Changes in serum levels of apolipoprotein A-1 as an indicator of protein metabolism after hepatectomy.

The clinical significance of serum apolipoprotein A-1 levels as an indicator of hepatic protein synthesis after hepatectomy was investigated. A total of 50 patients who had undergone hepatectomy at our department from 1997 to 1999 were selected for this study. The serum levels of apolipoprotein A-1, indocyanine green dye retention at 15 minutes, lectin-cholesterol acyltransferase, prealbumin, and high-density lipoprotein cholesterol were measured in these patients preoperatively and on postoperative days 7 and 14. The type of hepatic resection conducted was partial resection in 13 cases, subsegmentectomy in 13 cases, segmentectomy in five cases, and bisegmentectomy in 19 cases. All the patients tolerated the operation, and none of the cases had any severe complications, such as liver failure. In most cases, the serum apolipoprotein A-1 levels decreased on postoperative day 7 and recovered by day 14. There were no significant differences in the changes in apolipoprotein A-1 levels between patients with the individual types of operative procedures. The serum apolipoprotein A-1 levels showed significant correlations with the serum high-density lipoprotein cholesterol, lectin-cholesterol acyltransferase and prealbumin levels on postoperative days 7 and 14; however, there was no significant correlation with the indocyanine green retention test. When the cases were divided into three groups according to the serum level of apolipoprotein A-1 on postoperative day 7 (group A: over 81 mg/dl, group B: 61-80 mg/dl, group C: under 60 mg/dl), the serum indocyanine green retention, prealbumin, lectin-cholesterol acyltransferase and high-density lipoprotein cholesterol levels in group C were significantly lower than those in group A on postoperative day 7. On the basis of these results, it is suggested that the pattern of changes in the serum apolipoprotein A-1 levels may be a good indicator of the hepatic protein synthetic ability during the perioperative period after hepatectomy.