脾切除对肝豆状核变性脾功能亢进病人肝功能改善的实验室指标分析

陆雅春; 孙泰; 朱俊; 张波克; 刘漪; 周导

doi:10.13898/j.cnki.issn.1000-2200.2023.08.020

脾切除对肝豆状核变性脾功能亢进病人肝功能改善的实验室指标分析

Analysis of laboratory indicators of splenectomy on improvement of liver function in patients with Wilson's disease

摘要

摘要:
目的探讨脾脏切除对肝豆状核变性(Wilson's disease, WD)脾功能亢进(脾亢)病人肝功能的影响。
方法97例WD病人作为病例组, 依据腹部二维彩超和血小板计数(PLT)将其分为脾正常组、脾大组、脾亢组, 同期31名健康体检人员作为对照组。比较组间肝功能各项指标差异。28例脾亢进病人进行了脾切除手术, 比较术前和术后肝功能各项指标差异。
结果除天门冬氨酸氨基转移酶线粒体同工酶(m-AST)和乳酸脱氢酶(LDH)在各组间差异无统计学意义(P>0.05), 其余各肝功能指标在各组中差异均有统计学意义(P < 0.05~P < 0.01)。与对照组比较, 脾正常组中总胆汁酸(TBA)和活化部分凝血活酶时间(APTT)升高, 前白蛋白(PA)和血红蛋白(Hb)降低; 与脾正常组比较, 脾大组中总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、总胆汁酸(TBA)、碱性磷酸酶(ALP)、腺苷脱氨酶(ADA)、凝血酶原时间(PT)、APTT升高, PA、血清纤维连接蛋白(FN)、PLT降低; 与脾大组比较, 脾亢组中天门冬氨酸氨基转移酶(AST)、DBIL、TBA、ADA、PT、APTT、凝血酶时间(TT)升高, PA、FN、总胆固醇(T-CHO)、白细胞计数(WBC)、红细胞计数(RBC)、Hb、PLT降低, 差异均有统计学意义(P < 0.05)。WD脾亢病人脾切除术后14 d TBIL、DBIL、IBIL、TBA、ADA、PT、APTT和TT水平较术前下降, 总蛋白、白蛋白、FN、T-CHO、WBC、PLT、丙氨酸氨基转移酶、AST、m-AST、γ-谷氨酰基转移酶、LDH水平较术前增高, 差异均有统计学意义(P < 0.01)。
结论WD病人脾切除术后肝脏合成功能与肝脏代谢功能均显著改善。排除手术创伤短期因素, 肝细胞损伤及膜通透性也有所好转, 脾脏切除术可以显著改善WD脾亢病人的肝功能。

Abstract:
ObjectiveTo investigate the effect of splenectomy on liver function in patients with Wilson's disease (WD).
MethodsA total of 97 WD patients were divided into normal spleen group, splenomegaly group and hypersplenism group according to abdominal two-dimensional color ultrasound and platelet count, and 31 healthy physical examiners were used as control group during the same period.The differences in liver function indexes between groups were compared.Splenectomy was performed in 28 patients with hypersplenism, and the differences in liver function indicators before and after surgery were compared.
ResultsExcept for aspartate aminotransferase mitochondrial isoenzyme (m-AST) and lactate dehydrogenase (LDH) had no significant difference between the groups (P>0.05), the other liver function indexes were statistically significant in each group (P < 0.05 to P < 0.01).Compared with the control group, the total bile acid (TBA) and activated partial thromboplastin time (APTT) were increased, and the prealbumin (PA) and hemoglobin (Hb) were reduced in the normal spleen group; compared with the normal spleen group, total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), total bile acid (TBA), alkaline phosphatase (ALP), adenosine deaminase (ADA), prothrombin time (PT), and APTT were increased in the splenomegaly group, and PA, serum fibronectin (FN), and PLT were reduced.Compared with the splenomegaly group, the aspartate aminotransferase (AST), DBIL, TBA, ADA, PT, APTT and the thrombin time (TT) were increased in the hypersplenism group, and PA, FN, total cholesterol (T-CHO), white blood cell count (WBC), red blood cell count (RBC), Hb, PLT were reduced, and the differences were statistically significant (P < 0.05).TBIL, DBIL, IBIL, TBA, ADA, PT, APTT and TT levels decreased compared with preoperative levels in hypersplenism patients with WD 14 days after splenectomy, total protein, albumin, FN, T-CHO, WBC, PLT, alanine aminotransferase, AST, m-AST, γ-glutamyltransferase and LDH were significantly higher than those before surgery (P < 0.01).
ConclusionsAfter splenectomy, liver synthesis function and liver metabolic function are significantly improved.Excluding short-term factors of surgical trauma, hepatocyte damage and membrane permeability are also improved, and splenectomy can significantly improve liver function in patients with WD hypersplenism.

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