熊去氧胆酸减轻移植肝缺血再灌注损伤的临床前瞻性随机对照研究  

A prospective, randomized, controlled clinical trial of the effects of ursodeoxycholic acid alleviatingischemia/reperfusion injury in liver transplantation

作　　者：王书云[1] 唐华美[1] 彭志海[1] 裘国强[1] 陈国庆[1] 徐军明[1] 钟林[1] 

机构地区：[1]上海市器官移植中心、上海交通大学附属第一人民医院,200080

出　　处：《中华器官移植杂志》2008年第3期133-136,共4页Chinese Journal of Organ Transplantation

摘　　要：目的 探讨熊去氧胆酸（U）CA）减轻移植肝缺血再灌注损伤（IRI）的临床效果。方法 将80例终末期肝病成人患者随机分为两组，一组42例，肝移植术后第1天起给予UDCA10～15mg·kg^-1·d^-1，维持治疗3个月，为USCA组；另一组38例肝移植患者不使用UDCA，作为对照。分析两组术后3周内的肝生化指标、“严重IRI致移植物功能恢复延迟”、急性细胞性排斥反应（ACR）及药物性肝损伤的发生情况，以及术后3个月内血管及胆管并发症、患者死亡率、病毒性肝炎和原发性肝病复发情况。结果 UDCA组供肝热缺血时间和冷缺血时间分别为（3．33±0．92）min和（10．3±1．9）h，对照组分别为（3．68±1．16）min和（9．8±2．4）h，两组间的差异无统计学意义。UDCA组术后第7、14及21天的血清丙氨酸转氨酶显著低于对照组（P〈0．05），第7天的天冬氨酸转氨酶（AsT）和γ-谷氨酰转移酶（γ-GT）也显著低于对照组（P〈0．05）；两组其它时段AST、γ-GT及各时段胆红素总量、直接胆红素及碱性磷酸酶水平的差异均无统计学意义。U）CA组“严重IRI致移植物功能恢复延迟”发生率为9．5％（4／42），对照组为26．3％（10／38），两组比较，差异有统计学意义（P＜0．05）。两组术后3周内ACR发生率和严重程度、药物性肝损伤发生率及术后3个月内胆管和血管并发症发生率的差异无统计学意义，患者死亡率的差异也无统计学意义。结论 UDCA可有效减轻移植肝的缺血再灌注损伤，降低“严重IRI致移植物功能恢复延迟”的发生率；但在冷缺血时间〈12h的情况下，未能显示出保护胆管的临床效果。Objective To investigate the effects of ursodeoxycholic acid （UDCA） alleviating ischemia/reperfusion injury （IRI） in liver transplantation. Methods Eighty adult patients with endstage liver diseases were randomly divided into two groups： UDCA group （n = 42） in which UI3CA was given at 10-15 mg-kg^-1·d^-1 from the post-operative 1st day till 3 months, or control group （n = 38） in which UDCA was not administered. The two groups were statistically compared in liver biochemical parameters, rate of severe IRI-induced graft dysfunction, acute cellular rejection （ACR） episodes, drug-induced hepatotoxicity, viral hepatitis and recurrence of primary liver disease within post-transplant 3 weeks as well as rate of vascular, biliary complications and death within post-transplant 3 months. Results Warm ischemia time （WIT） and cold ischemia time （CIT） in UDCA group were re- spectively （3. 33 ±0. 92） rain and （10. 3 ± 1.9） h, and those in control group were （3.68 ± 1.16） min and （9. 8 ±2. 4） h. There were no significant differences in these two parameters between the two groups. In UDCA group, serum ALT levels on post-transplant day 7, 14, 21 were significantly lower than those in control group （P〈0. 05）, and compared with control group, serum levels of AST and 7-GT on day 7 were also lower in UDCA group （P〈0. 05）. The cases of severe IRI-induced graft dysfunction in UDCA group were fewer than those in control group with the difference being significant （9. 5 % vs. 26. 3 %, P〈0. 05）. There were no significant difference between the two groups in rate of ACR episode, drug-induced hepatotoxicity within post-transplant 3 weeks as well as rate of vascular, biliary complications and death within post-transplant 3 months. Conclusion UDCA treatment can alleviate graft IRI early after liver transplantation. It significantly decreased incidence of severe IRI-induced graft dysfunction. Protective effects of bile duct by UDCA were not shown when CIT was beneath 12 h.

关 键 词：熊去氧胆酸 肝移植 再灌注损伤 

分 类 号：R657.3[医药卫生—外科学] R979.1[医药卫生—临床医学]