胆道闭锁胆汁成分与预后的关系研究

目的 探讨胆道闭锁术中胆汁成分变化与预后的关系。方法 本组对62例BA患儿在Kasai术中收集从肝门流出的胆汁，以25例胆总管囊肿患儿术中收集的胆汁作为对照组。采用全自动生化仪检测胆汁中总蛋白(TP)、胆汁酸(TBA)、总胆红素(TBIL)、直接胆红素(DBIL)、总胆固醇(CHO)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、谷氨酰胺转肽酶(GGT)、碱性磷酸酶(ALP)的浓度。术后随访2～16个月，随访内容有黄疸消退时间，术后血生化，术后胆管炎发生情况及术后1年存活情况。结果 BA组胆汁中ALT(210.13±127.75) U/L、GGT(319.03±206.73) U/L、TP(45.86±18.16)g/L、CHO (0.08±(0.04) mmol/L浓度显著高于对照组，ALT:(69.39±44.55) U/L; GGT:(73.22±99.29)U/L; TP:(21.78±15.36)g/L; CHO:(0.02±0.03) mmol/L(P＜0.05); BA组胆汁中TBA( 189.81±107.81) μmol/L和DBIL (61.31±25.53 )μmol/L浓度显著低于对照组TBA:(735.06±199.75)μmol/L; DBIL:(90.43±27.18)μmol/L(P=0.000和P=0.035)。术前肝功能较好组胆汁中ALT(86.24±65.63) U/L、AST(801.64±516.50) U/L和GGT (205.82±112.25) U/L 浓度显著低于术前肝功能较差组，ALT:(244.67±175.69) U/L; AST:(1409.52±927.05) U/L；GGT:(362.05±235.57)U/L(P＜0.05)；术前肝功能较好组胆汁中TBA (346.04±279.33)μmol/L 浓度显著高于术前肝功能较差组(192.47±93.55)μmbl/L(P=0.029)。术后3个月黄疸消退者胆汁TBA显著高于未消退者(251.18±131.83)μmol/L比(121.43±80.42) μmol/L，(P=0.007)；术后3个月黄疸消退者胆汁DBIL(72.08±32.51 )μmol/L显著高于未消退者(40.22±23.47) μmol/L (P=0.022)。术后1年存活者胆汁TBA浓度较术后1年死亡者显著增高(258.63±105.63)μmol/L比(110.63±46.08) μmol/L，P= 0.015）；术后1年存活者胆汁ALT浓度较术后1年死亡者显著降低(8.72±8.83)U/L比(95.15±44.18)U/L，P=0.048。结论 BA术中胆汁成分与预后有明显的关系，胆汁中TBA较高、DBIL较高的BA患儿术后3个月黄疸消退较好；胆汁中TBA较高、ALT较低的BA患儿术后1年存活情况较好。胆汁TBA和ALT浓度可作为评价BA短期预后和中期预后的可靠指标。

The relationship between intraoperative bile composition and the prognosis of biliary atresia

Objective To assess the relationship between intraoperative bile composition and the outcome of Kasai' s procedure. MethodsBile samples were collected intraoperatively in 62 patients with BA. Bile samples from 25 patients with choledochal cyst were also collected as controls. The concentrations of total protein (TP), total bile acid (TBA), total bilirubin (TBIL), direct bilirubin (DBIL),total cholesterol (TC),aspertate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamine (GGT), alkaline phosphatase (ALP) in bile were assayed with automatic biochemistry analyzer( HITACHI 7020, Japan). All of patients with BA were followed for 2 to 16 months. Time to jaundice disappearance, serum biochemical indexes and the mortality in 1-year were recorded during follow-up. ResultsThe bile levels of ALT, GGT, TP and CHO in BA were significantly higher than those of the control group (P＜0. 05). The bile concentrations of TBA and DBIL in BA were significantly lower than those of the control group (P = 0. 000 and P = 0. 035). The bile concentrations of ALT, AST and GGT in better liver function group were significantly lower than those of the poor liver function group (P＜0. 05). The TBA level in better liver function group was significantly higher than that of the poor liver function group (P = 0. 029). The levels of TBA and DBIL in jaundice-clear group were significantly higher than those in the jaundice group (P＜0. 05). The survivors after 1-year had higher bile TBA level and less bile ALT level. ConclusionsThe high bile TBA and DBIL are associated with a good jaundice-clear rate 3 months after operation. The high bile TBA and less bile ALT are associated with a good prognosis in BA patients 1-year after operation. The levels of bile TBA and ALT can effectively predict the short-term prognosis of BA.