中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2014年
20期
1-6
,共6页
魏思东%陈国勇%孙建军%汤高枫%谢占涛%徐化恩%王维伟%陈永峰%周绍棠%孟祥光%袁振华%陈小兵
魏思東%陳國勇%孫建軍%湯高楓%謝佔濤%徐化恩%王維偉%陳永峰%週紹棠%孟祥光%袁振華%陳小兵
위사동%진국용%손건군%탕고풍%사점도%서화은%왕유위%진영봉%주소당%맹상광%원진화%진소병
肝移植%胆红素%直接胆红素%并发症%诊断
肝移植%膽紅素%直接膽紅素%併髮癥%診斷
간이식%담홍소%직접담홍소%병발증%진단
Liver transplantation%Bilirubin%Direct bilirubin%Complication%Diagnosis
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。
目的：探討直接膽紅素（DBil）和總膽紅素（TBil）比值在肝移植術後併髮癥鑒彆中的作用。方法根據術前 TBil 值，將216例肝移植受者分為無黃疸、輕度黃疸和中重黃疸組，另根據術後併髮癥，將216例受者分為普通、衰竭、排斥和梗阻組，分析各組 TBil 和 DBil/ TBil 的變化。結果中重度黃疸組術後1 d TBil 迅速下降後逐步下降，但術後2週內仍高于無黃疸組和輕度黃疸組（P ﹤0.05）；無黃疸、輕度黃疸和中重度黃疸組的 DBil/ TBil 術後均升高，術後3 d 達峰值後緩慢下降，TBil 高者 DBil/ TBil 相對較高，術後3 d 輕度黃疸組（0.72±0.1）和中重度度黃疸組（0.75±0.11）均高于無黃疸組（0.68±0.09），P ﹤0.05。TBil 在衰竭、梗阻和排斥組術後5 d 內均先下降後上升，術後5 d 內均高于普通組（P ﹤0.05）。術後 DBil/ TBil 在梗阻、排斥和普通組術後5 d 內均逐步升高後下降，而衰竭組 DBil/TBil 術後2、3、4 d 分彆為0.60±0.12、0.58±0.17和0.60±0.15，低于梗阻組同時間點的0.75±0.10、0.77±0.08和0.78±0.09（P ﹤0.05），同時低于術後2 d 和3 d 排斥組的0.67±0.04和0.65±0.02，P ﹤0.05。結論肝移植術後TBil 和 DBil/ TBil 變化可以從膽道梗阻、免疫排斥中鑒彆齣肝功能衰竭，但前二者的鑒彆還需其他措施。
목적：탐토직접담홍소（DBil）화총담홍소（TBil）비치재간이식술후병발증감별중적작용。방법근거술전 TBil 치，장216례간이식수자분위무황달、경도황달화중중황달조，령근거술후병발증，장216례수자분위보통、쇠갈、배척화경조조，분석각조 TBil 화 DBil/ TBil 적변화。결과중중도황달조술후1 d TBil 신속하강후축보하강，단술후2주내잉고우무황달조화경도황달조（P ﹤0.05）；무황달、경도황달화중중도황달조적 DBil/ TBil 술후균승고，술후3 d 체봉치후완만하강，TBil 고자 DBil/ TBil 상대교고，술후3 d 경도황달조（0.72±0.1）화중중도도황달조（0.75±0.11）균고우무황달조（0.68±0.09），P ﹤0.05。TBil 재쇠갈、경조화배척조술후5 d 내균선하강후상승，술후5 d 내균고우보통조（P ﹤0.05）。술후 DBil/ TBil 재경조、배척화보통조술후5 d 내균축보승고후하강，이쇠갈조 DBil/TBil 술후2、3、4 d 분별위0.60±0.12、0.58±0.17화0.60±0.15，저우경조조동시간점적0.75±0.10、0.77±0.08화0.78±0.09（P ﹤0.05），동시저우술후2 d 화3 d 배척조적0.67±0.04화0.65±0.02，P ﹤0.05。결론간이식술후TBil 화 DBil/ TBil 변화가이종담도경조、면역배척중감별출간공능쇠갈，단전이자적감별환수기타조시。
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-
<br> (0. 78 ±0. 09)],P ﹤0. 05,at the same time,were lower than that of the rejection group on the 2nd day and 3rd day after operation[(0. 67 ±0. 04)and(0. 65 ±0. 02)],P ﹤0. 05. Conclusions From changes of TBil and DBil/ TBil in liver transplantation,liver failure can be identified from biliary obstruction and immune rejection,but the identification of obstruction and rejection needs other measures.
