肝移植缺血再灌注对肺损伤的影响  

The influences of ischemia-reperfusion injury in liver transplantation on intraoperative lung injury and postoperative pulmonary complications

作　　者：蔡志仕[1] 江艺[1] 吕立志[1] 张小进[1] 蔡秋程[1] 

机构地区：[1]南京军区福州总医院肝胆外科,福州350025

出　　处：《中华肝胆外科杂志》2011年第5期386-389,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的研究原位肝移植缺血再灌注对肺部病理生理变化的影响，探讨肺损伤的发生机制。方法选择南京军区福州总医院施行的23例原位肝移植患者。分别于手术开始进腹后5min（Ta）、门静脉开放前5min（Tb）和新肝期3h（Tc）各切取右下肺一小块组织行病理检查，并作IL-1β和TNF-α的免疫组化实验。分别于麻醉后手术前（T1）、门静脉开放前5min（T2）、门静脉开放后10min（T3）、新肝期60min（T4）、新肝期3h（T5）以及术后12h（T6）各时间点采集外周血检测血浆中细胞因子IL-1β和TNF-α含量水平。结果外周血TNF-α和IL-1β于门静脉开放前升高不明显，但门静脉开放后显著升高。T1和T2分别与T3、T4和T5比较，差异均有显著统计学意义（P〈0．01）。光镜下和电镜下，Ta时间点的肺组织结构正常，Tb时间点变化不明显，Tc时间点出现显著异常变化。Tc时间点TNF-α和IL-1β表达的阳性平均积分明显高于Ta和Tb时间点，差异具有统计学意义（P〈0．01）。结论移植术中移植肝缺血再灌注可使机体产生严重的全身炎症反应综合征，并导致早期急性肺损伤的发生。TNF-α和IL-1β参与了急性肺损伤的发生过程。Objective To study the effects of ischemia-reperfusion in liver transplantation on the pathophysiological changes of the lung and mechanisms of lung injury. Methods We studied 23 patients who received liver transplantation at Fuzhou General Hospital of PLA. We cut a small piece of the right lung for pathological study and for L-1β and TNF-α immunohistochemistry studies at 5 minutes after the beginning of operation （Ta）, 5 minutes before the portal vein was opened （Tb） and three hours after the new liver was transplanted （Tc）. We also collected peripheral blood to study the concentration of IL- 1β and TNF- a in the plasma at the beginning of operation （T1）, the portal vein 5 minutes before opening, the portal vein （T2） ten minutes after the opening （T3）, and one hour after the new liver was transplanted （T4）, three hours after the new liver was transplanted （T5）, and 12 hours after operation （T6）. Results The cytokines TNF-α and IL-1β in peripheral blood were not obviously increased in the portal vein before it was opened, but were significantly increased after the portal vein was opened. Comparison of T1 and T2 separately with T3, T4 and T5 showed significant differences （P〈0.01）. In light and electron microscopy, the structures of the lung tissues were normal at Ta. and did not change significantly at Tb. There were significant abnormalities at To. The average positive points of TNF-α and IL-1β expressions in the lung tissues at Tc were significantly higher than Ta and Tb （P〈0.01）. Conclusion Ischemia-reperfusion in liver transplantation led to a serious systemic inflammatory syndrome,and acute lung injury. TNF-α and IL-1β were involved in acute lung injury.

关 键 词：肝移植 缺血再灌注 TNF-Α IL -1β 肺损伤 

分 类 号：R657.3[医药卫生—外科学]