肝移植术后早期乳酸清除率与ALT和AST的相关性及对移植肝损伤的评估研究

摘要

Objective To analyze the early postoperative changes of early lactate clearance rate (ELCR) and liver-specific trans-aminases in patients with orthotopic liver transplantation (OLT), and investigate the relationship between ELCR and liver-specific transaminases, and the value of ELCR in evaluation of liver injury associated with liver transplantation. Methods Clinical data of 301 patients undergoing OLT were analyzed retrospectively. ELCR was calculated according to ALT and AST levels and arterial lactate concentration detected shortly after the patients underwent OLT and were transferred to surgical intensive care unit, and arterial lactate concentration at 6 hours after undergoing OLT. The relationship between ELCR and ALT, AST or AST/ALT ratio was analyzed. Results ELCR had moderately negative correlation with both ALT (r=-0.668, P<0.001) and AST (r=-0.602, P<0.001), had no correlation with AST/ALT ratio (r=0.077). Three ELCR grades were established, gradeⅠ<25%, gradeⅡ25%~50%, and gradeⅢ≥50%. ALT was 1670.20±897.41 U/L, 937.87±350.06 U/L and 556.16±173.56 U/L, and AST was 2835.98±1549.06 U/L, 1642.87 ±1106.00 U/L and 827.44 ±260.92 U/L, respectively, in ELCR gradesⅠ,ⅡandⅢgroups. ALT and AST levels were significantly different among the three groups (P<0.001). Patients with higher ELCR grade had a significantly lower levels of ALT and AST. Conclusions ELCR can be served as a convenient and prompt indicator for assessing hepatic ischemia/reperfusion injury after undergoing OLT. The different ELCR grades can evaluate graft function after undergoing OLT.%目的：分析肝移植术后早期乳酸清除率（early lactate clearance rate, ELCR）和初期肝特异性氨基转移酶水平变化的特点及相关性，探讨ELCR对移植肝损伤的评估价值。方法回顾性分析301例原位肝移植（orthotopic liver transplantation, OLT）病例资料，针对其术后转入重症监护室的初期ALT、AST、动脉血乳酸水平以及术后6 h动脉血乳酸水平计算ELCR，并与ALT、AST及AST/ALT比值进行相关性分析。结果 ELCR与ALT、AST呈中度负相关（r分别为-0.668、-0.602，P均<0.001），而与AST/ALT比值无相关性（r=0.077）。经统计分析构建的3个ELCR等级分别为Ⅰ级<25％、Ⅱ级为25％～50％、Ⅲ级≥50％。Ⅰ级、Ⅱ级和Ⅲ级对应ALT水平分别为（1670.20±897.41）U/L、（937.87±350.06）U/L和（556.16±173.56）U/L，AST为（2835.98±1549.06）U/L、（1642.87±1106.00）U/L和（827.44±260.92）U/L，3组间ALT和AST水平差异有统计学意义（P均<0.001）。随着ELCR等级增大，ALT和AST值降低。结论 ELCR可方便快速地反映肝移植后初期肝缺血-再灌注损伤程度，其不同等级可对肝移植术后初期移植肝功能进行初步评估。