Hrncárková H, Schück O, Malý J, Trunecka P, Spicák J
Klinika hepatogastroenterologie IKEM, Praha.
Vnitr Lek. 2000 Feb;46(2):102-6.
Subjects before and after orthotopic transplantation of the liver develop frequently renal disorders. Evaluation of the renal function based on the serum creatinine concentration or its clearance is difficult in these cases because the concurrent hyperbilirubinaemia usually interferes with the method used for creatinine assessment (based on Jaffé's positive chromogen) and gives incorrect lower values. In the submitted work the authors investigated the development of the serum creatinine concentration and serum bilirubin concentration in 50 subjects before and one year after transplantation of the liver. The findings suggest that although under conditions of hyperbilirubinaemia creatinine cannot be evaluated by the usual methods, it is possible to obtain clinically useful information by investigating the trend of the relationship of creatinine and bilirubin. A decline of bilirubin is associated with a rise of creatinine which need not imply a decline of renal function, as long as creatinine does not exceed the upper range of normal values. Conversely the rise of bilirubin associated with a drop of creatinine need not imply improved renal function. In the investigated group one year after transplantation of the liver an impaired renal function (creatinine > 105 mumol/l) at a normal bilirubin level (< 21 mumol/l) in 17 (49%) subjects was found. In 7 (64%) subjects with hyperbilirubinaemia the creatinine value was within a normal range--this finding however does not rule out reduced renal function. Evaluation of renal function with concurrent hyperbilirubinaemia calls for more accurate methods. With regard to the mentioned findings however investigation of the trend creatinine/bilirubin makes it possible to evaluate the dynamics of changes of renal function.
肝脏原位移植前后的患者经常出现肾脏疾病。在这些病例中，基于血清肌酐浓度或其清除率来评估肾功能是困难的，因为同时存在的高胆红素血症通常会干扰用于肌酐评估的方法（基于杰氏阳性色原），并给出错误的较低值。在提交的研究中，作者调查了50名患者在肝脏移植前及移植后一年血清肌酐浓度和血清胆红素浓度的变化情况。研究结果表明，尽管在高胆红素血症情况下，肌酐无法通过常规方法进行评估，但通过研究肌酐与胆红素关系的变化趋势，仍有可能获得临床上有用的信息。胆红素下降与肌酐升高相关，但只要肌酐不超过正常范围上限，这不一定意味着肾功能下降。相反，胆红素升高与肌酐下降相关，这也不一定意味着肾功能改善。在研究的肝脏移植后一年的患者组中，发现17名（49%）患者在胆红素水平正常（<21μmol/L）时肾功能受损（肌酐>105μmol/L）。在7名（64%）高胆红素血症患者中，肌酐值在正常范围内——然而，这一发现并不排除肾功能降低。同时存在高胆红素血症时评估肾功能需要更准确的方法。然而，鉴于上述研究结果，研究肌酐/胆红素的变化趋势能够评估肾功能变化的动态情况。
