移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义  

Expression and significance of local Thl and Th2 cytokines in the wafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage

作　　者：唐勇[1] 李建水[3] 何满西[4] 李冈栉[5] 韩方海[2] 张肇达[2] 

机构地区：[1]天津医科大学附属肿瘤医院胰腺肿瘤科,300060 [2]四川大学华西医院普外三科 [3]川北医学院普外科 [4]四川雅安市人民医院 [5]四川遂宁市人民医院普外科

出　　处：《中华实验外科杂志》2009年第7期876-879,共4页Chinese Journal of Experimental Surgery

基　　金：美国中华医学基金会资助项目（CMB）（82-412）

摘　　要：目的探讨Th1和Th2型细胞因子在猪胰肾联合移植门脉（PVD）和体静脉（SVD）回流术式移植物局部表达及意义。方法58例四川当地杂交第1代长白猪，分成假手术组（10例）、PE组（24例）和SE组（24例）。假手术组行开腹术，PE组和SE组切除受者胰腺制成I型糖尿病模型，并切除右肾。PE组门静脉与受者肠系膜上静脉吻合，SE组门静脉与受者肝下下腔静脉吻合，外分泌均采用肠道引流。术后第3、7天开腹取移植胰腺、肾脏组织，逆转录-聚合酶链反应（RT—PCR）和ELISA检测移植物局部Th1型细胞因子IFN-1和Th2型细胞因子白细胞介素（IL）-4mRNA及蛋白的表达。结果术后第3、7天，与对照组比较，移植肾和胰腺IFN-γ mRNA及蛋白在sE组和PE组均呈高表达（P〈0．05），SE组高于PE组（P〈0．05）（第7天，蛋白在对照组比SE组比PE组表达：移植胰腺，[（3．36±0．25）比（7．72±0．67）比（6．52±0．34）pg／mg蛋白]，移植肾[（3．66±0．28）比（10．83±1．48）比（7．79±0．60）pg／mg蛋白]。移植胰腺和肾IL4mRNA及蛋白在SE组和假手术组呈低表达，PE组呈高表达（P〈0．05）（第7天，蛋白在对照组比SE组比PE组表达：移植胰腺，[（7．18±0．16）比（6．10±0．16）比（20．66±1．47）pg／mg蛋白]；移植肾，[（5．74±0．48）比（10．38±0．92）比（19．66±1．57）pg／mg蛋白]。结论胰肾联合移植PVD术式移植物血流经过肝脏后可诱导Th1细胞向Th2细胞偏离，是PVD免疫学优越性的可能机制。Objective To investigate the expression and significance of local Thl and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham （n = 10）, PE （portal-enteric drainage） （n =24） and SE （ systemic-enteric drainage） （n =24） groups. Type 1 diabetic mellitus was induced by whole pancreatectomy,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to laparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γ and IIA by RT-PCR and ELISA on the day 3, and 7 after transplantation. Results Compared with sham group, the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated （ P 〈 0. 05 ） （ On the day 7, protein expression in sham, SE, and PE groups： in the graft pancreas, [ （ 3.36 ±0. 25 ）, （7.72 ±0. 67 ）, and （ 6.52 ±0. 34） pg/mg protein ] ; in the graft kidney, [ （3.66 ±0.28）, （ 10.83 ± 1.48） ,and （7.79 -0.60） pg/mg protein]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group （P 〈0.05） ,but down-regulated or no expression was detected in group SE （on the day 7, protein expression in sham, SE, and PE groups：in the graft pancreas, [ （7.18 ±0.16）, （6.10 ±0.16） ,and （20.66 ± 1.47） pg/mg protein] ;in the graft kidney, [ （5.74 ± 0.48）, （ 10.38 ± 0.92）, and （ 19.66 ± 1.57 ） pg/mg protein ]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Thl to Th2 immune shift. This may be one of mechanisms of immunologic benefits of PVD.

关 键 词：胰肾联合移植 细胞因子 门脉回流 体静脉回流 猪 

分 类 号：R657.5[医药卫生—外科学] R699.2[医药卫生—临床医学]