摘要目的 通过监测糖尿病受者胰岛移植前后门静脉内转氨酶水平的变化,分析其影响因素.方法 回顾分析天津市第一中心医院的16例接受门静脉内胰岛移植术的糖尿病受者,术后监测天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)和血清总胆红素(TBil)指标.采用单因素方差分析组间差异.结果 16例接受门静脉内胰岛移植术的糖尿病受者中,有11例受者术后AST水平升高,其中4例AST峰值达到正常上限(40 U/L)的2.5倍以上;8例受者ALT水平升高,其中3例ALT峰值超过正常值上限(50 U/L)的1.5倍.所有受者的T Bil水平术前、术后均在正常范围.移植胰岛的组织量过多是造成AST水平升高的主要影响因素(P<0.05).结论 门静脉内胰岛移植后肝功能异常与移植的胰岛组织量有关,胰岛制备的过程中,需要进一步提高胰岛的纯度,降低移植的组织量.输注胰岛时应尽可能缓慢,保持门静脉压力稳定.

abstractsObjective To investigate the effect factors of liver enzymes elevation by monitoring the liver function changes before and after intraportal islet transplantation .Methods 16 diabetic patients who received intraportal islet transplantation in our hospital were analyzed .The levels of aspartic aminotransferase (AST ) ,alanine aminotransferase (ALT )and total bilirubin (TBil)were monitored after islet transplantation .Results Among those 16 diabetic patients who received intraportal islet transplantation ,11 patients showed an increased AST and 8 patients showed an increased ALT ,among which a 2 .5-fold increase in AST was observed in 4 patients and over 1 .5-fold elevation of ALT was observed in 3 patients .The level of TBil were in the normal range before and after transplantation in all patients . Transplanted tissue volume of islet was the main factor for significantly increased AST (P< 0 .05) in this study .It is also shown that the change in portal pressure is related to the AST elevation after islet transplantation .Conclusions The amount of transplanted islet tissue volume is related to the liver enzymes elevation after intraportal islet transplantation .Therefore ,the improvement of the purity of islet to reduce the amount of transplanted tissue could be benefit to prevent the liver injury after islet transplantation .Meanwhile ,the purified islets should be injected as slowly as possible to maintain a stable portal pressure .