脂质代谢与肝脏缺血再灌注损伤的防治

Lipid metabolism and prevention and treatment of liver ischemia-reperfusion injury

脂质代谢包括脂类在小肠内消化、吸收,由淋巴系统进入血循环通过脂蛋白转运,经肝脏转化储存于脂肪组织,需要时被组织利用。脂类物质不仅参与机体的供能与储能,而且是机体的重要结构成分,还能转变为各种衍生物参与代谢活动。肝脏缺血再灌注损伤(HIRI)是肝脏切除和肝移植等手术过程中不可避免的并发症。研究发现,缺血阶段会影响机体的脂质代谢,进而影响机体的各项生命活动,因此,可以说,脂质代谢紊乱是HIRI的早期决定性触发因素,会直接导致肝脏移植术后出现器官衰竭和急慢性组织排异现象。HIRI的防治是临床上的热点、难点问题。在肝脏缺血前对实验动物进行预处理,可以增强肝脏对缺血的耐受力,减轻再灌注损伤,从而对机体起到保护作用。此外,某些内源性或者外源性物质可以通过不同方式影响脂质代谢的过程,减轻缺血再灌注损伤,这些方式包括信号分子途径、作用于某些酶影响代谢、作用于某些基因影响其表达等。其保护作用机制主要与减少氧化应激,降低细胞内钙超载及减少炎症和凋亡等有关。现就近几年脂质代谢与HIRI防治的研究进展作一综述。

Lipid metabolism includes the digestion and absorption of lipids in the small intestine,the transport of lipids from the lymphoid system to the blood circulation through lipoprotein,the transformation and storage of lipids in adipose tissue through the liver,and the lipids in adipose tissue are utilized when needing.The lipid materials are not only involved in the energy supply and energy storage of the body,but also the important structural component of the body,and can also be transformed into various derivatives to participate in metabolic activities.The hepatic ischemia-reperfusion injury(HIRI)is an inevitable complication in hepatectomy and liver transplantation.The studies find that the ischemic stage will affect the lipid metabolism of the body,and thus affect the life activities of the body.Therefore,it can be said that the disorder of lipid metabolism is the early decisive trigger factor of HIRI,which will directly lead to organ failure and acute and chronic tissue rejection after liver transplantation.The prevention and treatment of HIRI is a hotpoint and difficult problem in clinic.The pretreatment of experimental animals before liver ischemia can enhance the tolerance of liver to ischemia,alleviate the injury of reperfusion,and thus play a protective role in the body.In addition,some endogenous or exogenous substances can affect the process of lipid metabolism and reduce ischemia-reperfusion injury in different ways,including signal molecular pathway,acting on some enzymes affecting metabolism,affecting the expression of some genes,and so on.Its protective mechanism is mainly related to the reduction of oxidative stress,the decrease of intracellular calcium overload and the reduction of inflammation and apoptosis.In this paper,the research progress of lipid metabolism and the prevention and treatment of HIRI in recent years is reviewed.