肝脏缺血再灌注损伤时肝脏与肠道的相互作用-东南大学学报医学版

肝脏缺血再灌注损伤时肝脏与肠道的相互作用

单位：1.东南大学附属中大医院,普外科,江苏,南京,210009； 2.浙江大学附属第二医院,普外科,浙江,杭州,310009

分类号：R-332, R322.45, R322.47, R392.11, R619.9

出版年·卷·期（页码）：2002·21·第二期（150-152）

摘要：

目的:了解肝缺血再灌注时肝脏损伤和肠道损伤的相互作用及作用机制.方法:SD大鼠24只,雌雄各半,随机分为分流组(组1)、不分流组(组2)和假手术组(组3).组1、2在全麻下行肝门阻断45 min、再灌注2 h制备肝缺血再灌注损伤模型.组1在肝缺血再灌注前行门腔分流;组3仅作剖腹术,不作肝缺血再灌注.术前、后均抽取门静脉血并于术后切取部分肝脏及回肠以检测血清酶学、细胞因子、粘附分子水平及组织病理学改变.结果:术前各组动物血中天门冬氨酸氨基转移酶(AST)、丙氨酸转氨酶(ALT)、肿瘤坏死因-α(TNF-α)及白细胞介素-1(IL-1)水平均无显著性差异.在分流组和不分流组,肝脏缺血再灌注前后上述4项指标比较有显著性差异(P<0.05),术后明显高于术前.缺血再灌注后两组间上述指标亦有显著性差异(P<0.05),分流组明显低于不分流组.细胞内粘附分子1(ICAM-1)在肝脏中的表达分流组明显低于不分流组(P<0.05), 假手术组各项指标术前、后无显著性差异.肝脏及肠粘膜组织病理学检查显示分流组基本正常,不分流组存在细胞结构的改变.结论:肝缺血再灌注时,门静脉阻断所致的肠道损伤可加重肝脏的损害,可能通过ICAM-1的上调而介导.

Objective To investigate the interaction and its mechanism between liver injury and intestine injury during hepatic ischemia/reperfusion (I/R) in rats.Methods 24 SD rats,with the equal number of male and female,were allocated into three groups randomly:group 1(shunt group)?group 2 (non shunt group) and group 3(sham operation group ).The rats in group 1 underwent portal and inferior cava vein shunt before hepatic I/R(ischemia for 45 minutes and reperfusion for 2 hours).The rats in group 2 underwent the same procedure as that of group 1 except shunt procedure.All rats in group 3 were only subjected to laparotomy.Portal vein blood was obtained preoperation and post operation.Part of liver and ileum tissue were excised postoperatively for histological examination.Results The levels of ALT?AST?TNF? α and IL?1 have no significant difference among the three groups before operation,but after operation,the levels of the above measurement in group 1 and group 2 are higher than those of preoperation ( P <0.05).There were significant difference between group 1 and group 2 in postoperative measurements( P <0.05).As to group 3,no difference was found between preoperation and postoperation in all.There were significant differences among three groups in ICAM?1 expressed in liver.Conclusion This study demonstrated that not only ischemia itself does harm to liver,but the upgrated ICAM?1 in the liver by TNF? α and IL?1,which were induced by portal vein stasis,may aggravated the injury of the liver.Portal cava shunt may reduce this damage,and lead to a good liver function.

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