胆盐在肝移植术后缺血性胆道病变中的作用及研究进展  

Research progress on the role of bile salts in ischemic-type biliary lesion after liver transplantation

作　　者：刘汉林 代鑫 肖奕君 吴畏 Liu Hanlin;Dai Xin;Xiao Yijun;Wu Wei(Department of Anesthesiology and Pain,the General Hospital of Western Theater Command of Chinese People’s Liberation Army,Chengdu 610083,China)

机构地区：[1]中国人民解放军西部战区总医院麻醉疼痛科,成都610083 [2]中国人民解放军西部战区总医院普通外科,成都610083 [3]成都医学院

出　　处：《器官移植》2022年第4期537-542,共6页Organ Transplantation

基　　金：四川省科技计划项目(2018RZ0135、2016JQ0023)。

摘　　要：缺血性胆道病变(ITBL)是由于肝动脉供血不足所导致的胆道受损,是影响肝移植受者长期生存和生活质量的主要因素之一,其发病与冷、热缺血,急、慢性排斥反应,巨细胞病毒感染,胆汁作用等多种因素有关。ITBL的发生是一个多因素、多环节的复杂过程,其治疗手段匮乏,相当一部分患者需要再次肝移植。ITBL已成为阻碍肝移植疗效进一步提高的最主要因素之一,因此加强预防以及寻找更多有效的治疗途径显得尤为重要。近年来发现胆盐的毒性损伤在ITBL中起着中心环节的作用,胆汁成分的主动调节、胆汁酸相关受体表达的调控、胆汁酸相关信号通路的阻断或激活,可能在ITBL的预防和治疗中具备较大的潜力。本文综述了胆盐细胞毒性以及碳酸氢盐伞在肝移植术后ITBL发生、发展中的作用机制,旨在为未来ITBL的诊断和治疗提供参考。Ischemic-type biliary lesion(ITBL)refers to biliary tract injury caused by insufficient blood supply of hepatic artery,which is one of the main factors affecting the long-term survival and quality of life of liver transplant recipients.The incidence of ITBL is associated with cold and warm ischemia,acute and chronic rejection,cytomegalovirus infection and the bile effect,etc.The occurrence of ITBL is a complicated process involving with multiple factors and steps.The therapeutic option of ITBL is extremely limited.A large proportion of ITBL patients should undergo repeated liver transplantation.ITBL has become one of the most critical factors preventing further advancement of liver transplantation.Hence,it is of significance to strengthen prevention and explore more effective modalities.Recent studies have found that toxic injury of bile salts plays a central role in ITBL.Active regulation of bile components,regulation of bile acid-related receptor expression and blockage or activation of bile acid-related signaling pathways probably have potentials in the prevention and treatment of ITBL.In this article,the cytotoxicity of bile salts and the mechanism of bicarbonate umbrella in the incidence and progression of ITBL after liver transplantation were reviewed,aiming to provide reference for the diagnosis and treatment of ITBL.

关 键 词：胆盐 磷脂 肝移植 缺血性胆道病变(ITBL) 缺血-再灌注损伤 碳酸氢盐伞 阴离子交换蛋白2 可溶性腺苷酸环化酶(sAC) 

分 类 号：R617[医药卫生—外科学] R575.7[医药卫生—临床医学]