δ胆红素在肝移植术后早期的变化规律及价值

Early profile and clinical significance of serum delta bilirubin after orthotopic liver transplantation

目的 探讨血清δ胆红素 (δB)在肝移植术后早期的变化规律及临床意义。 方法 2 7例原位肝移植 ,按并发症有无分为 :病情平顺组 ( 10例 ) ,急性排斥反应组 ( 8例 ) ,两组合并为痊愈组 ( 18例 ) ,其余为围手术期死亡组 ( 9例 )。比较各组病人术后每日血清δB的变化。 结果 术后δB占总胆红素 (Totalbilirubin ,TB)的百分比 (δB % ) ,病情平顺组病人逐渐升高 ,2 1天时达 ( 37 5± 11 2 ) %。急性排斥反应发生后 ,δB %由 ( 2 6 4± 9 8) %下降至 ( 2 0 2± 12 7) % (n =8,t=2 12 ,P =0 0 7) ,TB、结合胆红素 (Conjugatedbilirubin ,CB)峰值比排斥反应前基值显著升高 (t=3 75 ,P =0 0 0 7;t=3 5 9,P =0 0 0 9)。术后 14天痊愈组δB % (n =18)明显高于死亡组 (n =9) ,分别为 ( 33 4± 12 2 ) %和 ( 2 2 0± 10 0 ) % (t=2 4 2 ,P =0 0 2 )。 结论 术后 14天时δB %与病人出院时转归有关。在排斥反应的诊断方面 ,血清TB和CB比δB %有更大优势。

Objective To investigate the early variations and clinical value of serum delta bilirubin after orthotopic liver transplantation. Methods Orthotopic liver transplantation was performed in 27 cases.Of them,10 cases were uneventful;8 patients suffered from acute rejection.According to the outcome,18 patients (including 10 uneventful cases and 8 cases with acute rejection) survived while other 9 died.Daily determination of serum delta bilirubin was examined in all patients. Results The changing patterns of serum delta bilirubin were different between uneventful patients and those with acute rejection.For those uneventful patients,δB% tended to increase after operation.On the 21st day after transplantation,it reached(37.5±11.2)%.To the contrary,after acute rejection occurred,δB% decreased from basal level(26.4±9.8)% to(20.2±12.7)%(n=8,t=2.12,P=0.07).Serum concentration of total bilirubin (TB) and conjugated bilirubin (CB) significantly increased after acute rejection arose.The difference between peak and basal level of TB and CB was (150.3±113.2)μmol/L(n=8)and(118.5±93.4)μmol/L(n=8)respectively(t=3.75,P=0.007;t=3.59,P=0.009).On the 14th day after operation,δB% in patients with good outcome(n=18) significantly higher than that in patients who died(n=9)(33.4%±12.2% vs 22.0%±10.0%,t=2.42,P=0.02).Conclusions Two weeks after operations,δB% is correlative to the outcome of the patients.But as for the diagnosis of the acute rejection,δB% shows no advantages over serum TB or CB.