肝移植术后三种主要并发症患者的肝生化指标变化特点分析

目的探讨肝移植术后三种主要并发症患者的肝功能指标变化规律及其与临床病理表现的对应关系,了解其在肝移植术后并发症鉴别诊断中的意义。方法收集209例肝移植术后病理诊断为急性排斥反应（AR）、缺血再灌注损伤（IRI）及胆道狭窄（BDS）患者的临床资料,选取肝穿刺前5d和肝穿刺后3d期间共9个时段的血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（γ-GT）、直接胆红素（DBil）和总胆红素（TBil）5项肝功能指标检测结果,与病理诊断结果进行配对分析。结果IRI组的AST及γ-GT的波动幅度显著高于AR组（P〈0.05）,而ALT的波动幅度显著高于BDS组（P〈0.05）;BDS组的DBil及TBil波动幅度显著高于其他两组（P〈0.05）。结论原位肝移植术后患者的肝功能指标变化能反映AR、IRI和BDS等并发症的基本病理生理特点,将这些特点与肝穿刺病理检查相结合,有助于对AR、IRI和BDS的发生和发展进程以及治疗转归做出客观评估。

Variance feature of hepatic biochemical indicators in three major complications following OLT

Objective To discuss the relationship between the level of three biochemical indicators and the underlying pathologic type of the major three complications following OLT.Methods Two-hundred and nine patients with ACR,IRI and BDS respectively after OLT were selected. Blood samples were collected at nine different time points in the phase of five days before to three days after liver puncture. Seram level of ALT,AST,γ-GT,DBil and TBil were then detected. Results At P0.05,the fluctuation amplitude of AST and γ-GT were higher in IRI than that in ACR,before liver puncture and after therapy respectively. ALT was higher in IRI than that in BDS. DBIL was higher in BDS than that in ACR before and after liver puncture. TBIL in BDS was higher than that in two others. Conclusion Variance feature of biochemical indicator reflected to the pathophysiological characters of three major complications after OLT. It was conduced to make a objective assessment about the ACR,IRI and BDS by binding these feature to pathological detection.