗前的水平,但1年后较治疗前升高。术前异常组Cr从术后第3 d开始显著降低,术后7 d至30 d接近正常水平,术后1年略有升高,但仍显著低于治疗前水平。术前正常组BUN从术后第1 d开始,7 d内持续上升,30 d降低至治疗后1 d的水平,但1年后仍比治疗前高。术前异常组BUN从术后第3 d开始上升,术后7 d维持在较高水平,30 d恢复至治疗前的水平,1年后低于治疗前水平。结论术前不同肾功能状态的患者其Cr和BUN术后变化规律不同,可为肝移植后肾损伤评估及临床用药提供重要依据。

Objective To investigate the changes of serum creatinine（ Cr） and urea nitrogen（ BUN） before and after orthotopic liver transplantation（ OLT）,and to explore its clinical value. Methods The dynamic changes of serum Cr and BUN were measured by Hitachi 7180 automatic biochemical analyzer in 88 patients with OLT 1 d before operation,and 1 d,3 d,7 d,30 d and 1 year after operation. According to the normal reference value of Cr and BUN,patients were divided into preoperative normal group and abnormal group and postoperative changing rules of the two groups were compared. Results The level of Cr in normal group increased significantly on 1 d after OLT and decreased gradually from 3 d until the first month after OLT to the preoperative level. However,the level of Cr in normal group was higher than preoperative level one year after OLT. In contrast,the level of Cr in abnormal group decreased to the normal level from 3 d to the first month after OLT. Moreover,the level of Cr in abnormal group was much lower than preoperative level one year after OLT. In normal group,the level of BUN increased continuously from 1 d to 7 d after OLT and decreased to the postoperative level one month after OLT. However,the level of BUN in normal group was higher than preoperative level one year after OLT. In abnormal group,the level of BUN increased from 3 d to7 d after OLT,and decreased to preoperative level one month after OLT. Furthermore,the level of BUN in abnormal group was lower than preoperative level one year after OLT. Conclusion Patients with different preoperative renal function may undergo different postoperative changes of Cr and BUN,which can provide an important basis for renal injury assessment and clinical drug use after liver OLT.