不同缺血预处理方法减轻肝切除患者术后肝损伤及调控自噬蛋白表达的应用比较  

Effects of different ischemic preconditioning methods on liver injury and the expression of autophagy protein after hepatectomy

作　　者：郭浩 王云[2] 王亦秋 拾锦 刘斌 GUO Hao;WANG Yun;WANG Yiqiu;SHI Jin;LIU Bin(Department of General Surgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;Department of Oncology,Xuzhou Central Hospital,Xuzhou,Jiangsu 221000)

机构地区：[1]徐州医科大学附属医院普外科,江苏徐州221002 [2]徐州市中心医院肿瘤外科,江苏徐州221000

出　　处：《徐州医科大学学报》2020年第11期805-811,共7页Journal of Xuzhou Medical University

摘　　要：目的探讨肝切除患者术前应用肢体缺血预处理,术中应用肝门缺血预处理,诱导肝脏组织自噬信号,进而减轻肝切除患者缺血再灌注造成的肝损伤。方法选择2016年6月—2019年6月行肝切除的肝细胞癌患者共160例。对照组:实施正常肝切除手术;实验组1:实施术前肢体缺血预处理+正常肝切除手术;实验组2:实施术中肝门缺血预处理+正常肝切除手术;实验组3:实施术前肢体缺血预处理+术中肝门缺血预处理+正常肝切除手术,每组40例。监测患者肝损害,检测患者肝组织中自噬蛋白、凋亡蛋白变化,并比较患者术中情况、术后并发症发生率及住院时间等。结果肝功能:实验组患者术后肝功能指标均较对照组下降,实验组3较实验组1和2效果更加明显(P<0.05)。自噬蛋白:实验组患者肝脏组织的自噬蛋白水平高于对照组,实验组3较实验组1和2自噬蛋白表达更加明显。凋亡蛋白:实验组较对照组凋亡蛋白表达降低,其中实验组3最低(P<0.05)。肝脏苏木精-伊红染色:各实验组患者肝脏均显示不同程度坏死、脂肪变性等,其中实验组3患者肝脏苏木精-伊红染色评分最低(P<0.05)。术中相关情况4组比较差异无统计学意义,实验组平均住院日明显短于对照组,而实验组之间比较差异无统计学意义。各实验组术后并发症发生率比较差异无统计学意义,但均优于对照组(P<0.05)。结论术前肢体缺血预处理联合术中肝门缺血预处理可以诱导患者肝脏组织中自噬信号,在一定程度上缓解肝切除患者缺血再灌注造成的肝损伤,且对肝功能损害的缓解效果较单独术前肢体缺血预处理及单独术中肝门缺血预处理更加明显,为临床减轻肝切除术后患者肝功能损伤提供了新思路。Objective To discuss the use of limb ischemic preconditioning before hepatectomy and hepatic portal ischemic preconditioning during surgery to induce autophagy signals,so as to relieve liver ischemia reperfusion(IR)injury in patients with hepatectomy.Methods A total of 160 hepatic cell cancer patients who underwent hepatectomy from June 2016 to June 2019 were enrolled.They were divided into the following groups(n=40).A control group underwent hepatectomy;a test group 1 received limb ischemia preconditioning and hepatectomy;a test group 2 received hepatic portal ischemic preconditioning and hepatectomy;and a test group 3 received limb ischemia preconditioning,hepatic portal ischemic preconditioning and hepatectomy.Their liver injury was monitored,the levels of autophagy and apoptotic protein in liver tissue were detected,and their intraoperative condition,postoperative complication rate and the length of hospitalization stay were compared.Results The values of liver function in the test groups were lower than that in the control group,and the values in the test group 3 was significantly lower than those in the test groups 1 and 2.The levels of autophagy protein was more higher in the test groups than those in the control group,and the levels in the test group 3 was significantly lower than those in the test groups 1 and 2.Furthermore,the levels of apoptotic protein in the test groups was lower than that in the control group,and the levels in the test group 3 was significantly lower than those in the test groups 1 and 2.Liver HE staining showed various degrees of necrosis and fatty degeneration in the test groups,where the liver HE staining scores was lower in the test group 3 than those in the test groups 1 and 2.No significant difference was found in intraoperative conditions among the four groups.The test groups presented remarkably shorter length of hospitalization stay than the control group,without statistical difference among the test groups.The test groups presented remarkably better postoperative complicat

关 键 词：肢体缺血预处理 肝门缺血预处理 缺血再灌注损伤 肝切除 自噬 

分 类 号：R605[医药卫生—外科学]