一氧化氮和内皮素在无心跳供肝体外灌流中的作用

The role of nitric oxide and endothelin in extracorporeal liver perfusion of NHBD livers

目的 利用无心跳供肝体外灌流系统（ECLP）来探讨NO和ET在肝脏缺血再灌注损伤中的作用机制。为有效利用无心跳供肝提供理论依据。方法 实验动物为普通健康的天津白猪，体重在20-25kg，雌雄不拘。按保存方法不同随机分为两组，再根据不同的阶段进行设计。A组（n=4）用HTK液低温保存10h；B组（n=4）用ECLP系统常温灌流10h。经过60min冷缺血期后，连接ECLP系统灌流4h。观察灌流后1、2、3、4h四个时间点灌流液中NO^-2／NO^-3、ET-1水平。结果 B组（ECLP系统灌流组）肝脏在1，2，3，4h四个时间点灌流液中ET-1水平均低于A组，NO^-2／NO^-3则高于A组，两组差异有统计学意义（P〈0．05）。结论 NO和ET在肝脏缺血再灌注损伤中起着非常重要的作用，利用ECLP系统灌流无心跳供肝能够抑制由此造成的NO合成降低和ET的分泌增多，从而改善NO和ET的平衡关系，改善肝脏的微循环障碍和降低肝细胞的损伤。

Objective To observe the role of nitric oxide and endothelin in extracorporeal liver perfusion of NHBD livers,and to investigate the mechanism of ischemia -reperfusion injury of non -heart -beating livers. Methods Livers were harvested from health pigs,which were preserved for 10hr by either cold storage in HTK solution （A group, n =4） or by perfusion with oxygenated autologous blood at body temperature （B group, n = 4）. Both groups were then tested on the circuit for a 4 hr reperfusion phase. The level of NO, ET in the blood for reperfusion were measured. Results At each time point, the levels of NO in the blood for reperfusion in group B were statisti tally higer than that of in group A （ P 〈 0.05）, but the levels of ET were lower than those of in group A （ P 〈0.05 or P 〈0.01）. Conclusion The unbalance between the NO and ET play an important role in the development of ischemia - reperfusion injury of NHBD liver,extracorporeal liver perfusion can improve the balance between NO and ET,which can reduce the ischemia- reperfusion injury of the NHBD livers.