组织型纤溶酶原激活物及其抑制剂-1在游离穿支皮瓣移植术后静脉危象早期表达变化  

Experimental study on the change of dynamic expression of t-PA and PAI-1 during early venous crisis after free perforator flap transplantation

作　　者：杜威[1] 唐举玉[1] 何晓凡[2] 卿黎明[1] 王聪杨[1] 吴攀峰[1] 俞芳[1] 

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008 [2]中南大学基础医学院生理学系

出　　处：《中华显微外科杂志》2013年第6期563-567,共5页Chinese Journal of Microsurgery

基　　金：湖南省自然科学基金重点资助项目（10JJ2013）

摘　　要：目的探讨组织型纤溶酶原激活物及其抑制剂-1（t-PA和PAI-1）在游离穿支皮瓣移植术后静脉危象早期不同时间点的变化规律与意义。方法将30只体质量为2．5—3．0kg、4个月龄健康新西兰大耳白兔随机分为实验组（n=15）和对照组（n=15）。两组均建立腹壁浅动脉穿支皮瓣游离移植模型。构建成功后，实验组采用体外留线结扎以阻断静脉回流来构建穿支皮瓣静脉危象模型而对照组体外留线不结扎。观察两组皮瓣血运变化，于静脉危象发生的不同时间点采血，采用Elisa法检测血浆t-PA和PAI-1浓度，切取部分皮瓣组织行组织形态学检查。利用SPSS17．0统计学软件行统计分析，P〈0．05为差异有统计学意义。结果实验组除1例发生麻醉意外、对照组1例发生静脉危象外，其余均成功构建穿支皮瓣游离移植和静脉危象模型。皮瓣在静脉结扎1h之内颜色无明显改变，在静脉结扎2h以后出现典型静脉危象表现。t-PA和PAI-1在皮瓣移植前、通血即刻、静脉结扎即刻、结扎后15min、30min、1h差异无统计学意义（P〉0．05），t-PA在静脉结扎后2、4、6、8h浓度显著降低（P〈0．05），PAI—1在静脉结扎后2、4、6、8h浓度显著升高（P〈0．05）。病理结果显示：随着穿支皮瓣发生静脉危象时间的延长，管腔内红细胞逐渐黏附聚集，最后导致血管堵塞。结论t-PA、PAI-1对穿支皮瓣移植术后静脉危象的早期（2h以内）无明显变化，不能应用于诊断早期静脉危象。Objective To investigate the change of dynamic expression of t-PA and PAI-1 during early venous crisis after free perforator flap transplantation. Methods Thirty healthy New Zealand white rabbits weighed 2. 5-3.0 kg were chosen and randomly divided into experimental group （n = 15） and control group （n = 15 ）. Free transplantation of superficial epigastric artery perforator flap （SEAPF） was implemented in all rabbits firstly. Then the model of venous crisis was established by ligating the anastomosis vein in order to interrupt venous blood outflow in experimental group. The blood supply of all flaps was monitored by observing their color, swelling degree and the filling reaction of the capillaries after operation. Peripheral blood was drawn from femoral artery at different time point for measuring the concentration of t-PA and PAI-1 by Elisa. Partial flap tissue was harvested for pathological examination at corresponding time point. Data analysis was performed by using SPSS 17.0 statistical software. P 〈 0. 05 was considered statistically significant. Results One rabbit died of anesthesia, and the venous congestion was observed in 1 rabbit in control group. The models of free transplantation of SEAPF and venous crisis were established successfully in the remaining rabbits. No significant appearance change was observed within 1 h after the outflow vein being ligated, while typical appearance of venous crisis could be observed 2 hours after the outflow vein being ligated. Compared with the control group,the concentration of t-PA was lower,but the concentration of PAI-1 was higher in experimental group at 2 hours,4 hours,6 hours,8 hours after the outflow vein being ligated（ P 〈 0.05 ） . However,there was no obvious differences between two groups at other time points （ P 〉 0. 05 ）. The pathological examination showed the red cells gradually got together and adhered to the venous wall, eventually the microcirculation had been blocked completely and the flap became necrosis after venous crisis

关 键 词：穿支皮瓣 游离移植 静脉危象 组织型纤溶酶原激活物 组织型纤溶酶原激活物抑制剂-1 

分 类 号：R622[医药卫生—整形外科]