肝移植术中应用S-腺苷-L-蛋氨酸对供肝热缺血损伤的影响  

Effects of S-Adenosyl-L-methionine on warm ischemia graft during liver transplatation

作　　者：许赤[1] 陈规划[1] 李智宇[1] 陆敏强[1] 杨扬[1] 蔡常洁[1] 李华[1] 易述红[1] 汪根树[1] 易慧敏[1] 

机构地区：[1]中山大学附属第三医院肝脏移植中心,广州510630

出　　处：《中华实验外科杂志》2005年第11期1341-1343,共3页Chinese Journal of Experimental Surgery

基　　金：广东省医学科研基金资助项目(A2005238);卫生部临床重点资助项目(2001321);科技部973计划子项目(2003CB515500);广东省名医工程研究项目

摘　　要：目的探讨术中S-腺苷-L-蛋氨酸(SAMe)加入UW液和血浆冲洗液对热缺血损伤供肝及其恢复的影响。方法建立10 min热缺血大鼠肝移植模型,分为A组:UW液灌注+乳酸钠林格氏液冲洗、B组:UW液灌注+血浆冲洗、C组:SAMe加入UW液灌注+血浆冲洗和D组:UW液灌注+SAMe加入血浆冲洗4组,观察肝组织组织病理学变化和电子显微镜下超微结构变化,并检测血清AST和透明质酸。结果C组和D组术后24 h血清AST均低于B组(P<0.05)。A组术后3 h和24 h血清HA高于B组(P<0.05),B组复流后3 h及24 h血清HA均高于C组和D组(P<0.05)。组织病理学表现B组复流后3 h和24 h肝细胞损伤和微循环紊乱较C组和D组明显;超微结构表现,A组复流后3 h线粒体肿胀,肝窦内皮细胞肿胀,细胞核不规则,可见内皮细胞凋亡,大部分区域肝窦状隙明显狭窄,内皮层结构模糊,红细胞淤积,受压变形,白细胞附壁,可见内皮层完整性破坏;复流后24 h,可见线粒体嵴断裂,核融解。B组内皮细胞损伤较A组轻,C组和D组超微结构表现微循环紊乱和肝细胞损伤表现较B组轻。结论供肝切取术中UW液中加入SAMe灌注保存,血浆冲洗液中加入SAMe可改善热缺血供肝微循环,减轻缺血再灌注损伤,并减轻肝细胞热缺血损伤,有利于10 min热缺血供肝功能的恢复。Objictive To investigate the effects of SAMe on warm ischemia graft during donor liver procurement, preservation and implantation respectively. Methods The rat liver transplantation model of warm ischemia was established, and the warm ischemia time was 10 min. Four groups were designed： In group A, liver grafts were perfused and preserved with UW solution, and rinsed with lactated Ringer＇s Solution;In group B, UW ＋ rinse with fresh plasma; In group C, UW solution ＋ SAMe ＋ rinse with fresh plasma; In group D, UW solution ＋ rinse with fresh plasma ＋ SAMe. Histopathological and ultrastructural changes were observed under the microscopy and the transmission electron microscopy respectively, and the levels of AST and hyaluronic acid （HA） were detected. Results AST levels were lower 24 h after reperfusion in groups C and D than in group B. HA levels were higher 3 h and 24 h after reperfusion in group A than in group B （ P 〈 0.05 ）, and HA levels were higher 3 h and 24 h after reperfusion in group B thanin groups C and D （ P 〈 0.05 ）. Histopathological changes showed deteriorated microcirculation and hepatocyte injury in group A, Ultrastructural changes included： 3 h after reperfusion in group A swollen mitochondria; krista integrity, swollen endothelial cells of hepatic sinusoids, irregular nuclea, marginally accumulated chromosome, apoptusis of endothelial cells; obviously obstructed sinusoids, blur structure of endothelial lining, hemocytes accumulated, leucocytes marginated and adhered, and the destructed integrity of endothelial lining. Spot necrosis of hepatoctes presented in group A 24 h after reperfusion. Injury of endothelial cells in group B was slighter than that in group B. Microcirculatory disturbance and hepatocellular injuries in groups C and D were slighter than those in group B. Conclusion The regimen, addition of SAMe into UW solution or to plasma rinse solution, both improved the microcirculation of donor liver, alleviated hepatocytes injury from warm ischemia, and faci

关 键 词：肝移植 再灌注损伤 超微结构 S-腺苷-L-蛋氨酸 热缺血损伤 肝移植模型 术中应用 供肝切取 缺血再灌注损伤 超微结构变化 

分 类 号：R657.3[医药卫生—外科学]