Ohshio G, Manabe T, Tamura K, Kudo H, Yoshioka H, Tobe T
Department of Surgery and Geriatric Medicine, Faculty of Medicine, Kyoto University, Japan.
Ann Surg. 1990 Apr;211(4):428-32. doi: 10.1097/00000658-199004000-00008.
Biliary obstruction induces a increase in the permeability between blood and bile, and a decrease in the rate of immunoglobulin A (IgA) transport into bile. We investigated the effects of percutaneous transhepatic biliary drainage (PTBD) on these derangements. PTBD reduced the extent of elevation of the bile-to-serum ratio of Immunoglobulin G (IgG; IgG-BS ratio) in patients with obstructive jaundice. Because IgG is known to be passively transported from serum to bile, the results indicate that PTBD restores the blood-bile barrier function. The IgA-BS ratio/IgG-BS ratio index (IgA/IgG index) and the IgM/IgG index, which indicated the function of selective transport of IgA and IgM into bile, initially decreased and then returned to the normal range 17 days after PTBD in patients who experienced a rapid resolution of hyperbilirubinemia. However these indices remained low in patients who did not experience this resolution. The serum secretory IgA levels in patients who did not experienced rapid resolution of hyperbilirubinemia markedly increased before PTBD. The serum secretory IgA levels in the patients who did and those who did not experience rapid resolution of hyperbilirubinemia, after initially increasing, decreased after PTBD. However the level returned to the control range only in patients who experienced a rapid resolution. These results indicate that the secretory IgA level is a sensitive indicator of hepatobiliary function, and measurement of the level of secretory IgA could predict the effect of PTBD.
胆道梗阻会导致血液与胆汁之间的通透性增加，以及免疫球蛋白A（IgA）向胆汁中的转运速率降低。我们研究了经皮经肝胆道引流术（PTBD）对这些紊乱情况的影响。PTBD降低了梗阻性黄疸患者胆汁与血清中免疫球蛋白G（IgG；IgG - BS比值）升高的程度。由于已知IgG是从血清被动转运至胆汁的，结果表明PTBD可恢复血 - 胆汁屏障功能。IgA - BS比值/I IgG - BS比值指数（IgA/I IgG指数）以及IgM/I IgG指数，这两个指数表明了IgA和IgM向胆汁中选择性转运的功能，在高胆红素血症迅速消退的患者中，PTBD术后最初下降，然后在17天后恢复到正常范围。然而，在未出现这种消退情况的患者中，这些指数仍保持较低水平。在未迅速消退高胆红素血症的患者中，PTBD术前血清分泌型IgA水平显著升高。在经历和未经历高胆红素血症迅速消退的患者中，血清分泌型IgA水平在最初升高后，PTBD术后均下降。然而，只有在经历迅速消退的患者中，该水平才恢复到对照范围。这些结果表明，分泌型IgA水平是肝胆功能的一个敏感指标，测定分泌型IgA水平可以预测PTBD的效果。
