供肝灌洗液中内皮素-1与供肝质量关系的实验研究

An experimental study on the relationship between graft quality and endothelin-1 levels in donor organ washout effluents

目的探讨供肝冷保存后灌洗液中内皮素-1(ET-1)水平与供肝质量之间的关系,为供肝植入前评价供肝质量寻求一种可能的方法。方法建立大鼠肝移植的供肝切取的动物模型,切取供肝后0～4℃冷保存,测定冷保存0、4、8、12、16和20h后,肝脏灌洗液中ET-1、丙氨酸氨基转移酶(ALT)及天门冬氨酸氨基转移酶(AST)含量,取少许肝左中叶组织做病理学检查,观察供肝肝窦内皮细胞(SEC)超微结构变化。结果(1)在热缺血时间相同的情况下,大鼠供肝灌洗液中ET-1含量随冷保存时间延长逐渐升高,但是冷保存早期变化不明显(冷保存4h与冷保存0h组相比,P>0·05),冷保存8h后有显著差异(与冷保存0h组相比,P<0·01)。(2)ALT及AST水平随着冷保存时间的延长逐渐升高,但是冷保存早期上述指标变化不明显(冷保存8h、4h与冷保存0h组相比,P>0·05),冷保存中晚期12h后有显著差异(与冷保存0h组相比,P<0·01)。(3)随着保存时间的延长,肝窦内皮细胞发生明显的形态学的改变。结论大鼠供肝灌洗液中ET-1含量变化与肝窦内皮细胞形态学的改变明显相关,肝脏冷保存末期灌洗液中ET-1的含量可反映移植前肝窦内皮细胞的损伤程度及肝脏质量,对早期评价大鼠供肝质量有重要的价值。

Objective To investigate the relationship between ET-1 in the graft caval effluent after flushing of the liver and the graft quality,and to seek a potential method to evaluate the graft quality before implantation. Methods The animal model was liver harvest of rat liver transplantation, and the liver was preserved in 0 - 4℃ UW fluid. The changes of endothelin-1 （ ET-1 ） content in the graft caval effluent, alanine aminotransferase （ ALT）, aspartate aminotransferase （AST） in reperfused liquid were measured in each group. The morphological changes of sinusoidal endothelia cell were observed. Results In the same warm ischemic time, the concentration of ET-1 in the graft caval effluent increased with the prolongation of liver cold preservation, especially in the early cold preservation （ P 〈 0. 01 ） ; while ALT, AST activity had obvious changes（ P 〈 0. 01 ） just afler long term preservation. Abnormal morphological changes of sinusoidal endothelia cell was more obvious along with the prolongation of cold preservation. Conclusions The concentration of ET-1 in the graft caval effluent has obvious correlation with the degree of injury of sinusoidal endothelia cell and can reflect the degree of injury of sinusoidal endothelia cell. There is a significant diagnostic value of ET-1 in evaluating the quality of donor liver in rat.