Clinical Significance of Changes in Serum Hyaluronic Acid and α₁-Antitrypsin Levels during the Perioperative Period of Hepatic Resection -Relation with Postoperative Complications-

Toru Kimura, Tsuyoshi Takahashi, Kooshi Sato and Akira Kakita

Department of Surgery, School of Medicine, Kitasato University

Aim: We evaluated the usefulness of serum hyaluronic acid (HA) levels as a predictor of postoperative complications. Methods: Serum HA and α₁-antitrypsin (AT) was measured perioperatively in 29 patients undergoing hepatic resection. Patients were divided into 2 groups, high-level group (HH group, n=14) and normal-level group (HN group, n=15), based on the preoperative serum HA. The change in these two groups was compared by considering gastric resection group (GX group, n=10) as contrast. Furthermore, changes were compared between with and without postoperative complications. Results: Preoperative serum HA correlated significantly with liver function. Moreover, in the histological degree of hepatic fibrosis, the significant difference was showed between HH group and HN group (p<0.01). Postoperative complications occurred in 8 patients from the SIRS case of HH group. Pre-and postoperative serum HA was significantly higher in patients with postoperative complications than in those without (p<0.05). Patients with postoperative complications had significantly lower serum AT after POD 3, compared to those without complications (p<0.05). Preoperative serum HA correlated well with serum AT on POD 3. Conclusions: The function of sinusoidal endothelial cells is falling at the patient with preoperative high serum HA level. And postoperative production of AT is falling at such a patient. Furthermore, it was possible that it was easy to develop from SIRS to the postoperative complications at such a patient. Consequently, an occurrence of postoperative complications could be predicted by the perioperative serum HA levels.

Key words
hyaluronic acid, α₁-antitrypsin, hepatic resection, postoperative complication

Reprint requests
Toru Kimura Department of Surgery, National Sagamihara Hospital
18-1 Sakuradai, Sagamihara, 228-8522 JAPAN

Accepted
September 24, 2003

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