供肝能量代谢与肝移植术后缺血性胆管损伤的关系探讨
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摘要
目的探讨肝移植手术过程中血管开放前后供肝能量代谢是否与肝移植术后缺血性胆管损伤的发生具有相关性。方法回顾性分析2014年3月-2015年8月天津市第一中心医院150例接受原位肝脏移植手术的患者资料。将满足入组标准的患者于肝移植过程中分别于门静脉开放前、肝动脉开放前及肝动脉开放后1小时取肝组织标本,然后将入组患者随访至1年。根据胆道造影结果将其分为缺血性胆道损伤组(ITBL组)和非缺血性胆道损伤组(NITBL组),将两组患者3个时间段的ATP、ADP及AMP定量检测结果进行分析统计并得出结果。结果 ITBL组与NITBL组在门静脉开放前、肝动脉开放前、肝动脉开放后3个时间段的能量代谢相关指标,即ATP、ADP及AMP含量差异均无统计学意义(P>0.05)。结论供肝组织能量代谢情况与肝移植术后ITBL的发生并无相关性。
Objective To analyze the relationship between the energy metabolism of donor liver before and post recanalization of blood vessels and the ischemic injury of bile duct injury after liver transplantation. Methods The data of patients who received liver transplantation in Tianjin First Center Hospital between March 2014 and August 2015 were analysed retrospectively. The patients who were satisfied with the standard were enrolled,and samples were taken before recanalization of portal vein,before recanalization of hepatic artery and 1 hour after recanalization of hepatic artery. Patients were followed for one year, patients enrolled were divided into ischemic-type biliary lesions(ITBL) group and non-ischemic-type biliary lesions(NITBL) group according to results of cholangiography. ATP, ADP and AMP at three timepoints in two groups were compared. Results There was no significance difference in energy metabolism showed by indices such as ATP, ADP and AMP,between ITBL group and NITBL group before recanalization of portal vein, before recanalization of hepatic artery and1 hour after recanalization of hepatic artery(P > 0.05). Conclusion There was no relationship between energy metabolism of donor liver and the occurrence of ITBL post liver transplantation.
Objective To analyze the relationship between the energy metabolism of donor liver before and post recanalization of blood vessels and the ischemic injury of bile duct injury after liver transplantation. Methods The data of patients who received liver transplantation in Tianjin First Center Hospital between March 2014 and August 2015 were analysed retrospectively. The patients who were satisfied with the standard were enrolled,and samples were taken before recanalization of portal vein,before recanalization of hepatic artery and 1 hour after recanalization of hepatic artery. Patients were followed for one year, patients enrolled were divided into ischemic-type biliary lesions(ITBL) group and non-ischemic-type biliary lesions(NITBL) group according to results of cholangiography. ATP, ADP and AMP at three timepoints in two groups were compared. Results There was no significance difference in energy metabolism showed by indices such as ATP, ADP and AMP,between ITBL group and NITBL group before recanalization of portal vein, before recanalization of hepatic artery and1 hour after recanalization of hepatic artery(P > 0.05). Conclusion There was no relationship between energy metabolism of donor liver and the occurrence of ITBL post liver transplantation.
引文
[1]朱铭力,严玉澄.肝移植患者急性肾损伤的发生和预后问题[J].中华危重病急救医学,2008,20(5):315-317.
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[11]董辉,丛文铭.肝移植后抗体介导性排斥反应的进展[J].中华器官移植杂志,2014,35(8):509-511.
[12]唐晖.肝移植术后缺血性胆道损伤研究进展[J].器官移植,2014,5(2):123-127.
[13]Luo Y,Ji WB,Duan WD,et al.Graft cholangiopathy:etiology,diagnosis,and therapeutic strategies[J].Hepatobiliary Pancreat Dis Int,2014,13(1):10-17.
[14]Verhoeven CJ,Farid WR,de Ruiter PE,et al.Micro RNA profiles in graft preservation solution are predictive of ischemic-type biliary lesions after liver transplantation[J].J Hepatol,2013,59(6):1231-1238.
