肝門阻斷時肝動脈與門靜脈不同開放時序對肝臟缺血再灌注的影響_《中國普外基礎與臨床雜志》

作者：

顧國文 , 李相成 , 孫勇

南京醫科大學第一附屬醫院肝臟外科，活體肝移植中心(南京210029);

關鍵詞：

再灌注損傷肝動脈門靜脈氧自由基

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目的　研究大鼠肝臟熱缺血后經門靜脈和肝動脈不同時序灌注對其損傷的影響，探索是否可由此減輕大鼠肝臟缺血再灌注損傷及其可能的機理。
方法　選用健康雄性SD大鼠96只，按隨機數字表法等分成6組，1組為假手術組，其余5組為實驗組。假手術組(16只)只作開腹和肝門部解剖; 實驗組(共5組，每組16只)根據再灌注時門靜脈和肝動脈不同開放時序分組：先開放門靜脈1 min后再開放肝動脈組、先開放門靜脈2 min后再開放肝動脈組、先開放肝動脈1 min后再開放門靜脈組、先開放肝動脈2 min后再開放門靜脈組及同時開放門靜脈和肝動脈組。各組分別于術后2 h和4 h檢測血清中ALT和AST值，肝組織中丙二醛（MDA）、超氧化物歧化酶（SOD）及谷胱甘肽（GSH）含量變化；采用病理組織切片HE染色觀察肝組織損傷情況；　TUNEL法檢測各組肝組織細胞凋亡情況。
結果　假手術組大鼠肝臟基本正常，各指標均好于各實驗組，差異均有統計學意義(P＜0.01)。在各實驗組中先開放門靜脈1 min后再開放肝動脈組大鼠肝臟缺血再灌注損傷最輕，其ALT、AST、MDA和凋亡指數值均明顯低于其他各實驗組，差異有統計學意義(P＜0.05或P＜0.01)，并且其SOD和GSH值均高于其他各實驗組，差異亦有統計學意義(P＜0.05或P＜0.01)。肝組織HE染色也顯示，先開放門靜脈1 min后再開放肝動脈組大鼠肝組織損傷較其他各實驗組輕。
結論　肝臟熱缺血后，通過短暫開放門靜脈再開放肝動脈的措施可以減輕大鼠肝臟缺血再灌注損傷，可能與降低活性氧的產生及保護肝臟抗氧化系統有關。

引用本文： 顧國文,李相成,孫勇. 肝門阻斷時肝動脈與門靜脈不同開放時序對肝臟缺血再灌注的影響. 中國普外基礎與臨床雜志, 2009, 16(3): 203-207. doi: 復制

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11.	Zhang W, Wang M, Xie HY, et al. Role of reactive oxygen species in mediating hepatic ischemia-reperfusion injury and its therapeutic applications in liver transplantation [Ｊ]. Transplant Proc, 2007; 39(5):1332.
12.	Becker LB. New concepts in reactive oxygen species and cardiovascular reperfusion physiology [Ｊ]. Cardiovasc Res, 2004; 61(3):461.
13.	Wu BQ, Chu WW, Zhang LY, et al. Protection of preconditioning, postconditioning and combined therapy against hepatic ischemia/reperfusion injury [Ｊ]. Chin J Traumatol, 2007; 10(4):223.
14.	冉江華, 郭永章, 李立, 等. 重組人生長激素對大鼠肝臟缺血再灌注損傷的保護作用 [Ｊ]. 中國普外基礎與臨床雜志， 2006; 13(5):555.
15.	王科, 王學浩, 張峰，等. 誘導HO-1改善氧化應激狀態減輕老年供肝缺血-再灌注損傷 [Ｊ]. 中國普外基礎與臨床雜志, 2005; 12(2):109.
16.	Demirbilek S, Karaman A, Gürünlüoglu K, et al. Polyenylphosphatidylcholine pretreatment protects rat liver from ischemia/reperfusion injury [Ｊ]. Hepatol Res, 2006; 34(2):84.
17.	Yuan GJ, Ma JC, Gong ZJ, et al. Modulation of liver oxidant-antioxidant system by ischemic preconditioning during ischemia/reperfusion injury in rats [Ｊ]. World J Gastroenterol, 2005; 11(12):1825.
18.	Hausenloy DJ, Yellon DM. Preconditioning and postconditioning: united at reperfusion [Ｊ]. Pharmacol Ther, 2007; 116(2):173.
19.	Davidson SM, Hausenloy D, Duchen MR, et al. Signalling via the reperfusion injury signalling kinase (RISK) pathway links closure of the mitochondrial permeability transition pore to cardioprotection [Ｊ]. Int J Biochem Cell Biol, 2006; 38(3):414.
20.	Piper HM, Abdallah Y, Schfer C. The first minutes of reperfusion: a window of opportunity for cardioprotection [Ｊ]. Cardiovasc Res, 2004; 61(3):365.
21.	Kloner RA, Rezkalla SH. Preconditioning, postconditioning and their application to clinical cardiology [Ｊ]. Cardiovasc Res, 2006; 70(2):297.
22.	Yellon DM, Hausenloy DJ. Realizing the clinical potential of ischemic preconditioning and postconditioning [Ｊ]. Nat Clin Pract Cardiovasc Med, 2005; 2(11):568.
23.	Rastaldo R, Penna C, Cappello S, et al.Ischemic postconditioning: an effective strategy of myocardial protection? [Ｊ]. G Ital Cardiol (Rome), 2006; 7(7):464.

