胰岛素门静脉灌注促进活体肝移植术后肝再生的临床研究

Augmented hepatic regeneration of living donor liver graft by intraportal insulin administration

目的探讨成人活体肝移植（LDLT）术后胰岛素门静脉灌注对移植肝再生的促进作用。方法2005年7月至2007年9月间接受右肝LDLT并自愿接受术后门静脉胰岛素灌注、有完整临床资料并存活超过30d的15例成人受者作为研究对象（胰岛素组），同期未接受门静脉胰岛素灌注治疗、有完整临床资料并存活超过30d的连续15例成人受者作为对照组研究对象（对照组）。胰岛素组受者LDLT术中从胃网膜右静脉插入一根18G硅胶管至门静脉系统，另一端固定于腹壁，术后以2U／h速度静脉微泵持续均匀门静脉灌注胰岛素7d。对照组无门静脉插管及胰岛素灌注。LDLT术前1d、术后7d及30d检测肝功能与外周血胰岛素水平，术中、术后7d及术后30d测量移植肝体积（GV）。以GV比例（术后移植肝体耕术中移植肝体积之百分比）和供肝受者体重比（GRWR）比例（术后GRWR／术中GRWR之百分比例）作为移植肝再生检测指标。结果LDLT术后7d胰岛素组与对照组受者移植肝GV比例分别为（186．1±35．4）％和（160．6±22．1）％，胰岛素组移植肝再生率高于对照组（P〈0．05）；胰岛素组与对照组受者GRWR比例分别为（179．0±35．8）％和（156．6±18．5）％，胰岛素组移植肝再生率亦高于对照组（P〈0．05）。LDLT术后30d胰岛素组与对照组受者移植肝再生率的差异无统计学意义（P〉0．05）。LDLT术后7d胰岛素组患者血清总胆红素、丙氨酸转氨酶和天冬氨酸转氨酶水平低于对照组。术后两组患者外周血胰岛素水平及外周胰岛素用量的差异均无统计学意义。结论LDLT术后胰岛素门静脉灌注可能促进术后第1周移植肝再生。

Objective To evaluate the effect of postoperative intraportally administration of insulin on hepatic regeneration in adult patients underwent living donor right lobe liver transplantation （LDLT）. Methods From July 2005 to September 2007,15 fight lobe LDLT adult recipients voluntarily receiving post- transplant intraportal insulin administration, without postoperative vascular and bile duct complications, without immune rejection,with more than 1 month survival and complete clinical data were enrolled in this study as intraportal insulin-therapy group （Group I ）. Another consecutive 15 right lobe LDLT adult recipients meeting the upwards referred criteria were enrolled in as non-insulin-therapy control group （Group NI）. Recipients in Group I were treated postoperatively with intraportal insulin infusion, as follows, a 18- gauge catheter was inserted into right gastroomental vein during surgery, regular insulin was administered just after the operation at the rate of 2 units/hour for 7 days. Liver function and serum insulin level were measured at before-operative day 1, postoperative day （POD） 7 and 30. Graft volume （GV） were measured during operation,and at POD 7 and 30. Results The rate defined as ratio of POD 7 GV/operation GV in Group Iwas higher than that of Group NI [（186. 1±35.4）% vs. （160.6 ±22. 1）% ,P 〈0.05]. The rate defined as ratio of POD 7 GRWR/operation GRWR was also higher in Group I than Group NI[ （ 179. 0 ± 35.8 ） % vs. （ 156. 6± 18. 5 ） %, P 〈 0.05 ], whereas significant differences were not appeared between two groups in terms of regeneration rates at POD 30. Serum levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase in Group I were lower than that in Group NI at POD 7 （ P 〈 0. 05 ）. Significant differences were not presented between two groups in terms of post-transplant serum insulin levels and total insulin dosage by subcutaneous administration and venous injection （P 〉 0. 05）. Conclusions These results suggest that intraportal insulin administration could augment liver graft regeneration during the first postoperative week.