肝移植术后胆汁γ-GT、AST水平变化及对EAD的预测价值

CHANGES OF GAMMA-GLUTAMYL TRANSPEPTIDASE AND ASPARTATE AMINOTRANSFERASE IN BILE AND THEIR VALUE IN PREDICTING EARLY ALLOGRAFT DYSFUNCTION AFTER LIVER TRANSPLANTATION

目的 分析早期肝移植术后患者胆汁中γ-谷氨酰转肽酶(γ-GT)、天冬氨酸氨基转移酶(AST)水平变化,探讨其对早期移植物功能不全(EAD)发生的预测价值。方法 选取原位肝移植患者32例,根据病人是否发生EAD将其分为EAD组与非EAD组,留取患者术后1~7d胆汁,分别比较两组胆汁中AST、γ-GT的水平。采用ROC曲线评价胆汁中γ-GT、AST水平对患者术后发生EAD的预测价值。结果 重复测量设计的方差分析显示,时间、分组及时间与分组的交互作用对患者胆汁中AST的水平具有明显的影响(F组别=49.708,F时间=49.332,F时间*组别=10.093,P<0.01),同时对患者胆汁中γ-GT的水平也具有明显的影响(F组别=12.827,F时间=17.421,F时间*组别=2.918,P<0.05);术后1~6dEAD组胆汁中AST的水平显著高于非EAD组(F=8.175~40.527,P<0.01),术后1~5dEAD组胆汁γ-GT水平显著高于非EAD组(F=4.396~13.199,P<0.05)。患者血清中AST水平与相应胆汁中AST水平呈显著正相关(r=0.855,P<0.01)。ROC曲线分析显示,术后1~4d胆汁中γ-GT、AST水平对判断肝移植术后发生EAD的AUC均>0.75。结论 肝移植患者术后1~7d胆汁中γ-GT、AST水平的变化一定程度反映肝细胞破坏的程度,术后1~4d胆汁中γ-GT、AST水平对EAD的发生具有早期预测价值,临床上可借助胆汁中γ-GT、AST水平判断患者发生EAD可能性,进而指导早期治疗。

Objective To investigate the changes of gamma-glutamyl transpeptidase(γ-GT)and aspartate aminotransferase(AST)in bile in the early stage after liver transplantation and their value in predicting early allograft dysfunction(EAD).Methods A total of 32 patients who underwent orthotopic liver transplantation were enrolled,and according to the presence or absence of EAD,they were divided into EAD group with 6 patients and non-EAD group with 26 patients.Bile samples were collected on days 1-7 after surgery to compare the levels ofγ-GT and AST in bile between the two groups.The receiver operating characte-ristic(ROC)curve was used to evaluate the value ofγ-GT and AST levels in bile in predicting postoperative EAD.Results The repeated-measures analysis of variance showed that time,group,and interaction between time and group had a significant influence on the level of AST in bile(F group=49.708,F time=49.332,F time*group=10.093,P<0.01)and the level ofγ-GT in bile(F group=12.827,F time=17.421,F time*group=2.918,P<0.05).On days 1-6 after surgery,the EAD group had a significantly higher level of AST in bile than the non-EAD group(F=8.175-40.527,P<0.01),and on days 1-5 after surgery,the EAD group had a significantly higher level ofγ-GT in bile than the non-EAD group(F=4.396-13.199,P<0.05).The serum level of AST was positively correlated with the level of AST in bile(r=0.855,P<0.01).The ROC curve analysis showed that the levels ofγ-GT and AST in bile on days 1-4 after surgery had an area under the ROC curve of>0.75 in predicting EAD after liver transplantation.Conclusion To a certain degree,the changes of the levels ofγ-GT and AST in bile on days 1-7 after liver transplantation can reflect the degree of hepatocyte destruction,and the levels ofγ-GT and AST in bile on days 1-4 after surgery have a certain value in the early prediction of EAD.The levels ofγ-GT and AST in bile can be used in clinical practice to evaluate the possibility of EAD and guide early treatment.