1. Romanque UP, Uribe MM, Videla LA. Molecular mechanisms in liver ischemic-reperfusion injury and ischemic preconditioning [Ｊ].　Rev Med Chil, 2005; 133(4):469.
2. 胡軍, 劉志蘇, 孫權, 等. 缺血后處理對肝臟缺血再灌注中肝竇內皮細胞損傷的保護作用 [Ｊ]. 肝臟， 2004; 9(1):21.
3. Galaris D, Barbouti A, Korantzopoulos P. Oxidative stress in hepatic ischemia-reperfusion injury: the role of antioxidants and iron chelating compounds [Ｊ]. Curr Pharm Des, 2006; 12(23):2875.
4. Sun K, Liu ZS, Sun Q. Role of mitochondria in cell apoptosis during hepatic ischemia-reperfusion injury and protective effect of ischemic postconditioning [Ｊ]. World J Gastroenterol, 2004; 10(13):1934.
5. Puhl G, Schaser KD, Pust D, et al. The delay of rearterialization after initial portal reperfusion in living donor liver transplantation significantly determines the development of microvascular graft dysfunction [Ｊ]. J Hepatol, 2004; 41(2):299.
6. van As AB, Lotz Z, Tyler M, et al. Reperfusion injury associated with portal venous and hepatic arterial perfusion in liver transplantation [Ｊ].Transplantation, 2002; 74(2):158.
7. Moreno C, Sabaté A, Figueras J, et al. Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft [Ｊ]. Liver Transpl, 2006; 12(11):1607.
8. Polak WG, Porte RJ. The sequence of revascularization in liver transplantation: it does make a difference [Ｊ]. Liver Transpl, 2006; 12(11):1566.
9. Vinten-Johansen J, Zhao ZQ, Zatta AJ, et al. Postconditioning—A new link in nature’s armor against myocardial ischemia-reperfusion injury [Ｊ]. Basic Res Cardiol, 2005; 100(4):295.
10. Glantzounis GK, Salacinski HJ, Yang W, et al. The contemporary role of antioxidant therapy in attenuating liver ischemia-reperfusion injury: a review [Ｊ]. Liver Transpl, 2005; 11(9):1031.
11. Zhang W, Wang M, Xie HY, et al. Role of reactive oxygen species in mediating hepatic ischemia-reperfusion injury and its therapeutic applications in liver transplantation [Ｊ]. Transplant Proc, 2007; 39(5):1332.
12. Becker LB. New concepts in reactive oxygen species and cardiovascular reperfusion physiology [Ｊ]. Cardiovasc Res, 2004; 61(3):461.
13. Wu BQ, Chu WW, Zhang LY, et al. Protection of preconditioning, postconditioning and combined therapy against hepatic ischemia/reperfusion injury [Ｊ]. Chin J Traumatol, 2007; 10(4):223.
14. 冉江華, 郭永章, 李立, 等. 重組人生長激素對大鼠肝臟缺血再灌注損傷的保護作用 [Ｊ]. 中國普外基礎與臨床雜志， 2006; 13(5):555.
15. 王科, 王學浩, 張峰，等. 誘導HO-1改善氧化應激狀態減輕老年供肝缺血-再灌注損傷 [Ｊ]. 中國普外基礎與臨床雜志, 2005; 12(2):109.
16. Demirbilek S, Karaman A, Gürünlüoglu K, et al. Polyenylphosphatidylcholine pretreatment protects rat liver from ischemia/reperfusion injury [Ｊ]. Hepatol Res, 2006; 34(2):84.
17. Yuan GJ, Ma JC, Gong ZJ, et al. Modulation of liver oxidant-antioxidant system by ischemic preconditioning during ischemia/reperfusion injury in rats [Ｊ]. World J Gastroenterol, 2005; 11(12):1825.
18. Hausenloy DJ, Yellon DM. Preconditioning and postconditioning: united at reperfusion [Ｊ]. Pharmacol Ther, 2007; 116(2):173.
19. Davidson SM, Hausenloy D, Duchen MR, et al. Signalling via the reperfusion injury signalling kinase (RISK) pathway links closure of the mitochondrial permeability transition pore to cardioprotection [Ｊ]. Int J Biochem Cell Biol, 2006; 38(3):414.
20. Piper HM, Abdallah Y, Schfer C. The first minutes of reperfusion: a window of opportunity for cardioprotection [Ｊ]. Cardiovasc Res, 2004; 61(3):365.
21. Kloner RA, Rezkalla SH. Preconditioning, postconditioning and their application to clinical cardiology [Ｊ]. Cardiovasc Res, 2006; 70(2):297.
22. Yellon DM, Hausenloy DJ. Realizing the clinical potential of ischemic preconditioning and postconditioning [Ｊ]. Nat Clin Pract Cardiovasc Med, 2005; 2(11):568.
23. Rastaldo R, Penna C, Cappello S, et al.Ischemic postconditioning: an effective strategy of myocardial protection? [Ｊ]. G Ital Cardiol (Rome), 2006; 7(7):464.

《中國普外基礎與臨床雜志》

肝門阻斷時肝動脈與門靜脈不同開放時序對肝臟缺血再灌注的影響

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《中國普外基礎與臨床雜志》

肝門阻斷時肝動脈與門靜脈不同開放時序對肝臟缺血再灌注的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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