[15]张莹,别平,石承先.线粒体ATP酶6、8基因及编码蛋白表达改变对移植肝脏能量代谢的影响[J].中华医学杂志,2010,90(10):708-711.
[16]Sheth H,Hafez T,Glantzounis GK,et al.Glycine maintains mitochondrial activity and bile composition following warm liver ischemia-reperfusion injury[J].J Gastroenterol Hepatol,2011,26(1):194-200.
[17]Furukori M,Matsuno N,Meng LT,et al.Subnormothermic machine perfusion preservation with rewarming for donation after cardiac death liver grafts in pigs[J].Transplantation Proc,2016,48(4):1239-1243.
[2]李静,杨怡萍,王兰英.肝移植患者术前访视的效果分析[J].中国中西医结合急救杂志,2016,23(3):318-319.
[3]滕大洪.劈离式肝移植术临床进展[J/CD].实用器官移植电子杂志,2017,5(4):309-314.
[4]Deng Y,Zhao L,Lu X.A multidrug cocktail approach attenuates ischemic-type biliary lesions in liver transplantation from nonheart-beating donors[J].Medical Hypotheses,2016,91:47-52.
[5]Hessheimer AJ,Cárdenas A,García-Valdecasas JC,et al.Can we prevent ischemic type biliary lesion in DCD liver transplantation?[J].Liver Transpl,2016,22(7):1025-1033.
[6]Kienlein S,Schoening W,Andert A,et al.Biliary complications in liver transplantation:Impact of anastomotic technique and ischemic time on short-and long-term outcome[J].World J Transplant,2015,5(4):300-309.
[7]陈光,刘英秀,王健,等.肝移植术后非肝动脉性缺血性胆管损伤的早期胆管造影诊断[J].中华放射学杂志,2008,42(8):835-839.
[8]Jiang T,Li C,Duan B,et al.Risk factors for and management of ischemic-type biliary lesions following orthotopic liver transplantation:A single center experience[J].Ann Hepatol,2016,15(1):41-46.
[9]Foley DP,Fernandez LA,Leverson G,et al.Biliary complications after liver transplantation from donation after cardiac death donors an analysis of risk factors and long-term outcomes from a single center[J].Ann Surg,2011,253(4):817-825.
[10]Sankary HN,Mc Chesney L,Frye E,et al.A simple modification in operative technique can reduce the incidence of nonanastomotic biliary strictures after orthotopic liver transplantation[J].Hepatology,1995,21(1):63-69.
[11]董辉,丛文铭.肝移植后抗体介导性排斥反应的进展[J].中华器官移植杂志,2014,35(8):509-511.
[12]唐晖.肝移植术后缺血性胆道损伤研究进展[J].器官移植,2014,5(2):123-127.
[13]Luo Y,Ji WB,Duan WD,et al.Graft cholangiopathy:etiology,diagnosis,and therapeutic strategies[J].Hepatobiliary Pancreat Dis Int,2014,13(1):10-17.
[14]Verhoeven CJ,Farid WR,de Ruiter PE,et al.Micro RNA profiles in graft preservation solution are predictive of ischemic-type biliary lesions after liver transplantation[J].J Hepatol,2013,59(6):1231-1238.
[15]张莹,别平,石承先.线粒体ATP酶6、8基因及编码蛋白表达改变对移植肝脏能量代谢的影响[J].中华医学杂志,2010,90(10):708-711.
[16]Sheth H,Hafez T,Glantzounis GK,et al.Glycine maintains mitochondrial activity and bile composition following warm liver ischemia-reperfusion injury[J].J Gastroenterol Hepatol,2011,26(1):194-200.
[17]Furukori M,Matsuno N,Meng LT,et al.Subnormothermic machine perfusion preservation with rewarming for donation after cardiac death liver grafts in pigs[J].Transplantation Proc,2016,48(4):1239-1243.