中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2011年
5期
386-389
,共4页
蔡志仕%江艺%吕立志%张小进%蔡秋程
蔡誌仕%江藝%呂立誌%張小進%蔡鞦程
채지사%강예%려립지%장소진%채추정
肝移植%缺血再灌注%TNF-a%IL-1β%肺损伤
肝移植%缺血再灌註%TNF-a%IL-1β%肺損傷
간이식%결혈재관주%TNF-a%IL-1β%폐손상
Liver transplantation%Ischemia-reperfusion%TNF-a%IL-1β%Lung injury
目的 研究原位肝移植缺血再灌注对肺部病理生理变化的影响,探讨肺损伤的发生机制.方法 选择南京军区福州总医院施行的23例原位肝移植患者.分别于手术开始进腹后5 min(Ta)、门静脉开放前5 min(Tb)和新肝期3 h(Tc)各切取右下肺一小块组织行病理检查,并作IL-1β和TNF-a的免疫组化实验.分别于麻醉后手术前(T1)、门静脉开放前5 min(T2)、门静脉开放后10 min(T3)、新肝期60 min(T4)、新肝期3 h(T5)以及术后12 h(T6)各时间点采集外周血检测血浆中细胞因子IL-1β和TNF-a含量水平.结果 外周血TNF-a和IL-1β于门静脉开放前升高不明显,但门静脉开放后显著升高.T1和T2分别与T3、T4和T5比较,差异均有显著统计学意义(P<0.01).光镜下和电镜下,Ta时间点的肺组织结构正常,Tb时间点变化不明显,Tc时间点出现显著异常变化.Tc时间点TNF-a和IL-1β表达的阳性平均积分明显高于Ta和Tb时间点,差异具有统计学意义(P<0.01).结论 移植术中移植肝缺血再灌注可使机体产生严重的全身炎症反应综合征,并导致早期急性肺损伤的发生.TNF-a和IL-1β参与了急性肺损伤的发生过程.
目的 研究原位肝移植缺血再灌註對肺部病理生理變化的影響,探討肺損傷的髮生機製.方法 選擇南京軍區福州總醫院施行的23例原位肝移植患者.分彆于手術開始進腹後5 min(Ta)、門靜脈開放前5 min(Tb)和新肝期3 h(Tc)各切取右下肺一小塊組織行病理檢查,併作IL-1β和TNF-a的免疫組化實驗.分彆于痳醉後手術前(T1)、門靜脈開放前5 min(T2)、門靜脈開放後10 min(T3)、新肝期60 min(T4)、新肝期3 h(T5)以及術後12 h(T6)各時間點採集外週血檢測血漿中細胞因子IL-1β和TNF-a含量水平.結果 外週血TNF-a和IL-1β于門靜脈開放前升高不明顯,但門靜脈開放後顯著升高.T1和T2分彆與T3、T4和T5比較,差異均有顯著統計學意義(P<0.01).光鏡下和電鏡下,Ta時間點的肺組織結構正常,Tb時間點變化不明顯,Tc時間點齣現顯著異常變化.Tc時間點TNF-a和IL-1β錶達的暘性平均積分明顯高于Ta和Tb時間點,差異具有統計學意義(P<0.01).結論 移植術中移植肝缺血再灌註可使機體產生嚴重的全身炎癥反應綜閤徵,併導緻早期急性肺損傷的髮生.TNF-a和IL-1β參與瞭急性肺損傷的髮生過程.
목적 연구원위간이식결혈재관주대폐부병리생리변화적영향,탐토폐손상적발생궤제.방법 선택남경군구복주총의원시행적23례원위간이식환자.분별우수술개시진복후5 min(Ta)、문정맥개방전5 min(Tb)화신간기3 h(Tc)각절취우하폐일소괴조직행병리검사,병작IL-1β화TNF-a적면역조화실험.분별우마취후수술전(T1)、문정맥개방전5 min(T2)、문정맥개방후10 min(T3)、신간기60 min(T4)、신간기3 h(T5)이급술후12 h(T6)각시간점채집외주혈검측혈장중세포인자IL-1β화TNF-a함량수평.결과 외주혈TNF-a화IL-1β우문정맥개방전승고불명현,단문정맥개방후현저승고.T1화T2분별여T3、T4화T5비교,차이균유현저통계학의의(P<0.01).광경하화전경하,Ta시간점적폐조직결구정상,Tb시간점변화불명현,Tc시간점출현현저이상변화.Tc시간점TNF-a화IL-1β표체적양성평균적분명현고우Ta화Tb시간점,차이구유통계학의의(P<0.01).결론 이식술중이식간결혈재관주가사궤체산생엄중적전신염증반응종합정,병도치조기급성폐손상적발생.TNF-a화IL-1β삼여료급성폐손상적발생과정.
Objective To study the effects of ischemia-reperfusion in liver transplantation on the pathophysiological changes of the lung and mechanisms of lung injury. Methods We studied 23 patients who received liver transplantation at Fuzhou General Hospital of PLA. We cut a small piece of the right lung for pathological study and for L-1β and TNF-a immunohistochemistry studies at 5 minutes after the beginning of operation (Ta), 5 minutes before the portal vein was opened (Tb) and three hours after the new liver was transplanted (Tc). We also collected peripheral blood to study the concentration of IL-1β and TNF-a in the plasma at the beginning of operation (T1), the portal vein 5 minutes before opening, the portal vein (T2) ten minutes after the opening (T3) , and one hour after the new liver was transplanted (T4), three hours after the new liver was transplanted (T5), and 12 hours after operation (T6). Results The cytokines TNF-a and IL-1β in peripheral blood were not obviously increased in the portal vein before it was opened, but were significantly increased after the portal vein was opened. Comparison of T1 and T2 separately with T3, T4 and T5 showed significant differences (P<0. 01). In light and electron microscopy, the structures of the lung tissues were normal at Ta and did not change significantly at Tb. There were significant abnormalities at Tc. The average positive points of TNF-a and IL-1β expressions in the lung tissues at Tc were significantly higher than Ta and Tb(P<0. 01). Conclusion Ischemia-reperfusion in liver transplantation led to a serious systemic inflammatory syndrome,and acute lung injury. TNF-a and IL-1β were involved in acute lung injury.
