大鼠自体原位肝移植术后早期小肠黏膜损伤的病理及炎症因子变化特点  

Characters of pathology and inflammatory factor of small intestinal mucosa injury at early stage after autologous orthotopic liver transplantation in rats

作　　者：黎尚荣[1] 高婉菱[1] 池信锦[1] 李晓芸[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广州510630

出　　处：《器官移植》2013年第3期136-140,共5页Organ Transplantation

基　　金：广东省自然科学基金(9151008901000192);广东省科技计划项目(2010B080701084)

摘　　要：目的观察大鼠自体原位肝移植术后早期不同时期小肠黏膜病理变化特点与肿瘤坏死因子(TNF)-α、白介素(IL)-1β和IL-6水平的动态变化,探讨肝移植术后肠道损伤的发生机制。方法 Sprague-Dawley(SD)大鼠25只,随机分为假手术组(S组)和模型组(R组):假手术组大鼠开腹后只进行肝血管的分离,模型组大鼠建立自体原位肝移植模型,在肝脏阻断20min后,根据再灌注时间不同分为再灌注后4、8、16、24h4个亚组(即R4组、R8组、R16组和R24组),每组各5只动物。检测各组小肠黏膜组织病理学改变与小肠组织IL-1β、TNF-α和IL-6水平变化。结果在光镜下观察发现S组大多数未见明显病理改变,各模型组肠组织光镜下可见上皮层结构出现破坏,由最初的绒毛尖端上皮下间隙增大逐渐发展到上皮层与固有层大量分离,累及绒毛两侧,部分绒毛顶端甚至出现破损,这些病理改变在R8和R16组达到高峰,然后逐渐恢复。与S组比较,各模型组Chiu's评分增高(均为P<0.05);各模型组相比,R8组、R16组较R4组、R24组Chiu's评分增高(均为P<0.05)。与S组比较,R16组肠组织TNF-α、IL-1β和IL-6水平均增高(P<0.05);各模型组的肠组织TNF-α、IL-1β、IL-6在肝脏再灌注后4h(R4组)开始升高,在16h达到高峰(R16组),在24h开始逐渐恢复(R24组)。结论大鼠自体原位肝移植术后早期出现小肠黏膜损伤,4h内损伤逐渐加重,24h开始逐渐恢复;该损伤可能与小肠组织炎症因子TNF-α、IL-1β和IL-6的改变相关。Objective To observe the changing characters of pathology and tumor necrosis factor （TNF） -α, interleukin （IL） -1β, and IL-6 level of small intestinal mueosa in different periods of early stage autologous orthotopie liver transplantation in rats, and to investigate the mechanisms of intestinal injury after liver transplantation. Methods Twenty-five Sprague-Dawley rats were randomly divided into sham operated group （group S, n = 5 ） and model group （group R）. Separation of hepatic vascular was only performed in rats of group S, and autologous orthotopic liver transplantation was performed in rats of group R. After blocking liver for 20 rain, the rats in group R were divided into 4 h after reperfusion （ group R4, n = 5 ） , 8 h after reperfusion （ group R8, n = 5 ）, 16 h after reperfusion （ group R16, n = 5 ）, 24 h after reperfusion （ group R24, n = 5） according to the time of liver reperfusion. Changes of pathology and IL-1β, TNF-α, and IL- 6 level of small intestinal mucosa were measured in each group. Results The results of intestinal tissue in light microscope showed that no significant pathological change was observed in sham group and injury of epithelial structure was observed in each model group. Firstly, subepithelial clearance of intestinal villus tip enlarged. Then, epithelial layer and lamina propria separated from each other involving both sides of intestinal villus, even some villus tip began to be damaged. All of these pathological changes reached their peak in group R8 and R16, and then recovered gradually. Compared with group S, the Chiu＇s score of group R increased significantly （all in P 〈 0. 05 ）. Compared with group R4 and group R24, the Chiu＇s score of group R8 and group R16 increased significantly （ all in P 〈 0.05 ）. Compared with group S, the levels of TNF-α, IL-1β and IL- 6 increased significantly in group R4, R8, R16 and R24 （P 〈 0. 05）. The levels of TNF-α, IL-1β and IL- 6 increased at 4 h after reperfusion （group R4）, reac

关 键 词：肝移植 小肠损伤 白介素-1Β 肿瘤坏死因子-α 白介素-6 

分 类 号：R617[医药卫生—外科学]