活体肝供者长时间间歇性肝血流阻断所致血清胆红素与术中急性高血糖之间的关联

Association between Serum Bilirubin and Acute Intraoperative Hyperglycemia Induced by Prolonged Intermittent Hepatic Inflow Occlusion in Living Liver Donors.

作者信息

Han Sangbin, Jin Sang-Man, Ko Justin Sangwook, Kim Young Ri, Gwak Mi Sook, Son Hee Jeong, Joh Jae-Won, Kim Gaab Soo

机构信息

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Department of Anesthesiology and Pain Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.

出版信息

PLoS One. 2016 Jul 1;11(7):e0156957. doi: 10.1371/journal.pone.0156957. eCollection 2016.

DOI:10.1371/journal.pone.0156957

PMID:27367602

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4930162/

Abstract

BACKGROUND

Intermittent hepatic inflow occlusion (IHIO) is associated with acute hyperglycemia during living donor hepatectomy when the ischemia is prolonged. Bilirubin is a potent antioxidant to play an important role for maintaining insulin sensitivity and preventing hyperglycemia. Thus, we aimed to test whether serum bilirubin level is associated with prolonged IHIO-induced intraoperative hyperglycemia.

METHODS

Seventy-five living liver donors who underwent a prolonged IHIO with a >30 minute cumulative ischemia were included. The association between preoperative serum bilirubin concentrations and the risk of intraoperative hyperglycemia (blood glucose concentration >180 mg/dl) was analyzed using binary logistic regression with adjusting for potential confounders including age and steatosis.

RESULTS

The number of donors who underwent 3, 4, 5, and 6 rounds of IHIO was 41, 22, 7, and 5, respectively. Twenty-nine (35%) donors developed intraoperative hyperglycemia. Total bilirubin concentration was inversely associated with hyperglycemia risk (odds ratio [OR] 0.033, 95% confidence interval [CI] 0.004-0.313, P = 0.003). There was an interaction between age and total bilirubin concentration: the effect of lower serum total bilirubin (≤0.7 mg/dl) on the development of hyperglycemia was greater in older donors (>40 years) than in younger donors (P = 0.0.028 versus P = 0.212). Both conjugated bilirubin (OR 0.001 95% CI 0.001-0.684) and unconjugated bilirubin (OR 0.011 95% CI 0.001-0.246) showed an independent association with hyperglycemia risk.

CONCLUSIONS

Lower preoperative serum bilirubin was associated with greater risk of prolonged IHIO-induced hyperglycemia during living donor hepatectomy particularly in older donors. Thus, more meticulous glycemic management is recommended when prolonged IHIO is necessary for surgical purposes in old living donors with lower serum bilirubin levels.

摘要

背景

在活体肝移植供体肝切除术中，当肝缺血时间延长时，间歇性肝血流阻断（IHIO）与急性高血糖有关。胆红素是一种有效的抗氧化剂，在维持胰岛素敏感性和预防高血糖方面发挥重要作用。因此，我们旨在测试血清胆红素水平是否与延长的IHIO诱导的术中高血糖有关。

方法

纳入75例接受累计缺血时间>30分钟的延长IHIO的活体肝供体。使用二元逻辑回归分析术前血清胆红素浓度与术中高血糖风险（血糖浓度>180mg/dl）之间的关联，并对包括年龄和脂肪变性在内的潜在混杂因素进行校正。

结果

接受3、4、5和6轮IHIO的供体数量分别为41、22、7和5例。29例（35%）供体发生术中高血糖。总胆红素浓度与高血糖风险呈负相关（比值比[OR]0.033，95%置信区间[CI]0.004-0.313，P=0.003）。年龄与总胆红素浓度之间存在交互作用：血清总胆红素较低（≤0.7mg/dl）对老年供体（>40岁）高血糖发生的影响大于年轻供体（P=0.028对P=0.212）。结合胆红素（OR 0.001，95%CI 0.001-0.684）和非结合胆红素（OR 0.011，95%CI 0.001-0.246）均与高血糖风险独立相关。