Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1990 Apr;211(4):428–432. doi: 10.1097/00000658-199004000-00008

Effects of percutaneous transhepatic biliary drainage on blood-bile permeability and selective IgA transport in patients with biliary obstructions.

G Ohshio 1, T Manabe 1, K Tamura 1, H Kudo 1, H Yoshioka 1, T Tobe 1
PMCID: PMC1358028  PMID: 2322037

Abstract

Biliary obstruction induces a increase in the permeability between blood and bile, and a decrease in the rate of immunoglobulin A (IgA) transport into bile. We investigated the effects of percutaneous transhepatic biliary drainage (PTBD) on these derangements. PTBD reduced the extent of elevation of the bile-to-serum ratio of Immunoglobulin G (IgG; IgG-BS ratio) in patients with obstructive jaundice. Because IgG is known to be passively transported from serum to bile, the results indicate that PTBD restores the blood-bile barrier function. The IgA-BS ratio/IgG-BS ratio index (IgA/IgG index) and the IgM/IgG index, which indicated the function of selective transport of IgA and IgM into bile, initially decreased and then returned to the normal range 17 days after PTBD in patients who experienced a rapid resolution of hyperbilirubinemia. However these indices remained low in patients who did not experience this resolution. The serum secretory IgA levels in patients who did not experienced rapid resolution of hyperbilirubinemia markedly increased before PTBD. The serum secretory IgA levels in the patients who did and those who did not experience rapid resolution of hyperbilirubinemia, after initially increasing, decreased after PTBD. However the level returned to the control range only in patients who experienced a rapid resolution. These results indicate that the secretory IgA level is a sensitive indicator of hepatobiliary function, and measurement of the level of secretory IgA could predict the effect of PTBD.

Full text

PDF
428

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Delacroix D. L., Hodgson H. J., McPherson A., Dive C., Vaerman J. P. Selective transport of polymeric immunoglobulin A in bile. Quantitative relationships of monomeric and polymeric immunoglobulin A, immunoglobulin M, and other proteins in serum, bile, and saliva. J Clin Invest. 1982 Aug;70(2):230–241. doi: 10.1172/JCI110610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Dive C., Heremans J. F. Nature and origin of the proteins of bile. I. A comparative analysis of serum and bile proteins in man. Eur J Clin Invest. 1974 Aug;4(4):235–239. doi: 10.1111/j.1365-2362.1974.tb00398.x. [DOI] [PubMed] [Google Scholar]
  3. Dive C., Nadalini R. A., Vaerman J. P., Heremans J. F. Origin and nature of the proteins of bile. II. A comparative analysis of serum, hepatic lymph and bile proteins in the dog. Eur J Clin Invest. 1974 Aug;4(4):241–246. doi: 10.1111/j.1365-2362.1974.tb00399.x. [DOI] [PubMed] [Google Scholar]
  4. Kloppel T. M., Hoops T. C., Gaskin D., Le M. Uncoupling of the secretory pathways for IgA and secretory component by cholestasis. Am J Physiol. 1987 Aug;253(2 Pt 1):G232–G240. doi: 10.1152/ajpgi.1987.253.2.G232. [DOI] [PubMed] [Google Scholar]
  5. Kutteh W. H., Prince S. J., Phillips J. O., Spenney J. G., Mestecky J. Properties of immunoglobulin A in serum of individuals with liver diseases and in hepatic bile. Gastroenterology. 1982 Feb;82(2):184–193. [PubMed] [Google Scholar]
  6. Lemaître-Coelho I., Jackson G. D., Vaerman J. P. High levels of secretory IgA and free secretory component in the serum of rats with bile duct obstruction. J Exp Med. 1978 Mar 1;147(3):934–939. doi: 10.1084/jem.147.3.934. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. McPherson G. A., Benjamin I. S., Hodgson H. J., Bowley N. B., Allison D. J., Blumgart L. H. Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg. 1984 May;71(5):371–375. doi: 10.1002/bjs.1800710522. [DOI] [PubMed] [Google Scholar]
  8. Norlander A., Kalin B., Sundblad R. Effect of percutaneous transhepatic drainage upon liver function and postoperative mortality. Surg Gynecol Obstet. 1982 Aug;155(2):161–166. [PubMed] [Google Scholar]
  9. Ohshio G., Furukawa F., Manabe T., Tobe T., Hamashima Y. Comparative studies on immunoglobulins, complement component (C3), albumin, and immunoglobulin A-containing circulating immune complexes in serum and bile of patients with biliary obstruction. Dig Dis Sci. 1988 May;33(5):570–576. doi: 10.1007/BF01798359. [DOI] [PubMed] [Google Scholar]
  10. Ohshio G., Furukawa F., Manabe T., Tobe T., Hamashima Y. Relationship between secretory IgA, IgA-containing (C3-fixing) circulating immune complexes, and complement components (C3, C4) in patients with obstructive jaundice. Scand J Gastroenterol. 1986 Mar;21(2):151–157. doi: 10.3109/00365528609034640. [DOI] [PubMed] [Google Scholar]
  11. Ohshio G., Furukawa F., Sekita K., Manabe T., Tobe T., Hamashima Y. IgA containing circulating immune complexes and IgA anti-single stranded DNA antibodies in patients with obstructive jaundice. Clin Exp Immunol. 1985 Feb;59(2):435–441. [PMC free article] [PubMed] [Google Scholar]
  12. Ohshio G., Kudo H., Yoshioka H., Nonaka A., Manabe T., Tobe T., Hamashima Y. Plasma levels of secretory IgA in patients with gastric cancer. J Cancer Res Clin Oncol. 1987;113(6):573–575. doi: 10.1007/BF00390868. [DOI] [PubMed] [Google Scholar]
  13. Ohshio G., Manabe T., Tobe T., Yoshioka H., Hamashima Y. Circulating immune complex, endotoxin, and biliary infection in patients with biliary obstruction. Am J Surg. 1988 Feb;155(2):343–347. doi: 10.1016/s0002-9610(88)80729-3. [DOI] [PubMed] [Google Scholar]
  14. Pitt H. A., Gomes A. S., Lois J. F., Mann L. L., Deutsch L. S., Longmire W. P., Jr Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg. 1985 May;201(5):545–553. doi: 10.1097/00000658-198505000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Robenek H., Herwig J., Themann H. The morphologic characteristics of intercellular junctions between normal human liver cells and cells from patients with extrahepatic cholestasis. Am J Pathol. 1980 Jul;100(1):93–114. [PMC free article] [PubMed] [Google Scholar]
  16. Roughneen P. T., Gouma D. J., Kulkarni A. D., Fanslow W. F., Rowlands B. J. Impaired specific cell-mediated immunity in experimental biliary obstruction and its reversibility by internal biliary drainage. J Surg Res. 1986 Aug;41(2):113–125. doi: 10.1016/0022-4804(86)90016-8. [DOI] [PubMed] [Google Scholar]
  17. Smith R. C., Pooley M., George C. R., Faithful G. R. Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized, controlled trial examining renal function. Surgery. 1985 Jun;97(6):641–648. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES