肝移植术后胆汁中胆汁酸水平变化及其对EAD的预测价值

Changes of Bile Acid Level in Bile and Its Predictive Value for EAD after Liver Transplantation

目的:观察肝移植术后7天内胆汁中各种胆汁酸的水平变化,探讨其水平变化对肝移植术后早期移植物功能不全(early allograft dysfunction, EAD)发生的预测价值。方法:本文回顾性地选取2020年7月至2020年12月原位肝移植患者40例,根据2010年OLTHOFF等提出的EAD诊断标准,将患者分为EAD组和非EAD组。留取患者术后1、3、5、7 d胆汁,分别比较EAD组与非EAD组术后第1、3、5、7 d胆汁中各种胆汁酸的变化水平。采用ROC曲线评价胆汁中各胆汁酸水平变化对肝移植患者术后发生EAD的预测价值。结果:患者术后第1 d,EAD组测定的GDCA水平较非EAD组降低,术后第5 d,EAD组测定的GCA、GDCA水平较非EAD组升高,术后第7 d,EAD组测定的TLCA、GCDCA、GDCA水平较非EAD组升高;组间比较(P 【0.05)。根据ROC曲线提示,患者术后第7 d,胆汁中GCDCA对判断患者术后早期发生EAD的AUC是0.762,同为第7 d,胆汁中TLCA水平对患者术后早期发生EAD的AUC为0.754,术后第5 d,患者术后胆汁中GCA的水平对判断患者术后早期发生EAD的AUC为0.721。结论:留取肝移植术后患者第1、3、5、7 d胆汁,测量胆汁中各种胆汁酸的含量,肝移植术后7 d内胆汁中的GCDCA、GCA、TLCA水平会升高,三者的水平对肝移植患者术后早期发生EAD具有一定的预测价值,进而指导早期治疗。

Objective: To observe the changes of various bile acids level in bile within 7 days after liver transplantation, and to explore the predictive value of their changes in early allograft dysfunction (EAD) after liver transplantation. Methods: In this paper, 40 patients with orthotopic liver transplantation from July 2020 to December 2020 were selected retrospectively. According to the diagnostic criteria of EAD proposed by Olthoff et al. in 2010, the patients were divided into EAD group and non-EAD group. The bile of the patients was collected on the 1st, 3rd, 5th and 7th day after operation, and the changes of various bile acids in the bile of EAD group and non-EAD group were compared on the 1st, 3rd, 5th and 7th day after operation. ROC curve was used to evaluate the predictive value of the changes of bile acid levels in bile for EAD after liver transplantation. Results: According to the data, the GDCA level measured in EAD group was lower than that in non-EAD group on the 1st day after operation, the GCA and GDCA levels measured in EAD group were higher than that in non-EAD group on the 5th day after operation, and the TLCA, GCDCA and GDCA levels measured in EAD group were higher than that in non-EAD group on the 7th day after operation;it is compared between groups (P <0.05). According to the ROC curve, on the 7th day after operation, the AUC of GCDCA in bile for judging the early postoperative EAD is 0.762, which is the same as the 7th day, the AUC of TLCA level in bile for judging the early postoperative EAD is 0.754, and on the 5th day after operation, the AUC of GCA level in bile for judging the early postoperative EAD is 0.721. Conclusion: The bile of patients on the 1st, 3rd, 5th and 7th days after liver transplantation was taken, and the contents of various bile acids in the bile were measured. The levels of GCDCA, GCA and TLCA in the bile within 7 days after liver transplantation will increase. The levels of GCDCA, GCA and TLCA have a certain predictive value for the early occurrence of EAD in patients after liver transplantation, to guide the early treatment.