血清肌酸激酶对肝癌肝切除患者缺血-再灌注损伤的预测价值

Predictive value of serum creatine kinase for ischemia-reperfusion injury in patients with primary liver cancer undergoing hepatectomy

目的探讨血清肌酸激酶(CK)对原发性肝癌(肝癌)肝切除患者缺血-再灌注损伤(IRI)的预测价值。方法回顾性分析2011年9月至2018年9月在南通大学附属南通第三医院行肝癌肝切除术的93例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男78例,女15例;年龄29~82岁,中位年龄60岁。根据有否采用间歇阻断第一肝门入肝血流(IPM),将患者分为IPM组和无IPM组。观察两组术后血清CK和肝功能变化。两组血清CK、肝功能指标比较采用t检验或Mann-Whitney秩和检验。血清CK与IPM时间的关系分析采用Spearman秩相关分析。结果IPM组术后1 d血清CK、ALT、AST、TB中位数分别为484(354)U/L、115(136)U/L、94(101)U/L、(30.9±2.2)μmol/L,明显高于无IPM组的75(58)U/L、98(53)U/L、78(39)U/L、(22.9±5.6)μmol/L(Z=8.292,2.260,2.186;t=9.002;P<0.05)。IPM组术后3 d血清CK、ALT、AST、TB分别为295(143)U/L、100(128)U/L、70(111)U/L、(29.7±2.1)μmol/L,明显高于无IPM组的55(50)U/L、87(48)U/L、62(39)U/L、(21.8±5.3)μmol/L(Z=8.229,2.153,2.223;t=9.256;P<0.05)。IPM组患者IPM时间为20(10)min,术后1、3 d血清CK与IPM时间成正相关(rs=0.896,0.790;P<0.05)。结论IPM是一种安全、有效的血流阻断技术,但会造成肝脏IRI,术后血清CK水平可作为预测IRI损伤程度的潜在指标。

Objective To explore the predictive value of serum creatine kinase(CK)for ischemia-reperfusion injury(IRI)in patients with primary liver cancer(PLC)after hepatectomy.Methods Clinical data of 93 PLC patients who underwent hepatectomy in Affiliated Nantong Hospital 3 of Nantong University from September 2011 to September 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,78 patients were male and 15 female,aged from 29 to 82 years,with a median age of 60 years.According to whether intermittent Pringle maneuver(IPM)was performed,all patients were divided into the IPM and non-IPM groups.Postoperative changes of serum CK and liver function were observed.Serum CK and liver function parameters were compared between two groups by using t test or Mann-Whitney rank-sum test.The relationship between serum CK and IPM time was analyzed by Spearman rank correlation analysis.Results In the IPM group,the median serum CK,ALT,AST and TB levels at postoperative 1 d were 484(354)U/L,115(136)U/L,94(101)U/L and(30.9±2.2)μmol/L,significantly higher than 75(58)U/L,98(53)U/L,78(39)U/L and(22.9±5.6)μmol/L in the non-IPM group(Z=8.292,2.260,2.186;t=9.002;P<0.05).In the IPM group,the serum CK,ALT,AST and TB levels at postoperative 3 d were 295(143)U/L,100(128)U/L,70(111)U/L and(29.7±2.1)μmol/L,significantly higher than 55(50)U/L,87(48)U/L,62(39)U/L and(21.8±5.3)μmol/L in the non-IPM group(Z=8.229,2.153,2.223;t=9.256;P<0.05).In the IPM group,the IPM time was 20(10)min,and the serum CK was positively correlated with IPM time at postoperative 1 and 3 d(rs=0.896,0.790;P<0.05).Conclusions IPM is a safe and effective approach for hepatic inflow occlusion.Nevertheless,it may lead to hepatic IRI.Postoperative serum CK level can be used as a potential biomarker to predict the degree of IRI injury.