术前 5-氨基酮戊酸给药与脑肿瘤手术后肝酶升高有关：一项回顾性队列研究。

Preoperative 5-aminolevulinic acid administration for brain tumor surgery is associated with an increase in postoperative liver enzymes: a retrospective cohort study.

机构信息

Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

出版信息

Acta Neurochir (Wien). 2019 Nov;161(11):2289-2298. doi: 10.1007/s00701-019-04053-6. Epub 2019 Aug 31.

DOI:10.1007/s00701-019-04053-6

PMID:31473825

Abstract

BACKGROUND

Besides 5-aminolevulinic acid (5-ALA), liver enzyme elevation after brain tumor surgery can be caused by anesthesia and medications. In this retrospective study, we determined whether preoperative 5-ALA administration is associated with postoperative elevation of liver enzymes (PELE) in brain tumor patients and identified predictive factors for PELE in patients treated with 5-ALA.

METHODS

In 179 patients undergoing brain tumor surgery with preoperative normal values of liver enzymes, laboratory data on serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and total bilirubin (T.bil) levels were collected preoperatively and through postoperative day (POD) 45.

RESULTS

Ninety-nine PELEs (ALT, 56; AST, 34; ALP, 5; and TB, 4) were observed in 62 (34.6%) patients. Four (4.2%) patients treated with 5-ALA showed grade 3 elevation of transaminases based on the Common Terminology Criteria for Adverse Effects. Preoperative 5-ALA treatment was predictive of PELE (odds ratio [95% confidence interval], 2.30 [1.14-4.67]; P = 0.021). In patients treated with 5-ALA (n = 95), 70 PELEs (ALT, 39; AST, 22; ALP, 5; and TB, 4) were observed in 41 (43.2%) patients and significant predictive factors for PELE were preoperative ALT level (1.10 [1.04-1.17]; P = 0.001) and body mass index (BMI, 1.29 [1.08-1.56]; P = 0.006). In patients treated with 5-ALA, 13 and 36 patients, of 39 patients whose maximum postoperative ALT levels > 40 U/L, showed the normal value of serum ALT on PODs 14 and 45, respectively. Only three patients showed ALT elevation > 40 U/L on PODs 15-45, with a downward trend.

CONCLUSIONS

The use of 5-ALA for brain tumor surgery in patients with preoperative normal values of liver enzymes was associated with increased transient PELE, but a low incidence of severely elevated liver transaminases levels. When 5-ALA is administered to patients with the upper normal value of preoperative serum ALT and overweight, attention is paid to PELE.

摘要

背景

除了 5-氨基酮戊酸（5-ALA）外，脑肿瘤手术后肝酶升高还可能由麻醉和药物引起。在这项回顾性研究中，我们确定了术前 5-ALA 给药是否与脑肿瘤患者的术后肝酶升高（PELE）有关，并确定了在接受 5-ALA 治疗的患者中预测 PELE 的因素。

方法

在 179 例术前肝酶正常的脑肿瘤手术患者中，收集了术前和术后第 45 天的血清丙氨酸转氨酶（ALT）、天门冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）和总胆红素（T.bil）水平的实验室数据。

结果

在 62 例（34.6%）患者中观察到 99 例 PELE（ALT，56；AST，34；ALP，5；TB，4）。4 例（4.2%）接受 5-ALA 治疗的患者根据常见不良事件术语标准显示转氨酶 3 级升高。术前 5-ALA 治疗与 PELE 相关（优势比[95%置信区间]，2.30[1.14-4.67]；P=0.021）。在接受 5-ALA 治疗的患者（n=95）中，41 例（43.2%）患者观察到 70 例 PELE（ALT，39；AST，22；ALP，5；TB，4），术前 ALT 水平（1.10[1.04-1.17]；P=0.001）和体重指数（BMI，1.29[1.08-1.56]；P=0.006）是预测 PELE 的显著因素。在接受 5-ALA 治疗的患者中，39 例患者中最大术后 ALT 水平>40 U/L 的 39 例患者，分别在术后第 14 天和第 45 天时血清 ALT 恢复正常，仅 3 例患者在术后第 15-45 天 ALT 升高>40 U/L，呈下降趋势。