乙型肝炎患者肝移植前后实验室常规检测指标的变化及意义分析

doi:10.3969/j.issn.1673-8640.2013.03.002

摘要/Abstract

摘要： 目的　分析乙型肝炎患者行肝移植手术前后实验室常规检测指标的变化特征，探讨患者手术前后及恢复过程中的规律和特点。方法　回顾性分析44例术前采用抗病毒治疗的肝移植受者术前和术后1、10、20、30 d丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBil）、直接胆红素（DBil）、总胆汁酸（TBA）、碱性磷酸酶（ALP）、γ-谷氨酰基转移酶（GGT）、总蛋白（TP）、白蛋白（Alb）、前白蛋白（PAlb)、血糖（GLU）、凝血酶原时间（PT)、部分凝血活酶时间（APTT）、血小板（PLT)以及乙型肝炎病毒（HBV） DNA载量等各项指标的变化规律，结果用中位数（范围）表示。结果　AST和ALT术前分别为70.2（15.5 ～ 539.6）IU/L和44.1（5.8 ～ 255.5）IU/L，术后1 d急剧上升至1 506.4（172.4 ～ 5 195.3）IU/L和749.1（142.2 ～ 2 874.2）IU/L，术后10 d快速下降至117.3（17.2 ～ 900.4）IU/L和135.3（27.5 ～ 1 237.1）IU/L，术后20 d接近正常水平。GGT和ALP术后1 d活性稍下降，10 d后上升，30 d后大部分患者仍保持高水平。TBil和DBil术后较术前大多持续下降，30 d后接近正常。TP、Alb术后1 d稍下降，10 d后基本恢复正常水平，而PAlb术后持续升高。 TBA术后持续下降。PT和APTT术后明显延长，10 d后基本恢复正常。PLT术后下降，10 d后基本恢复正常。除2例术前、术后乙型肝炎血清标志物和HBV DNA无明显变化外，其余42例肝移植患者术后血清乙型肝炎表面抗原（HBsAg）全部转阴，乙型肝炎表面抗体（抗HBs）全部转阳，HBV DNA水平低于检测下限。结论　肝移植术外加抗病毒和免疫学的综合治疗方案，可使HBsAg、乙型肝炎e抗原（HBeAg）发生血清学转换并大大降低血清中HBV DNA检出率和乙型肝炎复发率。肝移植围手术期常规检测指标改变的规律和特点可能为临床病情判断提供依据。

关键词: 血清标志物, 肝移植, 乙型肝炎病毒, 乙型肝炎

Abstract: Objective　To analyze the changes of clinical routine laboratory test results in patients with hepatitis B before and after undergoing liver transplantation，and investigate the regularity and characteristics before and after undergoing liver transplantation and in the period of recovery. Methods　A retrospective study was performed in 44 patients with preoperative antiviral therapy undergoing liver transplantation. Alanine aminotransferase (ALT)，aspartate aminotransferase (AST)，total bilirubin (TBil)，direct bilirubin (DBil)，total bile acid (TBA)，alkaline phosphatase (ALP)，gamma-glutamyltransferase (GGT)，total protein (TP)，albumin (Alb)，prealbumin (PAlb)，glucose (GLU)，prothrombin time (PT)，activated partial thromboplastin time (APTT)，platelet (PLT) and hepatitis B virus (HBV) DNA load and other clinical routine laboratory tests were determined before and 1，10，20，30 d after undergoing liver transplantation. The results were expressed as median(range). Results　Before the operation，AST and ALT were 70.2(15.5-539.6) IU/L and 44.1(5.8-255.5) IU/L，and they increased sharply to 1 506.4(172.4-5 195.3) IU/L and 749.1(142.2-2 874.2)IU/L after 1d，and then quickly dropped to 117.3(17.2-900.4) IU/L and 135.3(27.5-1 237.1) IU/L after 10 d，and ended up with the normal levels after 20 d. GGT and ALP decreased slightly after 1 d，and they increased after 10 d，and then remained high after 30 d. TBil and DBil mostly continued to decline，and came back to normal after 30 d. TP and Alb slightly decreased after 1 d，and returned to be normal after 10 d. PAlb continued to increase after the operation. TBA decreased after the operation. PT and APTT were prolonged after the operation，and returned to be normal after 10 d. PLT declined after the operation，and returned to be normal after 10 d. Except for 2 patients who had no change in serum hepatitis B markers and HBV DNA loads between preoperation and postoperation，the remaining 42 patients became negative in serum hepatitis B surface antigen (HBsAb) and turned positive in serum anti-hepatitis B surface antigen antibody (anti-HBs antibody)，and their HBV DNA loads became lower than the limit of detection. Conclusions　Liver transplantation combined with comprehensive antiviral and immunological treatments can induce the seroconversion of HBsAg and hepatitis B e antigen(HBeAg)，and has significant reduction of HBV DNA detection rate and hepatitis B recurrence rate. The variations and characteristics of perioperative routine laboratory test results in patients undergoing liver transplantation may perform as a basis for clinical condition judgments.

Key words: Serum marker, Liver transplantation, Hepatitis B virus, Hepatitis B

吉强，顾星，周军，陈冬梅，殷月鹏，高春芳. 乙型肝炎患者肝移植前后实验室常规检测指标的变化及意义分析[J]. 检验医学, 2013, 28(3): 178-182.

JI Qiang，GU Xing，ZHOU Jun，CHEN Dongmei，YIN Yuepeng，GAO Chunfang. The changes and significance of clinical routine laboratory test results in hepatitis B patients before and after undergoing liver transplantation[J]. , 2013, 28(3): 178-182.

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