CAJ | 학술논문

背景:据报道,供肝的热缺血、冷保存时间过长都可导致移植肝产生"毒性胆汁",并进而损伤胆道,然而胆道相对热缺血是否也会引起胆汁成分改变,目前尚无相关报道.目的:建立大鼠自体原位肝移植胆道相对热缺血损伤模型,观察胆道相对热缺血对大鼠移植肝分泌的胆汁中总胆汁酸盐、磷脂浓度的影响及与胆道损伤的相关性.方法:选用SD大鼠32只建立大鼠自体原位肝移植胆道相对热缺血损伤模型.按随机数字表法分为4组(n=8):Ⅰ组为假手术组,只游离肝脏,不进行肝脏冷灌注;Ⅱ、Ⅲ、Ⅳ组的胆道相对热缺血时间分别为0,30,60 min,即分别在门静脉开放后0,30和60 min时开放肝动脉.采用循环酶法测定术后胆汁中总胆盐浓度,酶比色法测定磷脂浓度.取肝门部胆管,光镜观察其组织学形态,透射电镜观察胆道上皮细胞的超微结构变化,原位末端标记法检测上皮细胞凋亡情况.分析总胆汁酸盐磷脂比例与胆道损伤的相关性.结果及结论:死亡1只,进入结果分析31只.肝移植胆道相对热缺血可以引起移植肝分泌的胆汁成分改变,表现为总胆汁酸盐/磷脂比例升高,胆汁毒性增加,这种改变与相对热缺血时间呈正相关,相对热缺血时间越长,胆汁成分改变越明显;而且与胆道损伤的病理学改变呈密切正相关,说明胆汁成分改变是相对热缺血导致胆道损伤的重要机制之一.
배경:거보도,공간적열결혈、랭보존시간과장도가도치이식간산생"독성담즙",병진이손상담도,연이담도상대열결혈시부야회인기담즙성분개변,목전상무상관보도.목적:건립대서자체원위간이식담도상대열결혈손상모형,관찰담도상대열결혈대대서이식간분비적담즙중총담즙산염、린지농도적영향급여담도손상적상관성.방법:선용SD대서32지건립대서자체원위간이식담도상대열결혈손상모형.안수궤수자표법분위4조(n=8):Ⅰ조위가수술조,지유리간장,불진행간장랭관주;Ⅱ、Ⅲ、Ⅳ조적담도상대열결혈시간분별위0,30,60 min,즉분별재문정맥개방후0,30화60 min시개방간동맥.채용순배매법측정술후담즙중총담염농도,매비색법측정린지농도.취간문부담관,광경관찰기조직학형태,투사전경관찰담도상피세포적초미결구변화,원위말단표기법검측상피세포조망정황.분석총담즙산염린지비례여담도손상적상관성.결과급결론:사망1지,진입결과분석31지.간이식담도상대열결혈가이인기이식간분비적담즙성분개변,표현위총담즙산염/린지비례승고,담즙독성증가,저충개변여상대열결혈시간정정상관,상대열결혈시간월장,담즙성분개변월명현;이차여담도손상적병이학개변정밀절정상관,설명담즙성분개변시상대열결혈도치담도손상적중요궤제지일.
BACKGROUND: Studieshave shown that long time of warm ischemia or cold preservation would injury the biliary tract in liver transplantation. However, whether relative warm ischemia (RWI) of biliary tract would result in bile component changes is unclearly. OBJECTIVE: To establish auto-liver transplantation bile ducts RWI models, observe the effects of RWI on the bile salts and phospholipid concentration secreted by the donor liver, and to study the correlation between the total bile salt/phosphoUpid ratio (TBA, PL ratio) and billary tract injury. METHODS: A total of 32 SD rats were selected for auto-liver transplantation models with bile ducts RWI, and the rats were randomly divided into 4 groups (n=8). In Group Ⅰ (sham operation group), rats only received liver dissociation without any cold reperfusion. The RWI time of Group Ⅱ,Ⅲ, and Ⅳ were 0 minutes, 30 minutes and 60 minutes, respectively. The concentration of TBA in bile was measured with enzymatic cycling assay, andPL with enzymic colorimetric. Pathological observation with light microscope and ultrastructural observation with transmission electron microscope were performed on the hilar bile duct. The endothelial cell apoptosis was detected with TUNEL assay. The correlation between TBA, PL ratio and biliary injury was analyzed. RESULTS AND CONCLUSION: One rat died, the other 31 rats were included in the final analysis. RWI could change the composition of bile secreted by donor liver, raise the TBA/PL ratio, and increase the bile toxicity. These changes had a positive correlation to RWI time, and the changes were obviously with time prolonged. In addition, the changes are closely related to the biliary tract injury. This study shows an important mechanism of the biliary tract injury caused by RWI-injury.