原位肝移植中移植肝早期功能评价.docVIP

原位肝移植中移植肝早期功能评价 　 作者:杨卫平，邱伟华，谢俊杰，陈 皓，施敏敏，申 川，沈柏用，彭承宏，李宏为 【摘要】 目的 通过测定原位肝移植中一些血清学指标来评价肝移植术后早期移植肝的功能状况。方法 随机选取瑞金医院肝移植中心原位肝移植患者20例。分别在麻醉开始后（S）、无肝期开始即刻（A1）、无肝期结束前即刻（A2）、门静脉血流开放即刻（R0）、门静脉血流开放60min（R1）、门静脉血流开放3h（R3）、门静脉血流开放6h（R6）、门静脉血流开放12h（R12）、门静脉血流开放24h（R24）时间点抽取外周血，测定血清ALT、AST、LDH、GMP-140、vWF和HA。结果 ALT、LDH在再灌注后即刻（R0）、AST在R6即达到峰值（Plt;0.05），以后逐渐下降，但仍维持较高水平。LDH与ALT呈高度正相关（R＝0.948，Plt;0.001），LDH与AST呈中度正相关（R＝0.646，Plt;0.001）。GMP-140再灌注后开始升高，R3、R6、R12点达到峰值（Plt;0.001），以后逐渐下降，但仍维持高水平。血管性血友病因子（von Willebrand factor，vWF）在再灌注后R6、R12、R24点高于正常。HA在再灌注后均高于正常。结论 AST和ALT仍然是原位肝移植术后早期反映移植肝功能状况的可靠指标；LDH与ALT及AST存在良好相关性；GMP-140、vWF和HA的升高反映了肝窦内皮细胞（SEC)的损伤程度，但能否准确反映早期移植肝功能状况则有待进一步证实。 【关键词】 原位肝移植；缺血－再灌注损伤 Early assessment of graft function in orthotopic liver transplantation 【Abstract】 Objective The aim of this study is to estimate the status of hepatic graft by measurement the levels of some serum index in orthotopic liver transplantation.Methods 20 recipients receiving orthotopic liver transplantation has been selected randomly in the transplantation center of Ruijin Hospital.The levels of serum ALT，AST，LDH，GMP-140，vWF and HA were determined at the following time points:the start of the operation (S)，the commencement of anhepatic phase (A1)，the end of anhepatic phase (A2)，instant (R0)，60 minutes (R1)，3 hours (R3)，6 hours (R6)，12 hours (R12) and 24 hours (R24) after reperfusion of portal vein.Results The level of ALT and LDH arrived the peak value at the time point of R0.The level of AST arrived the peak value at the time point of R6，and the level of LDH was correlated notably with the level of ALT and AST.The level of GMP-140 reached the peak value at the time point of R3，R6 and R12 (Plt;0.001) and higher than normal level.The level of vWF was higher than normal at the time point of R6，R12 and R24.The level of HA was higher than normal at every time point after reperfusion.Conclusion The levels of AST and ALT are still reliable parameters for the assessment of initial hepatic graft fu