供肝缺血再灌注损伤程度对肝移植术后肝癌复发的影响  

The degree of ischemia reperfusion injury of donor liver is a prognostic predictor of recurrence of hepatocellular carcinoma after liver transplantation

作　　者：周熠[1] 李华[1] 朱曙光[1] 袁泽南 汪国营[1] 杨扬[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝脏外科和肝移植科,广州510630

出　　处：《中华实验外科杂志》2017年第4期653-655,共3页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金（81172038）;广东省省级科技计划项目（2014A020212484）;广州市科技计划项目（201607010024）

摘　　要：目的 评估供肝缺血再灌注损伤（IRI）程度，探讨其与供肝Yes相关蛋白（YAP）表达、肝移植术后肝癌复发的关系。方法 分析2007年1月至2013年7月我科收治的69例肝细胞癌肝移植患者临床病例资料并收集其供肝标本，检测供肝IRI程度和YAP蛋白的表达。将影响肝移植术后肝癌复发的单因素纳入Cox回归模型进行多因素分析。结果 供肝中度IRI 29例，占42%（29/69），YAP蛋白阳性表达32例，占46.4%（32/69）。供肝YAP蛋白表达与IRI程度有关（χ2＝7.369，P＝0.007）。多因素分析表明：中度IRI（P＝0.015）、肝癌美国肿瘤联合委员会（AJCC）Ⅲ期（P＝0.000）是影响肝移植术后肝癌复发的独立危险因素。结论 供肝IRI程度是肝移植术后肝癌复发的独立危险因素，供肝IRI程度能影响YAP的表达，YAP蛋白表达增强可能是供肝中度IRI促进肝移植术后肝癌复发的重要机制。Objective To investigate the relationship between the degree of ischemia reperfusion injury （IRI） of donor liver and the expression of Yes-associated protein （YAP） or the recurrence of hepatocellular carcinoma （HCC） after liver transplantation （LT）. Methods The clinical date of 69 patients undergoing LT for HCC were retrospectively analyzed and the samples of the donor liver were collected to detect the degree of IRI and the expression of YAP in donor livers. Factors might influence the postoperative disease-free survival （DFS） after LT were analyzed using the Coxregression model. The survival curve was drawn by Kaplan-Meier method.Results The slight ischemia reperfusion injury of donor livers were 58% （40/69）, the positive expressions of YAP were 46.4% （32/69）. The expression of YAP in donor liver was related to the degree of IRI （χ2=7.369, P=0.007）. The result of multivariate analysis showed that the degree of IRI of donor livers, American Joint Committee on cancer （AJCC） stages Ⅲ were independent risk factors influencing tumor recurrence after LT. Conclusion The degree of IRI of donor liver is an independent risk factor for recurrence of HCC after LT. The degree of IRI of donor livers can affect the expression of YAP. Enhancement of YAP expression may be an important mechanism of HCC recurrence after LT with moderate IRI in donor liver.

关 键 词：肝移植 肝癌复发 Yes相关蛋白 缺血再灌注损伤 无瘤生存率 

分 类 号：R735.7[医药卫生—肿瘤]