The Clinical Meaning And The Change Of Serum Bile Acid Of A Patient After The Liver Transplantation

Objective: Liver transplantation as the last way to rescue a patient of the end state liver disease has been developed broadly in our country. But there is no efficient or reliable chemo-physiology index yet for the early diagnosis of the disease, such as the acute rejection reaction and the primary graft failure. Bile acid is the only serological index that can reflect synchronously these three aspects of the condition of liver secretion, the synthesis and metabolize in liver and the liver cell injury. Once there are pathological changes in the hepatobiliary system, the liver cell will be incapable in the abilities of ingestion, synthesis and bile acid excretion, and the thickness of bile acid in the peripheral blood will increase easily. This experiment does the retrospective analysis by observing and comparing with other indexes the total bile acid (TBA) in serum and the ratio of cholic acid/chemodeoxycholic acid (CA/CDCA) of a patient after the liver transplantation and probes into how they change in the disease after transplantation which can instruct the clinical treatment. Method: Collect the serum sample in the first, the third, the fifth days and the first, the second, the third weeks and the first month of a patient after the liver transplantation. Get data after treating the samples. Compare this data with other chemo-physiology indexes, such as the glutamicoxalacetic transaminase (AST) and the total bilirubin (TBIL), do clinical retrospective analysis and get a conclusion. Results: The total bile acid and the ratio of CA/CDCA can be early sensitive index for clinically evaluating the recovery condition of the liver function after transplantation. 1. Different level ill-function of liver exists before the transplantation of a patient. And the TBA in serum increases which makes a direct ratio to the liver injury. 2. As the recovery of liver function, the total bile acid in serum reduces gradually after the transplantation, whereas the change is severe when rejection reaction occurs. TBA increases rapidly. And along with the cure of rejection reaction and the recovery of liver function, TBA becomes normal again. 3. The ratio of CA/CDCA in serum of a common patient decreases a little after the transplantation. But the decrease is not severe and no obvious change occurs. But when the delay of liver function recovery or the rejection reaction occurs, there will be obvious decrease. Along with the cure of the rejection reaction and the recovery of the liver function, the ratio of TCA/CDCA increases gradually again. 4. When the rejection reaction occurs after the transplantation, the liver function indexes of AST, TBIL and others in serum increases obviously, and AST is the most obvious one. At the same time, the TBA and the ratio of CA/CDCA decrease obviously as well, and their decrease occurs earlier than AST for one to three days. 5. When function recovery delay of the transplanted liver occurs, the ASTV, TBIL and other liver function indexes in serum are keeping up, and AST is the most obvious one. At the same time, the TBA and the ratio of CA/CDCA decrease obviously, and the TBA is the most obvious one. The TBA changes earlier than the AST, and it becomes normal gradually as the transplanted liver function recovers. Conclusion: 1. Increasing in grade with Child, the TBA increases as well withgrade C>grade B>grade A, and there is distinct difference among thegrades. 2. In the rejection reaction, the TBA may increase obviously, and theratio of CA/CDCA decreases obviously as well. Along with the cure of therejection reaction and the recovery of liver function, the TBA and the ratioof CA/CDCA become normal gradually again, and this change occursearlier than the AST and the TBIL for one to three days, and the ratio ofCA/CDCA changes more early. So,TBA and CA/CDCA can be seen as theindex for clinically evaluating the rejection after the transplantation. 3. The ratio of CA/CDCA of the patient whose liver function delayswill decreases obviously in the first day after the operation,and the totalbi...