肝门阻断过程中扪摸对肝缺血再灌注损伤的影响及其机制研究

Effects of gentle liver manipulation in vivo on hepatic ischemia-reperfusion injury in rats and its mechanism

摘要:

目的：研究肝门阻断过程中扪摸对肝缺血再灌注损伤的影响及其机制。方法：30只雄性SD大鼠随机分为3组：假手术组仅行开腹及肝门分离；缺血再灌注模型（ischemia reperfusion，IR）组采用Pringle’s法阻断肝门15 min，再灌注6 h；干预（manipulaition，MN）组操作同IR组，且在肝门阻断过程中对大鼠肝脏进行轻柔挤压及摩擦13 min。分别取门静脉血清测转氨酶[（谷丙转氨酶（alanine transaminase，ALT），谷草转氨酶（aspartate aminotransferase，AST）]；取肝组织作病理学检查，同时行免疫组化法测定肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）和P-选择素表达水平。结果：MN组和IR 组较假手术组：血清ALT、AST水平明显升高（P=0.000）；肝组织病理损伤评分升高（P=0.000）；肝组织内TNF-α和P-选择素表达升高（P=0.000）。其中上述指标在MN组中水平较IR组均明显增高（P=0.000）。结论：在肝门阻断过程中手术操作本身即扪摸加重肝缺血再灌注损伤，可能是通过增加黏附因子的表达，加重中性粒细胞的聚集，从而导致炎症损伤加重。

Abstract:

Objective：To investigate the effects of the gentle liver manipulation，including toching，retracting and moving liver lobes gently，on hepatic ischemia-reperfusion injury during hepatic ischemia and its mechanism. Methods：Thirty SD rats were divided into three groups randomly：sham-operated group（sham group），ischemia reperfusion group（IR group：produced by total inflow occlusion for 15 min） and manipulation group（MN group：induced with 13 min gentle manipulation including touching，retracting and moving lobes during 15 min ischemia）. Serum aminotransferases alanine transaminase and aspartate aminotransferase（ALT and AST），tumor necrosis factor-α（TNF-α） and Pselection in the liver were measured after reperfusion. Results：In MN and IR groups，serum ALT and AST（P=0.000） as well as pathological injury scores（P=0.000） were increased；TNF-α and P-selection expressions were higher（P=0.000） compared with those in sham group. Those variables mentioned above were significantly increased in MN group compared with those in IR group（P=0.000）. Conclusions：Gentle in vivo liver manipulation increases the reperfusion injury during hepatic is－chemia，which may be caused by the decrease of pro-inflammatory and activity of neutophils.