Clinical significance of serum delta bilirubin during obstructive jandice.

胆红素是一种与白蛋白非酶共价结合的复合物，在血清中非酶促形成，与肝肾功能无关，其半衰期很长。目的是检查胆红素是否反映梗阻性黄疸的持续时间和胆道引流的效果。17只犬出现梗阻性黄疸4（短期，n=9）或11（长期，n=8） d，然后行外胆道引流术。采用高效液相色谱法分析血清总胆红素、直接胆红素和δ胆红素。胆道梗阻前血清中未检出胆红素。血清总胆红素和直接胆红素水平迅速升高，并在梗阻性黄疸发生后2天内达到平台期，而δ胆红素浓度和比例逐渐升高，且与梗阻性黄疸持续时间显著相关。胆道引流前，短期组δ胆红素比例28.9(]SY.+- .[)2.4%，长期梗阻组为42.5(]SY.+- .[)2.4%。短期梗阻组血清总胆红素、直接胆红素、总负胆红素下降指数（-0.17、-0.19、-0.26）显著高于长期梗阻组（-0.10、-0.10、-0.13），差异有统计学意义（P<0.05）。两组间δ胆红素本身的下降指数相似。综上所述，血清中δ胆红素的浓度和比例反映了黄疸的持续时间。由于δ胆红素不排泄到胆汁和尿液中，对脏器没有毒性，总胆红素下降指数减去δ胆红素、可排泄胆红素分数可能更好地评价胆道引流的疗效。从21个人体样本中获得了类似的结果。

delta-Bilirubin, a nonenzymatic covalently bound complex with albumin, is nonenzymatically formed in serum and has a long half-life irrespective of hepatorenal function. The aim was to examine if delta-bilirubin reflects the duration of obstructive jaundice and efficacy of biliary drainage. Obstructive jaundice was developed in 17 dogs either for 4 (short term ; n=9) or 11 (long term ; n=8) days and then external biliary drainage was performed. Serum total, direct, and delta-bilirubin fractions were analyzed by high-performance liquid chromatography. delta-Bilirubin was not detectable in serum before biliary obstruction. The serum total and derect bilirubin levels increased rapidly and reached a plateau within 2 days after the biliary obstruction, whereas the concentration and proportion of delta-bilirubin gradually increased and significantly correlated with the duration of obstructive jaundice. Before biliary drainage, the proportion of delta-bilirubin was 28.9(]SY.+-。[)2.4% in the shortterm and 42.5(]SY.+-。[)2.4% in the long-term obstruction group. The decline indices of serum total, direct, and total minus delta-bilirubin in the short-term group (-0.17, -0.19, and -0.26, respectively) were significantly (P<0.05) greater than those in the long-term obstruction group (-0.10, -0.10, and -0.13). The decline index of delta-bilirubin itself was similar between the groups. In conclusion, the concentration and proportion of delta-bilirubin in serum reflect the duration of jaundice. Because delta-bilirubin is not excreted into bile and urine and is not toxic to organs, a decline index of total bilirubin minus delta-bilirubin, the excretable bilirubin fraction might be better to assess the efficacy of biliary drainge. Similar results were obtained from 21 human samples.