小型猪胰腺节段移植术的实验研究

Experimental studys on segmental pancreas transplantation in minipigs

目的 :探讨胰液淀粉酶 (PJA) ,血清 C-肽、胰周渗液中淋巴细胞占白细胞总数的比例与急性排斥反应的关系。方法 :(1) 30～ 5 0 kg健康小型猪 18头 ,雌雄各半 ,随机分成 A、B、C 3组 ,3组均作带十二指肠袢的节段性胰腺移植 ,A、B两组为同种异体移植 ,C组为自体移植 ,仅 B组予以环孢素、甲基强的松龙、硫唑嘌呤三联免疫抑制治疗。 (2 )测定各组术后不同天数的胰液淀粉酶小时分泌量平均值、血清 C-肽水平 ;(3)术后胰周渗液涂片计数大淋巴细胞比例 ,计算各组的阳性率及其诊断急性排斥反应的敏感度及特异度。 (4)所有移植物术后均定期作病理活检 ,以此结果作为确诊急性排斥反应的标准。结果 :(1) 18头猪除 1例死于麻醉意外 ,2例(13.3%)移植胰因术后早期血栓形成致功能丧失而切除外 ,其余均存活 2周以上。(2 ) A组术后第 5天始血清 C-肽缓慢下降、PJA分泌急剧减少 ,均发生严重排斥反应 ;B、C组术后 C-肽、PJA分泌量无明显下降。(3)胰周渗液细胞学检查诊断急性排斥反应的敏感度为 10 0 .0 %,特异度为 71.4%,是一良好指标。结论 :(1) PJA,血清 C-肽的下降可预示急性排斥反应的发生。 (2 )胰周渗液细胞学检查是监测急性排斥反应的安全、简易、敏感的指标。

Objective:(1)To verify whether serum C-peptide、pancreatic juice amylase(PJA)can be correlated with acute rejection episodes in experimental pancreas transplantation.(2)To investigate if peripancreatic fluid cytology (PFC) could provide early diagnosis of acute rejection after vascularized pancreas transplantation.Methods:Eighteen minipigs received either a segmental pancreatic duodenal allograft or autograft. This study included three groups: allograft without immunosuppression (group A,n=6), allograft with immunosuppression (group B, n=6) and autograft without immuno-suppression (group C,n=6). Measurements of PJA and serum C-peptide were performed on days 1,3,5,7,9,10,12,14 monitoring the graft function. According to pathologic result,the percent of mononuclear cells among total leukocytes greater than 10% was defined as the standard to diagnosie acute rejection and analysize the sensitivity and specificity of PFC in all groups.Result:The recipient and graft survival rates were 94% (17/18) and 88.2%(15/17) at two weeks. One pig died of anesthetic accident and two grafts lost with thrombosis in earlier period. From day 5,the levels of serum c-peptide and PJA decreased sharply in group A, but not varied significantly in group B and C. The sensitivity and specificity of PFC were 100.0% and 71.4% respectively to diagnosis acute rejection.Conclusion:(1)C-peptide、PJA can be correlated with acute rejection episodes in pancreas transplantation.(2)PFC can be a safe, simple, sensitive tool for diagnosis early graft rejection.