Wu T W, Levy G A, Yiu S, Au J X, Greig P D, Strasberg S M, Ettles M, Abecassis M, Superina R A, Langer B
Liver Transplant Program, University of Toronto, Canada.
Clin Chem. 1990 Jan;36(1):9-14.
For 51 liver allograft recipients, we evaluated whether serum profiles of delta (Bd) and conjugated bilirubins (Bc) could be used to diagnose rejection during the first 30-50 postoperative days, in comparison with histology as the "gold standard." Daily measurements of aspartate aminotransferase, alkaline phosphatase, total bilirubin, Bd, and Bc were made, the last two by liquid chromatography. In 34 patients without any biochemical or histological evidence of rejection, within seven to 10 postoperative days Bd increased to greater than 40-50% of total bilirubin, while Bc decreased to less than 10%. In patients with severe rejections resulting in death, Bc increased rapidly to greater than 50%, while Bd remained less than 30%. In 24 histologically proven episodes of rejection in 17 patients there was either a rapid decrease in Bd or its persistence at 30%, plus either a steep increase in Bc, or its remaining at greater than 50% total bilirubin. Treatment of rejection resulted in a prompt reversal of these trends. Individually promising as prognostic adjuncts to existing liver-function markers, Bd and Bc also complemented each other, rendering the diagnosis of liver rejection much more incisive.
对于51例肝移植受者，我们评估了术后第30至50天血清δ胆红素（Bd）和结合胆红素（Bc）水平是否可用于诊断排斥反应，并将其与作为“金标准”的组织学检查结果进行比较。每日检测天冬氨酸转氨酶、碱性磷酸酶、总胆红素、Bd和Bc水平，后两项通过液相色谱法检测。在34例无任何生化或组织学排斥反应证据的患者中，术后7至10天内，Bd升至总胆红素的40%至50%以上，而Bc降至10%以下。在因严重排斥反应导致死亡的患者中，Bc迅速升至50%以上，而Bd仍低于30%。在17例患者经组织学证实的24次排斥反应中，Bd要么迅速下降，要么持续在30%，同时Bc要么急剧上升，要么占总胆红素的比例保持在50%以上。排斥反应的治疗使这些趋势迅速逆转。Bd和Bc作为现有肝功能标志物的预后辅助指标，各自都很有前景，且二者相互补充，使肝排斥反应的诊断更加准确。
