脑死亡状态下兔肾脏功能和形态学变化的研究  

The kidney quality evaluation and morphologic variations of brain death rabbits

作　　者：何重香[1] 李玲[1] 钟自彪[1] 范晓礼[1] 王彦峰[1] 李宁[1] 叶啟发[1] 

机构地区：[1]武汉大学中南医院武汉大学肝胆疾病研究院移植医学技术湖北省重点实验室,430071

出　　处：《中华器官移植杂志》2015年第6期367-371,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金重点项目（21334005）;湖北省自然科学基金项目（2013CFB258）;武汉市科技攻关项目（2013060705010326,2013060602010247）

摘　　要：目的观察兔脑死亡后不同时间点肾脏的功能及形态学的变化。方法采用随机数字表法将40只健康新西兰兔分为假手术组（仅行钻孔开颅及开腹和关腹手术）和脑死亡组（成功建立兔脑死亡模型），每组20只。各组术后2、4、6及8h，分别采集血液及肾脏组织，检测血清尿素氮和肌酐的水平，采用HE染色法观察肾组织病理改变，采用免疫组织化学法检测肾组织ICAM和HSP70的表达，采用原位末端标记法检测肾组织的细胞凋亡情况。结果术后各时间点，两组兔血清尿素氮水平均无明显变化，且两组间差异均无统计学意义（P〉0．05）。术后4、6和8h，脑死亡组血清肌酐水平较假手术组显著升高，差异均有统计学意义（P〈O．05），且随着术后时间的延长，脑死亡组血清肌酐水平均明显的逐渐升高（P〈0．05）。光镜下可见脑死亡组术后2和4h肾小球基本正常，6h时部分肾小管变性明显，细胞水肿、空泡变性也有所增加，部分近曲小管闭塞，8h时可见肾小管细胞明显水肿，变性区域较大，炎症表现明显。该形态学变化与炎症相关因子ICAM的蛋白表达及细胞凋亡指数的趋势一致。假手术组保护性炎症相关因子HSP70的表达呈明显阳性，而各时间点脑死亡组HSP70的表达均明显下降（P〈0．05），且呈逐渐下降的趋势。结论脑死亡状态可导致肾脏功能及形态学方面发生明显不良改变，随着脑死亡时间的延长而逐渐加重，且该变化伴随着炎症相关因子的参与。Objective To establish the rabbit brain death model, and observe the change of kidney function and morphology in the brain death rabbits, fully evaluate the possibility of transplantation surgery carried out with brain death donor kidney. Method 40 male healthy New Zealand rabbits were randomly divided into sham group （n = 20） and brain death group （n = 20）, and each group further was divided into four groups according to 2, 4, 6 and 8 h after brain death groups. At the end of the experiment, the blood samples and kidney tissues were collected. The level of blood urea nitrogen（BUN）, serum creatinine （Cr） and the apoptosis of kidney cells were determined by automatic biochemistry analyzer and TUNEL method, respectively. The morphology changes of liver were detected by HE staining. Result Although BUN values were with no obviously alteration （P〉0. 05） within 8 h after brain death, the renal Cr levels in the states of 2, 4 and 8 h （P〈0. 05） brain death were found significantly increased compared with shamed groups. The denaturalization in the epithelial cells of renal tubule, glomerulus atrophygradually, swelling and vacuolation of epithelial cells, edema in the interstitium and inflammatory cell infiltration and partly occlusion in proximal convoluted tubule gradually emerged in the brain dead groups. The inflammatory factor intercellular adhesion molecule （ICMA） and the apoptosis index in brain dead groups increased in a time dependent manner but the expressions of protective factor HSPT0 conducted a contrary tendency. Conclusion Brain death could lead to the damage of kidney function and morphology and this injury aggravated in a time dependent manner. The alterations might be relevant to the production of inflammatory factors. Within 8 h after brain death there were obvious changes in the kidney function and morphology, which provide experimental basis for the rational use of brain death donor kidney transplantation.

关 键 词：兔 脑死亡 肾功能 

分 类 号：R617[医药卫生—外科学]