간절제 및 간이식 후 간기능 회복의 평가인자로서의 Apolipoprotein A1의 역할

Apolipoprotein A-1 as a Factor to Assess Recovery of the Liver Function after Hepatectomy and Liver Transplantation

  • 배상인 (전북대학교 의학전문대학원 외과학교실 및 임상의학연구소) ;
  • 이정훈 (전북대학교 의학전문대학원 외과학교실 및 임상의학연구소) ;
  • 유희철 (전북대학교 의학전문대학원 외과학교실 및 임상의학연구소) ;
  • 조백환 (전북대학교 의학전문대학원 외과학교실 및 임상의학연구소)
  • 발행 : 2009.03.25

초록

Purpose: The aim of this study is to determine whether the serum apolipoprotein A1(apoA1) level, as measured at different time points after hepatectomy and liver transplantation, can predict the synthesis ability of the liver and the nutritional status. We also investigated the usefulness of regions of interest(ROIs) as an indicator of the recovery status of the liver after liver transplantation. Methods: 93 patients (21: laparoscopic cholecystectomy, 53: partial hepatectomy, 19: liver transplantation) were operated on under general anesthesia. The serum levels of apoA1, prealbumin, albumin, aspartate aminotransferase and alanine aminotransferase and the prothrombin time were measured at pre- and post-operation. The liver conditions were a normal liver (50 cases), hepatitis (16 cases) and liver cirrhosis (28 cases). The mean hepatic attenuation was calculated by averaging the ROI values that were obtained at different hepatic segments. Results: The serum apoA1 level was minimally changed during the perioperative period in the laparoscopic cholecystectomy group. Yet in most cases, the serum apoA1 level after partial hepatectomy and liver transplantation was decreased on postoperative days (PODs) 1 and 7, but it nearly recovered to the preoperative level on POD 30. There were significant differences in the values of apoA1 between the normal liver and co-existent liver disease at the various time points. The ROI value after transplantation gradually increased and it reached a normal level by POD 30. Conclusion: The serum apoA1 level can be an indicator of liver's ability to synthesize protein and the nutritional status after partial hepatectomy. In addition, ROIs of the unenhanced CT image can reflect the recovery status of the liver after transplantation.

키워드

참고문헌

  1. Takahashi T, Togo S, Tanaka K, Endo I, Fujii Y, Shimada H. Safe and permissible limits of hepatectomy in obstructive jaundice patients. World J Surg 2004;28:475–81. https://doi.org/10.1007/s00268-004-7128-7
  2. Kawamoto M, Mizuguchi T, Nagayama M, et al. Serum lipid and lipoprotein alterations represent recovery of liver function after hepatectomy. Liver Int 2006;26:203-10. https://doi.org/10.1111/j.1478-3231.2005.01217.x
  3. Schneider P D. Preoperative assessment of liver function. Surg Clin N Am 2004;84:355–73. https://doi.org/10.1016/S0039-6109(03)00224-X
  4. Pelton J J, Hoffman J P, Eisenberg B L. Comparison of liver function tests after hepatic lobectomy and hepatic wedge resection. Am Surg 1998;64:408–14.
  5. Katsuramaki T,Mizuguchi T, Kawamoto M, et al. Assessment of nutritional status and prediction of postoperative liver function from serum apolioprotein A-1 levels with hepatectomy. World J Surg. 2006;30:1886-91. https://doi.org/10.1007/s00268-005-0590-z
  6. Krempler F, Kostner GM, Bolzano K, Sandhofer F. Turnover of lipoprotein(a) in man. J Clin Invest 1980;65:1483-90. https://doi.org/10.1172/JCI109813
  7. Zago LB, Slobodianik NH, Gasali F, Torino F, Rio ME. Apolipoproteins A-I and B as predictors of complications in gallbladder lithiasis surgical patients. Nutrition. 2003;19:250-2. https://doi.org/10.1016/S0899-9007(02)00860-2
  8. Katsuramaki T, Hiarta K, Kimura Y, et al. Changes in serum levels of apolipoprotein A-1 as a indicator of protein metabolism after hepatectomy. Wound Rep Reg 2002;10:77–82. https://doi.org/10.1046/j.1524-475X.2002.10602.x
  9. Armstrong V W, Schutz E, Kaltefleiter M, et al. Relationship of apolipoproteins AI, B and lipoprotein Lp(a) to hepatic function of liver recipients during the early posttransplant period. Eur J Clin Invest 1995;25:485–93. https://doi.org/10.1111/j.1365-2362.1995.tb01734.x
  10. Cho JY, Suh KS, Kwon CH, et al. The hepatic regeneration power of mild steatotic grafts is not impaired in living-donor liver transplantation. Liver Transpl 2005;11:210-7. https://doi.org/10.1002/lt.20340
  11. Cho JY, Suh KS, Kwon CH, Yi NJ, Lee KU. Mild hepatic steatosis is not a major risk factor for hepatectomy and regenerative power is not impaired. Surg 2006;139:508-15. https://doi.org/10.1016/j.surg.2005.09.007
  12. Monroe P, Vlahcevic Z R, Swell L. In vivo evaluation of lipoprotein cholesterol ester metabolism in patients with liver disease. Gastroenterology 1983;85:820–9.
  13. Duhamel G, Nalpas B, Goldstein S, Laplaud P M, Berthelot P, Chapman M J. Plasma lipoprotein and apolipoprotein profile in alcoholic patients with and without liver disease: on the relative roles of alcohol and liver injury. Hepatology 1984;4:577–85. https://doi.org/10.1002/hep.1840040401