血清α谷胱甘肽-S-转移酶监测移植肝早期功能的临床价值

目的探讨应用血清α-GST监测肝移植术后早期移植肝功能的临床价值。方法采用酶联免疫测定法(EIA)对30例原位肝移植受体移植肝恢复再灌注72h内血清α-GST水平的动态变化进行监测,并与常规肝功能指标(AST、ALT、LDH)比较。结果本组中29例受体术后3d内未发生特殊并发症,其移植肝发生缺血再灌注损伤时血清α-GST水平会较ALT、AST、LDH等指标提前升高至高峰,并且升高速度更快、幅度更大;在再灌注损伤恢复时可很快降至正常,提示损害终止。1例受者术后确诊原发性移植肝无功能;其血清α-GST水平及常规肝功能指标均显示下降后再度上升趋势,而α-GST于再灌注后第8h即出现再次升高,较其余三种指标提前16h以上。结论肝移植术后早期严密监测血清α-GST变化可准确判断移植肝功能状态,血清α-GST水平下降迟缓或降而复升都应警惕PNF等早期移植肝功能损害的发生。

THE CLINICAL VALUE OF α- GLUTATHIONE S- TRANSFERASE MONITORING IN THE EARLY LIVER FUNCTION FOLLOWING AFTER LIVER TRANSPLANTATION

Objective This study was undertaken to determine the value of serum α-GST monitorting early liver function following liver transplantation.Methods Serum α-GST levels and conventional liver function paremeters(AST、ALT、LDH)were determined in 30 consecutive liver transplant recipients.All experimental paramentas were determined at predefined time points before reperfusion and after reperfusion:15 min and 1,2,4,8,12,18,24,36,48 and 72 hr.Results ①In 29 of 30 recipients,there were not any complications in the first 3 days following liver transplantation.Serum α-GST,AST,ALT and LDH levels all showed rapid increase tendencies and then reached their peaks,followed by progressive decrease tendencies.There were significant differences between α-GST and AST,ALT and LDH in the time to reach the peaks and in the time to reach the normal.There was alsosignificant greater maximal level in α-GST after reperfusion when compared with that in ALT,AST and LDH,respectively.②1 of 30 recipients developed primary graft nonfunction after liver transplantation.Serum α-GST level reached its first peak in the first hour after reperfusion and followed by a rapid decrease tendency.And then it showed a rapid increase tendency again in the 8th hour after reperfusion.But at this time,ALT,AST and LDH till remained decreasing after their first peaks.Not untill the 24th hour,ALT,AST and LDH didn't show their increase again.The time of the second increase in α-GST preceded that in ALT,AST and LDH 16 hours.Conclusion α-GST seems to be a sensitive indicator when monitoring early graft liver function following transplantation.It can offer an effective way to distinguish primary graft nonfunction from reversible reperfusion injury.