CAJ | 학술논문

目的探讨多烯磷脂酰胆碱对大鼠肝移植术中相对热缺血(relative warm ischemia time,RWIT)造成胆道损伤的保护作用.方法将60只SD大鼠分为胆道相对热缺血0 min(A组)、胆道相对热缺血60 min(B组)、胆道相对热缺血60 min并于术后每日腹腔注射多烯磷脂酰胆碱注射液(C组).建立大鼠自体原位肝移植胆道外引流模型,检测各组术后2 h及术后第1、3、5天胆汁中总胆汁酸(total bilirubin,TBA)浓度、磷脂(phospholipid,PL)浓度、TBA/PL值,并留取胆道标本进行组织病理学检测,并检测胆汁碱性磷酸酶(alkaline phosphatase,ALP)及谷氨酰基转移酶(gamma glutamyltransferase,γ-GT)水平作为观察胆管损伤的指标.结果 A组术后TBA、PL及TBA/PL均稳定,未出现明显变化;TBA浓度:术后早期B、C组明显低于A组(F=19.662,P＜0.05),此后逐渐升高,到第3天各组之间已无明显差异(F=1.244,P＞0.05).PL浓度:术后B组较C组下降明显,此后缓慢升高,至术后第5天仍低于C组(t=2.832,P＜0.05).TBA/PL值:术后早期B组明显高于A组,并于术后逐渐升高,至术后第3天达到最高,术后第5天开始下降.C组术后未出现明显变化,在各个时间点A、C组之间比较差异无统计学意义(t=0.307,P＞0.05).胆道损伤评分(胆汁ALP水平、γ-GT水平、胆道病理形态学评分、线粒体平均体积及胆道上皮细胞微绒毛密度)组间两两比较差异有统计学意义,A组(对照组)大致正常,B组(相对热缺血组)最重,C组(干预组)较轻.结论胆道相对热缺血再灌注损伤使肝移植术后早期分泌的胆汁中胆盐及磷脂分泌均降低,其中胆盐早期恢复分泌,而磷脂恢复分泌较迟,导致了早期TBA/PL值增高,胆汁毒性增强,是导致胆道损伤的因素之一;多烯磷脂酰胆碱注射液可增加胆汁中磷脂浓度,并降低TBA/PL值,减少胆汁毒性,减轻因相对热缺血导致的胆道损伤.
목적 탐토다희린지선담감대대서간이식술중상대열결혈(relative warm ischemia time,RWIT)조성담도손상적보호작용.방법 장60지SD대서분위담도상대열결혈0 min(A조)、담도상대열결혈60 min(B조)、담도상대열결혈60 min병우술후매일복강주사다희린지선담감주사액(C조).건립대서자체원위간이식담도외인류모형,검측각조술후2 h급술후제1、3、5천담즙중총담즙산(total bilirubin,TBA)농도、린지(phospholipid,PL)농도、TBA/PL치,병류취담도표본진행조직병이학검측,병검측담즙감성린산매(alkaline phosphatase,ALP)급곡안선기전이매(gamma glutamyltransferase,γ-GT)수평작위관찰담관손상적지표.결과 A조술후TBA、PL급TBA/PL균은정,미출현명현변화;TBA농도:술후조기B、C조명현저우A조(F=19.662,P＜0.05),차후축점승고,도제3천각조지간이무명현차이(F=1.244,P＞0.05).PL농도:술후B조교C조하강명현,차후완만승고,지술후제5천잉저우C조(t=2.832,P＜0.05).TBA/PL치:술후조기B조명현고우A조,병우술후축점승고,지술후제3천체도최고,술후제5천개시하강.C조술후미출현명현변화,재각개시간점A、C조지간비교차이무통계학의의(t=0.307,P＞0.05).담도손상평분(담즙ALP수평、γ-GT수평、담도병리형태학평분、선립체평균체적급담도상피세포미융모밀도)조간량량비교차이유통계학의의,A조(대조조)대치정상,B조(상대열결혈조)최중,C조(간예조)교경.결론 담도상대열결혈재관주손상사간이식술후조기분비적담즙중담염급린지분비균강저,기중담염조기회복분비,이린지회복분비교지,도치료조기TBA/PL치증고,담즙독성증강,시도치담도손상적인소지일;다희린지선담감주사액가증가담즙중린지농도,병강저TBA/PL치,감소담즙독성,감경인상대열결혈도치적담도손상.
Objective To investigate the preventive effects of polyene phosphatidylchaline on biliary tract injury induced by relative warm isehemia time (RWIT) in liver transplantation in rats.Methods Sixty SD rats were divided into three groups.The RWIT was 0 min for group A and 60 min for group B and C,and in group C polyene phosphatidylcholine was given intraperitoneally beginning 6 hrs before and QD postoperatively until the day the graft was harvested.Total bilirubin (TBA),phospholipid (PL)and TBA/PL was detected at 2 hours and 1st,3rd,5th day after operation.Histopathology,ALP and γ-GT were used to evaluate biliary tract damage.Results The levels of total bilirubin (TBA),phospholipid(PL) and TBA/PL were stable in group A; The levels of TBA :group B and C were lower than group A significantly in the early stage after operation (P ＜ 0.05) and increased gradually.There was no significant differences between three groups on the 3rd day.The levels of PL in group B were much lower than those in group C on the 5th day(P ＜0.05).TBA/PL ratio in group B was significantly higher than that in group A(P ＜0.05).TBA/PL in group C was stable and there were no significant differences between group A and group C.Compared with that of group B the injury of liver cells and biliary duct were significantly ameliorated in group C.Conclusion The RWIT in liver transplantation caused imbalanced bile salt and phospholipid secretion,resulting in an elevated TBA/PL ratio leaving the bile duct to bile salt DOI:10.3760/cma.j.issn.1007-631X.2010.02.009toxicity.When polyene phosphatidylcholine was given,it increased the concentration PL and decrease the value of TBA/PL.attenuating bile toxicity and alleviating bilary duct injury caused by RWIT.