活体肝移植患儿围手术期神经功能损伤评估的研究

Evaluation of neurological impairment in pediatric living donor liver transplantation recipients

目的探讨活体肝移植患儿围手术期血清β淀粉样蛋白(Aβ)、神经元微管相关蛋白(即Tau蛋白)水平和脑氧饱和度的变化,为优化围手术期处理提供依据。方法选择2020年9月—2021年3月于上海交通大学医学院附属仁济医院行活体肝移植手术的先天性胆道闭锁患儿40例,月龄3~36个月,体重5.3~13.5 kg。分别记录患儿手术开始前即刻(T_(1))、无肝期20 min(T_(2))、新肝期1 h(T_(3))和新肝期24 h(T_(4))时的心率、平均动脉压(MAP)、中心静脉压(CVP)、心指数、外周血管阻力指数(SVRI)、每搏量变异度(SVV)、动脉血pH值和脑氧饱和度。采用ELISA法检测血清中的Aβ,Thr181位点磷酸化Tau和总Tau蛋白水平。结果患儿T_(3)时间点MAP显著低于T_(1)时间点,T_(2)至T_(4)时间点动脉血pH值均显著高于T_(1)时间点(P值均<0.05);患儿T_(3)和T_(4)时间点MAP均显著低于T_(2)时间点(P值均<0.05);患儿各时间点间心率、心指数和SVV的差异均无统计学意义(P值均>0.05)。各时间点间血清Aβ和总Tau蛋白水平的差异均无统计学意义(P值均>0.05)。T_(4)时间点血清中的磷酸化Tau蛋白水平显著低于T_(1)时间点(P<0.05);各时间点间围手术期脑氧饱和度的差异均无统计学意义(P值均>0.05),但均低于50%。结论活体肝移植患儿围手术期的脑氧饱和度<50%,新肝期24 h时血清中磷酸化Tau蛋白水平较术前显著降低,其神经功能损伤的预防和管理策略有待进一步研究。

Objective To investigate perioperative serum levels ofβ-amyloid(Aβ),neuronal microtubule-associated(Tau)protein,and cerebral oxygen saturation in pediatric living donor liver transplantation recipients.Methods Forty pediatric patients with congenital biliary atresia treated by living donor liver transplantation,aged from 3 to 36 months and weighing from 5.3 to 13.5 kg were enrolled in this study.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),peripheral vascular resistance index(SVRI),stroke volume variation(SVV),pH level in arterial blood,and cerebral oxygen saturation were recorded before operation(T_(1)),20 min after anhepatic phase(T_(2)),1 h after the reperfusion of new liver(T_(3))and 24 h after the reperfusion of new liver(T_(4)).Plasma Aβ,phosphorylated Tau at Thr181 and total Tau protein were detected by enzyme-linked immunosorbent assay(ELISA).Results Compared with those at T_(1),MAP decreased at T_(3)(P<0.05),and pH level in arterial blood increased from T_(2)to T_(4)(both P<0.05).MAP at T_(3)to T_(4)was significantly lower than that at T_(2)(both P<0.05).There were no significant differences in HR,CI or SVV(all P>0.05).There were no significant differences in plasma Aβ or total Tau protein(all P>0.05).Plasma phosphorylated Tau protein T_(4)was significantly lower than that at T_(1)(P<0.05).Perioperative cerebral oxygen saturation did not change significantly,while the level was lower than 50%.Conclusion The level of perioperative brain oxygen saturation is lower than 50%,and plasma phosphorylated Tau protein is decreased at 24h after the reperfusion of new liver in pediatric patients undergoing living donor liver transplantation.It is necessary to establish prevention and management strategies for perioperative neurological impairment.