Tripodi V, Nuñez M, Carducci C, Mamianetti A, Agost Carreño C
Cátedra de Química Analítica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina.
Clin Nephrol. 2002 Nov;58(5):350-5. doi: 10.5414/cnp58350.
A direct relationship between serum bile acids (SBA) and hepatic and hepatobiliary dysfunction has been demonstrated. However, there is little evidence that SBA are related to renal insufficiency. In a previous study, we showed that hemodialysis patients with advanced chronic renal failure (ACRF) have an increase of SBA in predialysis and a decrease in postdialysis. Consequently, it was assumed that the restoration of renal function in transplanted patients might decrease SBA levels.
Transplanted patients receiving cyclosporine A (CyA) were studied by monitoring CyA and SBA levels to determine if a probable relationship exists between renal function, CyA treatment and SBA levels. SUBJECTS.
SBA levels were determined in 15 recently transplanted patients receiving CyA for 18 months and longer. In addition, 22 renal patients transplanted not less than 6 years ago were also included in the study and were characterized as the stable group. Five patients from this group received mycophenolate or azathioprine instead of CyA as immunosuppressant. In addition to SBA and CyA, creatinine, cholesterol, y-GT, viral markers and triglycerides were also determined in all patients.
A significant and constant increase in SBA levels was observed in the recently transplanted group. However, after 18 months, SBA levels gradually decreased to those of patients considered stable under CyA treatment. In both recently transplanted and stable patients who received CyA, SBA values remained higher than normal, but stable patients under mycophenolate or azathioprine treatment showed no such increase.
In recently transplanted patients, in patients studied for 18 months post transplant and in stable patients receiving CyA, the increase of SBA levels might be related to CyA treatment. This effect might be attributed to its cholestatic effect and also to a modification in uptake, metabolism, synthesis and excretion of SBA in the hepatocyte. These conclusions are supported by the results obtained in stable transplanted patients without CyA treatment showing normal SBA levels.
血清胆汁酸（SBA）与肝脏及肝胆功能障碍之间的直接关系已得到证实。然而，几乎没有证据表明SBA与肾功能不全有关。在之前的一项研究中，我们发现晚期慢性肾衰竭（ACRF）的血液透析患者透析前SBA升高，透析后降低。因此，推测移植患者肾功能的恢复可能会降低SBA水平。
通过监测环孢素A（CyA）和SBA水平，对接受CyA治疗的移植患者进行研究，以确定肾功能、CyA治疗与SBA水平之间是否可能存在关联。研究对象。
测定了15例接受CyA治疗18个月及更长时间的近期移植患者的SBA水平。此外，22例6年前及更早就接受移植的肾病患者也纳入研究，并被列为稳定组。该组中有5例患者接受霉酚酸酯或硫唑嘌呤替代CyA作为免疫抑制剂。除SBA和CyA外，还测定了所有患者的肌酐、胆固醇、γ-谷氨酰转移酶、病毒标志物和甘油三酯。
在近期移植组中观察到SBA水平显著且持续升高。然而，18个月后，SBA水平逐渐降至接受CyA治疗的稳定患者水平。在接受CyA治疗的近期移植患者和稳定患者中，SBA值均高于正常水平，但接受霉酚酸酯或硫唑嘌呤治疗的稳定患者未出现此类升高。
在近期移植患者、移植后研究18个月的患者以及接受CyA治疗的稳定患者中，SBA水平升高可能与CyA治疗有关。这种效应可能归因于其胆汁淤积作用，也归因于肝细胞中SBA摄取、代谢、合成和排泄的改变。未接受CyA治疗的稳定移植患者SBA水平正常的结果支持了这些结论。
