直接胆红素和总胆红素比值在肝移植术后并发症鉴别诊断中的作用  

Role of direct bilirubin and total bilirubin ratio in the differential diagnosis of complications after liver transplantation

作　　者：魏思东[1] 陈国勇[1] 孙建军[1] 汤高枫[1] 谢占涛[1] 徐化恩[1] 王维伟[1] 陈永峰[1] 周绍棠[1] 孟祥光[1] 袁振华[1] 陈小兵 

机构地区：[1]郑州人民医院肝胆胰腺外科,450003 [2] 郑州大学附属肿瘤医院肿瘤内科

出　　处：《中国实用医刊》2014年第20期1-6,共6页Chinese Journal of Practical Medicine

基　　金：国家自然科学基金资助项目（81370577）;郑州市博士创业基金（201362）

摘　　要：目的：探讨直接胆红素（DBil）和总胆红素（TBil）比值在肝移植术后并发症鉴别中的作用。方法根据术前 TBil 值，将216例肝移植受者分为无黄疸、轻度黄疸和中重黄疸组，另根据术后并发症，将216例受者分为普通、衰竭、排斥和梗阻组，分析各组 TBil 和 DBil/ TBil 的变化。结果中重度黄疸组术后1 d TBil 迅速下降后逐步下降，但术后2周内仍高于无黄疸组和轻度黄疸组（P ﹤0.05）；无黄疸、轻度黄疸和中重度黄疸组的 DBil/ TBil 术后均升高，术后3 d 达峰值后缓慢下降，TBil 高者 DBil/ TBil 相对较高，术后3 d 轻度黄疸组（0.72±0.1）和中重度度黄疸组（0.75±0.11）均高于无黄疸组（0.68±0.09），P ﹤0.05。TBil 在衰竭、梗阻和排斥组术后5 d 内均先下降后上升，术后5 d 内均高于普通组（P ﹤0.05）。术后 DBil/ TBil 在梗阻、排斥和普通组术后5 d 内均逐步升高后下降，而衰竭组 DBil/TBil 术后2、3、4 d 分别为0.60±0.12、0.58±0.17和0.60±0.15，低于梗阻组同时间点的0.75±0.10、0.77±0.08和0.78±0.09（P ﹤0.05），同时低于术后2 d 和3 d 排斥组的0.67±0.04和0.65±0.02，P ﹤0.05。结论肝移植术后TBil 和 DBil/ TBil 变化可以从胆道梗阻、免疫排斥中鉴别出肝功能衰竭，但前二者的鉴别还需其他措施。Objective To investigate the role of direct bilirubin（ DBil）and total bilirubin （ TBil）ratio in the identification of complications after liver transplantation. Methods Two hundred and sixteen recipients of liver transplant were divided into without jaundice,mild jaundice and moderate jaun-dice group according to the preoperative TBil levels. On the other hand,the 216 recipients were also di-vided into common,failure,rejection and obstruction group by postoperative complications. TBil and DBil/ TBil levels were analyzed in each group. Results The postoperative TBil level rapidly fall at the first day and then gradually declined in moderate jaundice group and severe jaundice group,but it was still higher than that in without jaundice group and mild jaundice group within 2 weeks after operation （P ﹤ 0. 05）. The DBil/ TBil levels in no jaundice group,mild jaundice group moderate and severe jaun-dice group significantly increased after operation,and reached peak value on the 3rd day after operation, and then decreased slowly. DBil/ TBil level was relatively high in patients with high TBil,on the 3rd day after operation,that in mild jaundice group（0. 72 ±0. 1）and moderate and severe jaundice group（0. 75 ± 0. 11）,was higher than that in no jaundice group（P ﹤0. 05）. The TBil level within 5 d after operation of failure,obstruction and rejection group first decreased and then increased,and was higher than that in common group（P ﹤0. 05）. Postoperative DBil/ TBil levels in obstruction,rejection and common group with-

关 键 词：肝移植 胆红素 直接胆红素 并发症 诊断 

分 类 号：R446.11[医药卫生—诊断学]