冷缺血时间对危重症肝病肝移植术后早期肝功能的影响  

Effect of cold ischemia time on early changes of liver function after orthotopic liver transplantation for critical liver disease

作　　者：李自强 田彦 邹卫龙 游波 杨洋[2] 金海龙[2] 朱雄伟 Li Ziqiang;Tian Yan;Zou Weilong;You Bo;Yang Yang;Jin Hailong;Zhu Xiongwei(Hepatobiliary Department,Affiliated Hospital of Guizhou Medical University,Guiyang 550000,Guizhou,China;Department of Organ Transplantation,the Third Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]贵州医科大学附属医院肝胆外科,贵州贵阳550000 [2]解放军总医院第三医学中心器官移植科,北京100039

出　　处：《实用器官移植电子杂志》2023年第6期551-555,共5页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的 探讨冷缺血时间(cold ischemic time,CIT)对危重症肝病患者行原位肝移植术(orthotopic liver transplantation,OLT)后移植肝早期功能的影响。方法 收集并分析2015年1月1日至2019年6月25日中国人民解放军总医院第三医学中心59例危重症肝病行OLT患者的临床资料。按照CTI分为A组(CIT≤8 h,n=35)、B组(8 h <CIT≤10 h,n=16)、C组(CIT> 10 h,n=8)三组。收集受体术前和术后1、7、14、30、60 d的血液样本,检测丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate transaminase,AST)、凝血酶原时间国际标准化比值(prothrombin time international normalized ratio,PT-INR)和凝血酶原时间活动度(prothrombin time activity,PTA)等指标的变化情况。结果 各组ALT、AST水平均在术后1 d达到峰值,随后逐渐下降,A、B两组间至14 d两项指标无显著性差异,A、B、C三组间至30 d两项指标无显著性差异。相关性分析显示:CIT的长短与肝移植术后第1天ALT最高峰值大小呈正相关。各组术后PT-INR较术前均显著降低,PTA较术前均显著升高,各个独立样本内部差异均具有统计学意义。结论 危重症肝病患者肝移植术后早期肝功能恢复受CIT的影响,最佳的CIT应为8~10 h。Objective To investigate the effect of cold ischemic time(CIT) on liver transplantation function in the early stage after orthotopic liver transplantation(OLT) for critical liver disease.Methods From January 1,2015 to June 25,2019,the clinical data of 59 critically ill liver patients undergoing OLT at the Third Medical Center of Chinese PLA General Hospital were collected and analyzed.The clinical data were divided into group A(CIT ≤ 8 h,n = 35),group B(8 h < CIT ≤ 10 h,n = 16),and group C(CIT > 10 h,n = 8).Blood samples were collected preoperatively and 1,7,14,30,60 d after OLT to detect the dynamic changes of alanine aminotransferase(ALT),aspartate transaminase(AST),prothrombin time international normalized ratio(PT-INR) and prothrombin time activity(PTA).Results Comparing the levels of ALT and AST in each group at the early postoperative stage,the levels of ALT and AST in all three groups reached the peak on the first day after OLT,and then gradually decreased.Both ALT and AST were equivalent between groups A and B on the 14th day,and the two indices were equivalent among group A,B and C on the 30th day.Correlation analysis demonstrated that the length of CIT was positively correlated with the peak value of ALT on the first day after OLT.Postoperative PT-INR and PTA of recipients in each group were significantly lower than those before OLT,and the difference within each independent sample were statistically significant.Conclusion Early recovery of liver function in patients with critical liver disease after OLT was affected by CIT significantly,and the ideal CIT was less than 8 ~ 10 h.

关 键 词：冷缺血时间 危重症肝病 原位肝移植术 肝功能 

分 类 号：R657.3[医药卫生—外科学]