Zhao Ying, Feng Guofang, Feng Limin
Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.
Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Ann Palliat Med. 2020 Sep;9(5):2699-2709. doi: 10.21037/apm-20-133. Epub 2020 Jul 31.
Malignant obstructive jaundice (MOJ) leads to hyperbilirubinemia and systemic pathophysiological changes. The main clinical treatments for MOJ include radical pancreatoduodenectomy, palliative surgical treatment, and minimally invasive treatment, which can relieve biliary obstruction, drain bile, reduce jaundice, and improve liver function. In rat models, hepatic exposure to endotoxin resulted in rapid increases in biliary and plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) levels, and our previous study revealed that Lp-PLA2 activity was strongly associated with liver damage. The present study aimed to clarify the serum Lp-PLA2 activity changes and evaluate the associations between Lp-PLA2 activity and laboratory parameters in MOJ patients preoperatively and postoperatively.
Twenty-one patients with MOJ were enrolled in this prospective study. Lp-PLA2 activity and other laboratory parameters were analyzed using a Hitachi 7600 automatic biochemical analyzer. Spearman correlation coefficients, percent differences, and dynamic difference plots were used to evaluate the changes in preoperative and postoperative Lp-PLA2 activity and the associations of Lp-PLA2 activity with other laboratory parameters.
The postoperative Lp-PLA2 activity at 1 day [646 (range, 175-1,025) U/L], 1 week [419 (range, 144-949) U/L], and day of hospital discharge [347 (range, 165-698) U/L] differed significantly from the preoperative baseline activity (636 (range, 172-1,664) U/L; P<0.05 for all). Lp-PLA2 activity was correlated with total bilirubin (TB) at specific time points (P<0.05 for all). The percent differences and dynamic difference graphs revealed that Lp-PLA2 activity, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and TB gradually decreased after biliary obstruction was relieved by surgical treatment.
Lp-PLA2 activity in MOJ patients was associated with biliary obstruction and liver damage. Serum Lp-PLA2 can be used as a novel indicator for biliary obstruction severity and treatment monitoring.
恶性梗阻性黄疸（MOJ）可导致高胆红素血症及全身病理生理改变。MOJ的主要临床治疗方法包括根治性胰十二指肠切除术、姑息性手术治疗及微创治疗，这些治疗可缓解胆道梗阻、引流胆汁、减轻黄疸并改善肝功能。在大鼠模型中，肝脏暴露于内毒素会导致胆汁和血浆脂蛋白相关磷脂酶A2（Lp-PLA2）水平迅速升高，且我们之前的研究表明Lp-PLA2活性与肝损伤密切相关。本研究旨在明确MOJ患者术前及术后血清Lp-PLA2活性的变化，并评估Lp-PLA2活性与实验室参数之间的相关性。
21例MOJ患者纳入本前瞻性研究。使用日立7600自动生化分析仪分析Lp-PLA2活性及其他实验室参数。采用Spearman相关系数、百分比差异及动态差异图评估术前及术后Lp-PLA2活性的变化以及Lp-PLA2活性与其他实验室参数的相关性。
术后第1天[646（范围175 - 1025）U/L]、第1周[419（范围144 - 949）U/L]及出院日[347（范围165 - 698）U/L]的Lp-PLA2活性与术前基线活性（636（范围172 - 1664）U/L）相比差异有统计学意义（均P<0.05）。Lp-PLA2活性在特定时间点与总胆红素（TB）相关（均P<0.05）。百分比差异及动态差异图显示，手术治疗解除胆道梗阻后，Lp-PLA2活性、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）及TB逐渐降低。
MOJ患者的Lp-PLA2活性与胆道梗阻及肝损伤相关。血清Lp-PLA2可作为评估胆道梗阻严重程度及治疗监测的新指标。
