Baiocchi Leonardo, Angelico Mario, De Luca Linda, Ombres Domenico, Anselmo Alessandro, Telesca Claudia, Orlando Giuseppe, D'Andria Daniele, Tisone Giuseppe
Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy.
Transpl Int. 2006 May;19(5):389-95. doi: 10.1111/j.1432-2277.2006.00296.x.
Biliary lipids output is reduced after liver transplantation and tends to normalize thereafter. Cyclosporine A (CyA) is reported to interfere with the normal bile-restoring process after liver grafting, but data are inconclusive, in particular regarding the comparison with the other widely used calcineurin inhibitor tacrolimus (TCR). Furthermore, previous researches were conducted in patients taking multiple immunosuppressive therapies and with a short follow up. In this study we readdressed this issue by comparing biliary lipids in the first 3 months after liver transplant, in 20 patients randomized to receive immunosuppression with CyA or TCR monotherapy. Bile samples, harvested through a T-tube at days 1, 3, 7, 15, 30, 60 and 90 were assessed for cholesterol, phospholipids, and total and individual concentrations of bile acids (BA). Liver and kidney function tests were evaluated as well. We found no differences between CyA and TCR in biochemical findings or in total biliary BAs, cholesterol, and phospholipids. However, CyA-treated patients showed lower levels of glycochenodeoxycholic acid at day 15, compared to those treated with TCR (P < 0.04). This difference normalized thereafter, without any biochemical or clinical effect at 3-month follow up.
肝移植后胆汁脂质分泌减少，之后趋于正常。据报道，环孢素A（CyA）会干扰肝移植后胆汁恢复正常的过程，但数据尚无定论，尤其是与另一种广泛使用的钙调神经磷酸酶抑制剂他克莫司（TCR）相比。此外，以往的研究是在接受多种免疫抑制治疗且随访时间较短的患者中进行的。在本研究中，我们通过比较20例随机接受CyA或TCR单一疗法免疫抑制的患者肝移植后前3个月的胆汁脂质，重新探讨了这个问题。在第1、3、7、15、30、60和90天通过T管采集胆汁样本，评估胆固醇、磷脂以及胆汁酸（BA）的总量和各组分浓度。同时也评估了肝功能和肾功能测试。我们发现，CyA组和TCR组在生化指标、总胆汁酸、胆固醇和磷脂方面没有差异。然而，与TCR治疗的患者相比，CyA治疗的患者在第15天时甘氨鹅去氧胆酸水平较低（P < 0.04）。此后这种差异恢复正常，在3个月的随访中没有任何生化或临床影响。
