还原型谷胱甘肽和供氧对伴有脂肪变性的供肝移植后肝细胞凋亡及超微结构的影响  

The effect of reduced glutathione and venous systemic oxygen perfusion on apoptosis and ultrastructure of rat steatotic liver grafts

作　　者：叶晟[1] 韩本立[1] 董家鸿[1] 朱瑾[1] 李昆[1] 熊燕[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所

出　　处：《中华普通外科杂志》2004年第2期108-110,共3页Chinese Journal of General Surgery

摘　　要：目的探讨还原型谷胱甘肽 (GSH)和冷保存时供氧对脂肪变性供肝移植术后肝细胞凋亡及超微结构的影响。方法大鼠喂饲 79%标准饲料加 2 0 %猪油加 1%胆固醇 ,同时以 5 0 %酒精灌胃 1ml·10 0g-1·d-1,6周后诱导形成Ⅱ级脂肪变性供肝 ;GSH和静脉供氧预处理后行肝移植 ,正常供肝作对照 ;观察术后存活率、肝细胞凋亡、微循环及超微结构改变。结果大鼠脂肪变性供肝移植术后 3d肝细胞坏死率为 (38± 10 ) % ,凋亡率 (2 2± 11) % ;而给予预处理后坏死减少 (17± 6 ) % ,凋亡增多 (33± 8) % ;同时肝细胞内线粒体水肿减轻、肝窦内皮细胞损伤减少 ;微循环由 (5 96± 0 2 6 )伏 (相对值 )增为 (7 73± 0 4 3)伏 ;预处理后的脂肪变性供肝移植 1周存活率由 2 5 % (2 /8)提高到 6 2 % (5 /8) ,(χ2 =4 0 7,P =0 0 4 36 )。结论GSH和静脉供氧可通过减轻肝细胞线粒体损伤、减少肝窦破坏、改善微循环而提高大鼠脂肪变性供肝移植的存活率。Objective To explore the effect of reduced glutathione and venous systemic oxygen perfusion on apoptosis and ultrastructure of hepatocytes in rat steatotic liver grafts. Methods Before liver transplantation grade Ⅱ steatotic liver model was established by a diet consisting of 79% standard diet,20% lard and 1% cholesterol for 6 weeks. In pretreatment group, the donor received intraperitoneal injection of reduced glutathione at a dosage of 500 mg/kg/body weight 3 times a day for 2 days, and intrahepatic venous oxygen perfusion for 6 hours while kept in cold preservation. Results Preconditioning measures in steatotic liver grafts significantly decreased the hepatocytes necrosis (38±10)% vs (17±6)%, P < 0.01, while increased apoptosis (22±11)% vs (33±8)%.The damage of mitochondria and sinusoidal endothelial lining were decreased. The one week graft survival increased from 25% (2/8)to 62%(5/8)( P =0.043 6). Conclusion Short course and high dose of GSH in steatotic donors and venous systemic oxygen persufion in cold preservation effectively protected the steatotic donors from ischemic damage and increased graft survival.

关 键 词：还原型谷胱甘肽 供氧 脂肪肝 肝移植 肝细胞凋亡 超微结构 

分 类 号：R657.3[医药卫生—外科学]