缺血时间对肾脏影响的实验研究

THE EFFECT OF DIFFERENT WARM ISCHEMIATIME ON RAT KIDNEY CHANGES AND TRANSPLANTED KIDNEY'S FUNCTION

目的 :研究不同热缺血时间大鼠肾脏的变化及移植肾的存活情况。方法 :选择不同热缺血时间点 (零时、15min、30min、6 0min) ,观察缺血后光镜下和透射电镜下肾脏组织的病理改变以及肾组织谷胱肽过氧化物酶(GSH -PH)、Na+-K+ATP酶和Ca2 +-ATP酶活性、丙二醛 (MDA)水平的变化 ,也测定缺血后肾静脉血和肾组织乳酸脱氢酶 (LDH)的水平。并在不同热缺血时间 ,分别进行大鼠肾移植 ,观察手术后的存活率和肾功能的变化。结果 :随缺血时间的增加 ,肾脏病理改变逐渐加重。在缺血 30min肾组织内GSH -PX、Na+-K+ATP酶、Ca2 +-ATP酶的活力明显下降 ,而LDH在缺血 15min后就已经明显升高。缺血 30min开始肾组织内MDA水平就已明显增高。不同热缺血时间的肾脏进行大鼠肾移植 ,随着缺血时间的延长 ,所需要的灌注液使用量增加 ,术后 2 4h血肌酐的水平升高 ,而灌洗的效果、以及术后的存活率均下降。结论 :单纯低温保存在鼠肾移植热缺血时间以不超过 30min为宜。

Objective:To investigate rat renal histologic changes with different warm ischemia time and recipient survival under different donor kidney's ischemic conditions.Methods:Rats were subjected to ischemia time zero ,15 ,30 or 60 minutes .We observed the pathology of ischemic kidney with light microscope and transmission electron microscope ,and measured some enzyme's activity in the kidney including GSH-PX, Na +-K +ATPase, Ca 2+-ATPase and LDH.We also determined LDH levels of the renal vein together with renal tissue MDA levels. Then according to different warm ischemia time,we performed rat kidney transplantation and observed the survival rates and renal functions 24 hours after the operation.Results:In the study of warm ischemia's effect on kidney, we found that with the prolongation of ischemia duration,the kidney pathologic changes become more evident, especially proximal tubular injury. After 30 minutes ischemia some enzymes' activity of kidney including GSH-PX, Na +-K +ATPase, Ca 2+-ATPase began to reduce significantly, but kidney cell damage marker enzyme LDH increased dramatically after 15 minutes is chemia. Meantime, MDA levels in the kidney rose gradually at the time point of 30 minute ischemia, become much higher after warm ischemia 60 minutes. During the investigation of warm ischemia's influence on reciepient survival, we discovered that with ischemia duration extention ,the flushing solution volume increased and serum creatinine levels went higher wherever the flushing result became worse and the survival rates were lower.Conclusion:We think under hypothermic storage alone donor warm ischemia time should not be over 30 minutes.