一氧化氮和内皮素在体外肝脏灌流系统对无心跳供肝保存中的作用  

The Role of Nitric Oxide and Endothelin in Non-heart-beating Livers Preservation with Extracorporeal Liver Perfusion System

作　　者：龚瑾[1] 王西墨[2] 龙刚[2] 江涛[2] 陈实[3] 

机构地区：[1]暨南大学附属第一医院肝胆外科,510630 [2]天津市人民医院外科 [3]华中科技大学同济医学院附属同济医院器官移植研究所

出　　处：《天津医药》2008年第6期450-453,共4页Tianjin Medical Journal

基　　金：国家十五“863”课题(项目编号:2001AA216071);天津市卫生局科技处基金资助课题(项目编号:2002KY35)

摘　　要：目的:分析HTK液单纯低温保存和常温体外肝脏灌流(ECLP)保存无心跳供肝的效果,探讨一氧化氮(NO)和内皮素(ET)在其过程中的作用和可能的机制。方法:按保存方法不同将无心跳供肝随机分为2组,再根据不同的阶段进行设计。A组(n=4)供肝用HTK液低温保存10h;B组(n=4)供肝用ECLP系统常温灌流10h。2组供肝经过60min再灌流前准备期后连接ECLP系统灌流4h。观察灌流后不同时间点供肝的胆汁分泌量、血流动力学和耗氧率的变化,以及灌流液中NO、ET水平和灌流后的供肝病理变化。结果:B组肝脏在1、2、3、4h4个时间点胆汁分泌量多于A组,耗氧率和A组(HTK液保存组)比较1h降低,2、3、4h升高(P<0.05或P<0.01);灌流液中在各个时间点B组ET水平均低于A组,NO则高于A组(P<0.05或P<0.01);常规病理和超微病理检查显示B组病变明显较A组轻。结论:在无心跳供肝保存过程中NO和ET起着非常重要的作用,利用ECLP系统灌流无心跳供肝能够通过改善NO和ET的平衡关系来更好地维持其生理活性和功能。Objective： To observe the role of nitric oxide and endothelin in non-heart-beating livers preservation by comparing preservation with the standard method of simple cold storage in HTK solution with preservation by extracorporeal liver perfusion. Methods： Livers were harvested from health pigs,which were preserved for 10 h by either cold storage in HTK solution （group A, n = 4） or by perfusion with oxygenated autologous blood at body temperature （group B,n = 4）. Both groups were tested on the circuit for a 4 h reperfusion phase. Data of bile production, hemodynamic parameters and the markers of hepatocyte and reperfusion injury of extracorporeal livers in each group were tested. The level of NO and ET of blood for reperfusion were measured. The histological examine of liver tissues from each group were performed at the end of reperfusion. Results： There was a significant difference in bile production and hemodynamic parameters between group B and group A at 1,2,3 and 4 hours （P 〈 0.05 or P 〈 0.01 ）. At each time point, the levels of ET of blood for reperfusion in group B were significantly lower than that in group A （P 〈 0.05 or P 〈 0.01 ）, and the levels of NO were lower than those in group A （P 〈 0.05 or P 〈 0.01 ）. The pathological changes in group B were mild than that in group A by pathological examination. Gonclusion： NO and ET play an important role in the period of preservation, and extracorporeal liver perfusion can keep liver function to a viable level by improving the balance between NO and ET.

关 键 词：一氧化氮 内皮缩血管肽类 肝 灌注 局部 模型 动物 猪 

分 类 号：R657.3[医药卫生—外科学] R699.2[医药卫生—临床医学]