脾切除对大鼠小体积肝脏模型的小肝综合征的预防作用  

Protective effects of splenectomy of small-for-size syndrome in rat models

作　　者：吴刚[1] 孙会东[2] 杨蕾[1] 李弘[1] 程颖[1] 刘永锋[1] 

机构地区：[1]中国医科大学附属第一医院普外教研室器官移植科,沈阳110001 [2]山东省聊城市人民医院外科

出　　处：《中华器官移植杂志》2010年第6期365-368,共4页Chinese Journal of Organ Transplantation

基　　金：辽宁省教育厅重点实验室基金资助项目（20060903）

摘　　要：目的 探讨脾切除对大鼠小体积肝脏模型的小肝综合征（SFSS）的预防作用及其可能机制.方法 建立大鼠小体积肝脏模型,切除80%肝组织,即规则切除左外叶、左内叶、中叶和乳头叶,保留肝右叶和锥体叶,脾切除组在切除80%肝组织的同时行脾切除,对照组仅切除80%肝组织,另设仅游离肝脏而不行肝切除的假手术组.各组分别于术后0、3、6、12、24和72 h等6个时点各处死大鼠6只,取血清和肝组织,检测肝功能指标、肝组织中核因子Κb（NF-Κb）p65含量以及肝组织中肿瘤坏死冈子α（TNF-α）、细胞间黏附分子-1（ICAM-1）、增殖细胞核抗原（PCNA）Mrna和蛋白表达、髓过氧化物酶（MPO）活性,测量门静脉压力,计算SFSS发生率及动物术后1周存活率.结果 对照组术后门静脉压力明显升高,为（12.14±0.90）cm H2O,明显高于假手术组（P＜0.05）,而脾切除组门静脉压力为（11.11±0.80）cm H2O,明显低于对照组（P＜0.05）.对照组术后血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、乳酸脱氧酶（LDH）和胆红素总量（Tbil）明显升高,血清白蛋白（Alb）和胆碱酯酶（CHE）明显下降,脾切除组的ALT、AST、LDH和Tbil水平明显低于对照组,差异均有统计学意义（P＜0.05）.对照组术后NF-Κb p65含量升高,TNF-α和ICAM-1 Mrna及其蛋白表达增加,MPO活性亦增高,PCNA Mrna及其蛋白表达亦增强,与对照组比较,脾切除组的NF-κBp65含量明显减少,TNF-α和ICAM-1 Mrna及其蛋白表达显著降低,MPO活性减弱,但PCNAmRNA和蛋白的表达更明显（P＜0.05）.假手术组、对照组与脾切除组术后1周内的SFSS发生率分别为0、75%和25%,术后1周存活率分别为100%、50%和83.3%,后二者比较,差异均有统计学意义（P＜0.05）.结论 脾切除能降低大鼠小体积肝脏模型的SFSS发生率,可能与脾切除后减少门静脉灌流、抑制NF-Κb活化、减轻细胞损害和促进肝细胞再生有关.Objective To explore the role of splenectomy in the prevention and treatment of small-for-size liver in rat models, as well as its pathophysiologic mechanism in the development of a small-for-size syndrome （SFSS）. Methods The models of sham-operation and 80 % partial hepatectomy （PH） were used in rats. In the experiment group splenectomy was performed following 80% PH. The concentrations of serum tumor necrosis factor （TNF-α）, the content of NF-cB p65 in liver nuclear extracts, the expression of TNF-α, intercellular adhesion molecular （ICAM-1）, and proliferating cell nuclear antigen （PCNA） transcripts, the activities of serum aspartate transaminase （AST）, alanine transaminase （ALT）, lactate dehydrogenase （LDH）, total bilirubin （TB）, albumin （Alb） cholinesterase （CHE）, and liver myeloperoxidase （MPO） were analyzed. Portal venous pressures （PVP）,incidence of SFSS,and one-wk survival rate were measured. Results In the control rats,The PVP was obviously elevated immediately after PH. The level of NF-κB p65 was obviously increased at the first h and peaked at about 3rd h postoperatively. The transcription of TNF-α and ICAM-1 and the release of serum TNF-α were significantly increased 3 h after PH. Capillary endothelial cells of the livers strongly expressed ICAM-1 24 h after PH. Splenectomy significantly reduced the PVP and the content of NF-κB p65 in the livers in concurrence with the expression of TNF-α and ICAM-1 gene as well as the activity of MPO at the corresponding time points after PH （P＜0. 05）, while increased the expression of PCNA gene （P＜0. 05）. Administration of splenectomy resulted in a statistically significant decrease in AST, ALT, LDH, TB, the incidence of SFSS and increase in one-wk survival rate （P ＜ 0.05 ）. Conclusion Splenectomy alleviates liver injury and promotes liver regeneration in small-for-size liver rats by reducing portal vein perfusion and pressure,and suppressing NFκB activation and subsequent expression of pr

关 键 词：肝切除术 小肝综合征 脾切除术 大鼠 

分 类 号：R657.6[医药卫生—外科学]