低温机器灌注保存供肝对肝窦内皮细胞损伤的研究

Hypothermic machine perfusion reduces injury of sinusoidal endothelial cells in preserved livers

目的通过对低温缺血保存再灌注方法与低温机器灌注保存方法的比较,探讨低温机器灌注保存供肝的效果和机制。方法对照组肝脏置入4℃HC-A液中保存,实验组肝脏置入机器灌注系统保存,通过比较低温缺血保存再灌注方法与低温机器灌注保存再灌注后肝脏灌注流出液中丙氨酸转氨酶(ALT)以及透明质酸(HA)的摄取量,光镜下观察肝细胞及肝窦内皮细胞的形态学改变。结果对照组和实验组与健康组比较HA摄取量明显降低(P<0.05),ALT活性显著增高(P<0.05);随肝脏保存再灌注时间延长,实验组与对照组相同时点比较,灌注流出液中HA摄取量明显升高(P<0.05),ALT活性显著降低(P<0.05)。实验组肝组织病理改变均明显轻于对照组。结论低温机器灌注可以减少肝窦内皮细胞的损伤,减轻再灌注损伤,有效延长保存时间。

Objective To compare the efficiency for liver storage between hypothermic cold machine perfusion （CMP） and simple cold storage （SCS） and to explore the effects and mechanism underlying CMP. Methods The livers were preserved using SCS with HC-A solution at 4 degree Celcius （control group） or CMP （experiment group）. The hyaluronic acid （HA） uptake and alanine aminotransferase （ALT） activity in the efflux were analyzed, and morphology of hepatocytes and sinusoidal endothelial cells （SEC） studied under light microscopy, to explore for any advantages of SCS over CMP. Results Compared experiment group, the control group exhibited lowered HA uptake and higher ALT activity （both P〈0.05）. Along with the process of liver reperfusion, ALT activity was significantly lower （P〈0.05） and ttA uptake was significantly higher in CMP group than those in SCS group at same time spots （P〈O.05）. Livers in the experiment group showed milder changes in histopathology than those in the control group. Conclusion CMP may re- duce SEC injury and reperfusion injury, and may contribute to longer preservation time.