Kozaki N, Shimizu S, Higashijima H, Kuroki S, Yamashita H, Yamaguchi K, Chijiiwa K, Tanaka M
Department of Surgery I, Kyushu University, Faculty of Medicine, 3-1-1 Maidashi, Fukuoka, Higashi-ku, 812-8582, Japan.
J Surg Res. 1998 Sep;79(1):61-5. doi: 10.1006/jsre.1998.5357.
Delta-bilirubin is a bilirubin covalently bound with albumin, which is nontoxic and excreted neither in urine nor in bile. We previously reported that the percentage of delta-bilirubin increased after biliary drainage and that the rapidly excretable bilirubin fraction (total minus delta-bilirubin) was a better parameter to predict the effectiveness of biliary decompression in the dog model. The aim of the present study was to elucidate whether it is applicable to humans.
The serum bilirubin concentration was measured and its fractions were analyzed by high-performance liquid chromatography in 22 patients with obstructive jaundice before and after biliary drainage. In addition, the patients were subgrouped into good and poor drainage groups according to the decline index of serum bilirubin to examine the significance of delta-bilirubin.
The concentration of total bilirubin decreased from 14.1 mg/dl before biliary drainage to 5.4 mg/dl 28 days after drainage. During this period, the percentage of conjugated bilirubin steeply declined from 47.1 to 8.8% and that of excretable bilirubin from 63.4 to 28.6%. In contrast, the proportion of serum delta-bilirubin increased from 36.6 to 71.4%. There was an inverse correlation between percentage of delta-bilirubin and total bilirubin concentration (r = -0.69, P < 0.01). In the good drainage group, the percentage of delta-bilirubin increased above 60% within 7 days after biliary drainage, but it did not reach 60% by 28 days in the poor drainage group. A decreasing rate of total bilirubin minus delta-bilirubin, the excretable bilirubin fraction, was a better index than that of total bilirubin to assess the efficacy of biliary drainage (P< 0.01).
The increase in the percentage of serum delta-bilirubin indicates an effectiveness of biliary drainage in man. An analysis of serum delta-bilirubin for 7 days can distinguish the good drainage patients from the poor drainage patients.
δ胆红素是一种与白蛋白共价结合的胆红素，无毒，既不通过尿液也不通过胆汁排泄。我们之前报道过，在胆道引流后δ胆红素的百分比会升高，并且快速可排泄胆红素分数（总胆红素减去δ胆红素）是预测犬模型中胆道减压效果的更好参数。本研究的目的是阐明其是否适用于人类。
对22例梗阻性黄疸患者在胆道引流前后进行血清胆红素浓度测定，并通过高效液相色谱法分析其组分。此外，根据血清胆红素下降指数将患者分为引流良好组和引流不良组，以检验δ胆红素的意义。
总胆红素浓度从胆道引流前的14.1mg/dl降至引流后28天的5.4mg/dl。在此期间，结合胆红素的百分比从47.1%急剧下降至8.8%，可排泄胆红素的百分比从63.4%降至28.6%。相反，血清δ胆红素的比例从36.6%增加至71.4%。δ胆红素百分比与总胆红素浓度之间存在负相关（r = -0.69，P < 0.01）。在引流良好组中，胆道引流后7天内δ胆红素百分比升高至60%以上，但在引流不良组中28天时未达到60%。总胆红素减去δ胆红素（可排泄胆红素分数）的下降率是评估胆道引流效果比总胆红素下降率更好的指标（P < 0.01）。
血清δ胆红素百分比的升高表明胆道引流对人类有效。分析血清δ胆红素7天可区分引流良好患者和引流不良患者。
