肝移植后熊去氧胆酸对肝生物化学指标及胆管并发症影响的临床随机对照研究  

Effect of post-liver transplantation administration of ursodeoxycholic acid on serum liver tests and biliary complications： a randomized clinical trial

作　　者：王书云[1] 唐美华[2] 陈国庆[1] 徐军明[1] 钟林[1] 王兆文[1] 邓贵龙[1] 刑同海 陆伦根[3] 彭志海[1] 

机构地区：[1]上海交通大学附属第一人民医院普外科,200080 [2]上海交通大学附属第一人民医院病理科,200080 [3]上海交通大学附属第一人民医院消化科,200080

出　　处：《中华肝脏病杂志》2014年第7期529-535,共7页Chinese Journal of Hepatology

基　　金：上海市自然科学基金面上项目（13ZR1433400）

摘　　要：目的 研究原位肝移植（OLT）后早期熊去氧胆酸（UDCA）治疗对肝生物化学指标及胆管并发症的影响.方法 2005年4月至2008年4月本移植中心接受OLT的成人患者112例随机分为UDCA组（13～ 15 mg·kg-1·d-1,n=56）和安慰剂对照组（n=56）.检测术后4周内患者肝生物化学指标.分析患者术后胆管并发症发生率、患者和移植物生存率（平均随访期65.6个月）,用Kaplan-Meier法计算患者和移植物生存率,并用log-rank检验两组间差异. 结果 UDCA组术后第7、21、28天血清ALT、AST和γ-谷氨酰转移酶水平显著低于对照组.UDCA组术后1年内胆泥/胆道铸型并发症发生率显著低于对照组（3.6％对比14.3％）,两组比较x2=3.953,P=0.047,差异有统计学意义;UDCA组接受内镜下逆行胰胆造影术治疗率亦显著低于对照组（8.9％对比23.2％）,两组比较x2=4.236,P=0.04,差异有统计学意义.两组其他类型胆管并发症发生率及术后第1、3、5年患者和移植物生存率差异无统计学意义. 结论 OLT后早期UDCA治疗可显著改善肝生物化学指标,降低术后第1年胆泥/胆道铸型并发症的发生率.Objective Endogenous hydrophobic bile acids may be a pathogenetic factor of biliary complications after orthotopic liver transplantation （OLT）.This study was designed to investigate the effects of hydrophilic ursodeoxycholic acid （UDCA）,when administered early after OLT,on serum liver tests and on the incidence of biliary complications.Methods A total of 112 adult patients undergoing OLT were randomly assigned to one of two groups for receipt of UDCA （13-15 mg·kg1·d-1 for 4 weeks,n =56） or a placebo （n =56）.All patients underwent serum liver testing and measurement of serum bile acids during the 4 weeks following OLT.Patients with T-tube underwent measurement of biliary bile acids during the 4weeks following OLT.Biliary complications,as well as patient and graft survival rates,were analyzed during the follow-up period （mean of 65.6 months）.Results At post-OLT days 7,21 and 28,the UDCA-treated patients showed significantly lower levels of alanine aminotransferase,aspartate aminotransferase and gamma glutamyl transpeptidase （all P 〈 0.05）.In addition,the UDCA-treated patients showed significantly lower incidence of biliary sludge and casts within the first year post-OLT （3.6% vs.14.3%; x 2 =3.953,P =0.047）.However,there were no significant differences for the incidence of other biliary complications at post-OLT years 1,3 and 5.The graft and patient survival rates were also similar between the two groups.Conclusion UDCA,when administered early after OLT,improves results from serum liver tests and decreases the incidence of biliary sludge and casts within the first postoperative year.

关 键 词：肝移植 手术后并发症 胆汁酸 熊去氧胆酸 

分 类 号：R657.3[医药卫生—外科学]