摘要
目的:探讨肝酶在肝移植术中及术后早期临床肝功能诊断的价值。方法:应用受试者工作特征(ROC)曲线,以20例非肝移植的腹腔脏器移植患者为对照组,20例肝移植患者为阳性组。分别于术中及术后早期4个时间段(T1:血流再灌注前、T2:血流再灌注后2～3h、T3:次日晨、T4:第3天晨)抽血检测受者血清中丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酸激酶(CK)、谷氨酸脱氢酶(GLD)、γ-谷氨酰转移酶(γ-GT)、血清胆碱酯酶(PChE)、亮氨酸氨肽酶(LAP)、淀粉酶(AMY)、碱性磷酸酶(ALP)、乳酸脱氢酶(LD)活性。结果:①GLD、ALT、AST在T2～T4和LD在T2呈现最好的诊断试验ROC曲线图,其相应的曲线下面积(Az)均为1.0。②CK在T2～T4、LDH在T3和PChE在T1～T2呈现较好的诊断试验ROC曲线图,Az为0.9～1.0。③ALP、γ-GT、AMY、LAP4种酶中,除AMY在T3有较好的诊断价值(Az=0.87)外,其余均无诊断价值(Az<0.8)。结论:GLD、ALT、AST和LD在肝移植术中及术后早期可作为反映供肝热/冷缺血、保存性损伤及再灌注损伤的良好指标。肝移植术前、术中检测PChE可提高麻醉用药的安全性。AMY可用于术后急性胰腺炎的监测。
Objective To evaluate the value of the serum liver enzymes using receiver operating characteristic (ROC) curves in assessment of liver function in early post-hepatic transplantation. Methods Glutamic dehydrogenase (GLD), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (γ-GT), creatine kinase(CK), pseudocholinesterase (PChE), amylase (AMY), leucine aminopeptidase (LAP) and lactate dehydrogenase (LD) were assaied during operation (T1: pre-reperfusion, T2: 2-3 h after reperfusion),and early post-hepatic transplantation (T3: next day after the operation, T4: the third day) in 20 patients with liver transplantation, 20 patients with renal transplantation. ROC curves were drawn and areas under the curve (Az) were calculated. Results The ROC analysis showed that GLD,ALT,AST at T2 -T4 and LD at T2 were the best in indicating the liver function state (Az=1.0). CK at T2-T4, LD at T3 and PChE at T2-T4 also had the excellent diagnostic accuracy(Az 0.9-1.0). ALP, γ-GT, AMY and LAP showed the lower diagnostic accuracy(Az<0.8)except AMY at T3, Az of which was moderate e liver function state of 0.87. Conclusions In the early stage of the liver transplantation, the serum liver enzymes have an important diagnostic va-lue. The serum GLD, ALT, AST and LD are sensitive and specific parameters for liver ischemic reperfusion injury. The serum AMY can be used as an indicator for acute pancreatitis. Monitoring of the serum PChE before and during the liver transplantation may ensure the anesthesia safety.
出处
《诊断学理论与实践》
2005年第1期41-43,48,共4页
Journal of Diagnostics Concepts & Practice
