缺血预处理对器官保护作用的文献分析

A Literature Review for the Protective Function of Ischemic Preconditioning to Organs

目的对国内外公开发表的有关缺血预处理(ischemic preconditioning,IPC)对器官保护作用的基础与临床研究文献进行统计与分析,了解IPC的历史沿革、临床和基础研究进展,探索器官移植中IPC的作用和机制。方法计算机检索MEDLINE(1966～2009.8)、EMbase(1974～2009.8)和Cochrane Library(2009年第2期),由两名研究者独立筛选研究IPC的文献,进行分类整理和分析。结果最终纳入1398篇文献,其中75%为基础研究,临床研究仅占25%;研究的靶器官73%是心脏和肝脏。近年有关IPC对心脏、脑、脊髓和肝脏干预效应的研究明显增加,但关于IPC干预在心脏和肝外科及移植手术的临床研究则明显滞后于基础研究;IPC对其他器官如肾脏、肺、胃肠及胰腺效应的临床研究也相对较少。结论IPC对心脏外科及移植相关手术、肝外科手术及活体肝移植、肺普通手术及移植相关手术均有保护效果;IPC可有效减轻中枢神经系统缺血再灌注损伤的程度,但对尸肝移植无保护效果;IPC对肾脏、胃肠道的效应尚不明确。IPC干预对器官的保护效应机制尚无结论。

Objective To collect and analyze published experimental and clinical studies about the protective function of ischemic preconditioning（IPC） to organs,in order to learn the history of IPC,the progress of experimental as well as clinical studies,and explore the mechanism of IPC in organ transplantation.Methods The electronic search of MEDLINE（1966 to Aug.2009）,EMbase（1974 to Aug.2009） and The Cochrane Library（Issue 2,2009） were performed to include and exclude the retrieved articles by two reviewers independently.The included studies were further treated for analysis and discriptive review.Results A total of 1 398 papers were included,of which about 75 percent wereflexperimental studies,and only about 25 percent were clinical studies.About 73 percent studies focused on the heart and liver.Althrough the studies about the effects induced by IPC on the heart,brain,spinal cord and liver increased obviously in recent years,the clinical studies concerned the heart and liver operation and transplantation still far lagged behind experimental studies,especially very few clinical studies on the effect induced by IPC on kidney,lung,gastrointestinal tract and pancreas.Conclusion IPC intervention can effectively protect the heart and lung from the I/RI during the surgical and transplatational operations,and the hepat-surgical and living liver transplantational operations.IPC can effectively protect the brain and spinal cord from I/RI,but no protective function to cadaveric liver transplantation.However,the IPC effects on the kidney and gastrointestinal tract are not con rmed and neither is the mechanism of the effect induced by IPC.