肝移植后处于不同免疫状态的移植肝脏的病变对比分析  

The analysis of hepatic pathological characteristics in different immune conditions after liver transplantation

作　　者：薛飞[1,2] 陈伟[1] 徐国栋[1] 梁廷波[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科及肝脏移植中心卫生部多器官移植重点研究实验室,杭州310003 [2]河南省人民医院移植中心肝胆胰腺外科,450003

出　　处：《器官移植》2010年第1期13-16,共4页Organ Transplantation

基　　金：国家杰出青年自然基金(30925033);国家自然科学基金(30772054);浙江省自然科学基金(Y207420;Z2080283;Y2090368)

摘　　要：目的对比肝移植术后处于不同免疫状态的移植肝脏的病变特点,为明确受体所处的免疫学状态提供鉴别方法。方法建立大鼠同种同基因肝脏移植、急性排斥反应、自发免疫耐受和肝移植后急性移植物抗宿主疾病(acute graft-versus-host disease following liver transplanta-tion,LTx-aGVHD)模型,观察移植术后受体一般生存状态和大体表现,检测移植术后不同时间点受体外周血血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平和移植肝脏的病理学变化。结果在同种同基因大鼠肝脏移植、自发免疫耐受和LTx-aGVHD模型组,术后外周血血清ALT、AST值出现短暂升高,随之逐渐恢复,在相同时间点三组相比差异均无统计学意义(均为P>0.05),并且肝脏病理变化表现相似,汇管区及肝窦内未出现明显的炎症细胞的浸润。在急性排斥反应组,受体的外周血血清ALT、AST值呈现渐进性升高趋势,术后8d、12d、16d的ALT、AST值均明显高于以上三组(均为P<0.05),并且其移植肝脏的汇管区、肝窦内出现明显炎症细胞浸润现象。结论通过分析移植后肝脏的病变特点和大体表现,有助于正确判断受体所处的免疫学状态,为临床制定正确的治疗方案提供依据。Objective To investigate the characteristics of hepatic pathology in different immune conditions after liver transplantation.Methods The experimental animals consisted of four groups：syngeneic liver transplantation group,acute rejection group,spontaneous immune tolerance group and LTx-aGVHD group.Serum ALT,AST concentrations in peripheral blood were measured every 4 days after liver transplantation and the histopathologic examination of the liver was examined.The clinical course and animal survival were observed up to 100 days after transplantation.Results No significant difference in serum ALT and AST levels was observed among the syngeneic liver transplantation group,spontaneous immune tolerance group and LTx-aGVHD groups at different times after liver transplantation （all P 0.05）.And histological findings showed normal structure of liver grafts without obvious lymphocytes infiltration in these groups on day 16 after liver transplantation.In the acute rejection group,the serum ALT,AST concentrations increased progressively post-transplantation,which were significantly higher than those of syngeneic liver transplantation,spontaneous immune tolerance and LTx-aGVHD groups on 8th,12th and 16th days after transplantation （all P 0.05）.And obvious lymphocytes infiltration within the portal tracts and sinusoids were observed in the liver grafts.Conclusion Detection and continuously analysis of the hepatic pathological change would be helpful to distinguish the different immune condition after liver transplantation.

关 键 词：肝移植 免疫耐受 急性排斥反应 急性移植物抗宿主疾病 

分 类 号：R657.3[医药卫生—外科学]