肝缺血再灌注损伤时血浆内毒素的动态变化和对肾的影响

　　【关键词】 肝缺血

摘 要    目的：探讨肝缺血再灌注损伤过程中，肠源性内毒素的动态变化和继发性肝功能损害、继发性肾功能损害及结构改变。方法：取27只健康成年新西兰大耳白兔，体重1.4～2.3kg，随机分组，其中7只作为对照，另外20只作为实验组。对照组静脉血测肝功能(AST、ALT)、肾功能(BUN、Cr)，取门、腔静脉血测内毒素(ET)。实验组：以缺血10min(I10min)、缺血20min(I20min)、缺血30min(I30min)随机分为3组，夹闭第一肝门，按上述实验分组造成不同的缺血时段，松开血管夹分别再灌注30min(R30min)，其余同对照组。结果：反映肝功能的血浆AST、ALT及反映肾功能的BUN、Cr含量，在I10min/R30min组即有升高，但与对照组相比差异无统计学意义。而后随着缺血时限的延长AST、ALT、BUN、Cr水平明显升高，至I30min/R30min组达最高值。各试验组门静脉血中ET均高于对照组。腔静脉血中ET除了 I10min/ R30min组与对照组相比差异无统计学意义外，其余各组均高于对照组。且随着时间的延长内毒素水平进行性增高。ET与ALT、AST、Cr、BUN，ALT与Cr、BUN，AST与Cr、BUN均呈正相关(r值分别为0.51、0.58、0.78、0.81，0.59、0.69，0.78、0.80)。结论：肝门阻断过程中肝脏处于缺血缺氧状态，肝门再开放后又存在着缺血再灌注损伤的情况，因而致肝功能损害。肝门阻断时门静脉阻断造成的门静脉系统淤血，引起肠黏膜缺血、缺氧而受损，导致肠源性内毒素产生和移位。且随着缺血时限的延长，门、腔静脉血中内毒素水平亦进行性升高，肝功能进一步损害，最终致肾功能的损害。

　　关键词 肝缺血;再灌注损伤;内毒素;肾

　　中图分类号 R364

　　Dynamic Changes of Plasma Endotoxin and Its Effect on Kidney During Hepatic Ischemia/Reperfusion

　　YANG Shaoling

　　(Depatment of pathophysiology,Xingjiang Medical University)

　　Abstract Objective :Liver ischemic and reperfusion cannot be avoided during liver transplantation. It may be the main reason for postoperative acute renal failure (ARF) and hepatorenal syndrome(HRS). The prensent study is to explore the effect of hepatic inflow occlusion on renal and liver. Methods :Anesthtized rabbits (n=27) were randomized into four groups : control(n=7) ,Ischemia 10 minutes (I10min group n=6) ,Ischemia 20minutes (I20min group n=6) ,Ischemia 30minutes (I30mingroup n=8). Each ischemia groups had been reperfused 30 minutes(R30min) after ischemia. The contents of alanine transaminase (ALT), aspartate transaminase (AST), creatinine (Cr), blood urea nitrogen (BUN), endotoxin (ET) in portal vein and cediac vein were measured and renal tissue was observed by electron microscope. Results: Contents of ALT、AST、Cr、BUN and ET in plasma were significantly higher in I20min/R30min and I30min/R30min groups than those in control groups(P<0.0

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