肝酶和透明质酸变化作为供肝缺血/再灌注损伤的敏感指标研究  

The Changes of Liver Enzymes and Hyaluronic Acid in Serum as Sensitive Indexes of Warm and Cold Ischemia/reperfusion Injury after Graft Reperfusion

作　　者：王丹[1] 程烽[2] 

机构地区：[1]南京军区福州总医院检验科,福建福州350025 [2]南京军区福州总医院实验科,福建福州350025

出　　处：《标记免疫分析与临床》2009年第3期146-148,共3页Labeled Immunoassays and Clinical Medicine

摘　　要：为了探讨肝移植术中,患者血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酸脱氢酶(GLD)和透明质酸(hyaluronic acid,HA)的变化规律及此变化与供肝缺血保存/再灌注损伤的关系,对20例行原位肝移植术的病人进行手术期ALT、AST、GLD、HA的连续监测,即从门静脉阻断至术毕每半小时一次连续测定ALT、AST、GLD、HA的浓度。其中8例供肝植入前常规进行组织病理学检查提示供肝植入前病理有轻度器官保存性损伤。血清HA在门静脉阻断后呈明显的上升,无肝期结束前达最高峰(945±455μg/L),当供肝血流开放后,立即逐步下降;受体血清肝酶(ALT、AST、GLD)浓度在无肝期结束前都无明显的变化,直至供肝植入血流开放后出现明显上升。血清HA的水平与肝酶的水平呈负相关。肝移植术中,在供肝植入后,患者血清肝酶的上升反映了供肝细胞的缺血/再灌注损伤程度,而HA下降的变化反映了供肝窦状内皮细胞冷缺血/再灌注损伤的程度。To investigate the changes of serum liver enzyme and hyaluronic acid levels when the donor liver was transplanted and their relation with the ischemia/reperfusion injury, the serum levels of glutamic dehydnogenase （GLD）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and hyaluronic acid （HA） in 20 patients with orthotropic liver transplantation at a series of time till operation end were detected. 8 donors liver biopsies were performed at the end of cold ischemia phase. The results showed that the serum HA concentration increased after hepatic devascularisation and reached top at the end of a anhepatic period （945 ± 455g/L）. When the donor liver was transplanted and blood reperfused, the serum HA concentration fell rapidly. The serum liver enzyme （GLD, ALT, AST） increased after graft reperfusion during the operation. In the reperfusion period, the levels of HA was correlated negatively with the levels of liver enzyme （ GLD, ALT, AST）. There was mild tissue damage in 8 hepatic biopsy samples at the end of cold ischemia phase. In the reperfusion period, the increase of serum liver enzyme （GLD, ALT, AST） levels indicate the degree of graft warm ischemia/ reperfusion injury, and the decrease of serum HA indicate the degree of graft cold ischemia/reperfusion injury.

关 键 词：透明质酸 肝酶 肝移植术 缺血/再灌注损伤 

分 类 号：R657.3[医药卫生—外科学]