[1]郭浩,王云,王亦秋,等.不同缺血预处理方法减轻肝切除患者术后肝损伤及调控自噬蛋白表达的应用比较[J].徐州医科大学学报,2020,40(11):805-811.[doi:10.3969/j.issn.2096-3882.2020.11.006]
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不同缺血预处理方法减轻肝切除患者术后肝损伤及调控自噬蛋白表达的应用比较()
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《徐州医科大学学报》[ISSN:2096-3882/CN:32-1875/R]

卷:
40
期数:
2020年11期
页码:
805-811
栏目:
出版日期:
2020-11-25

文章信息/Info

Title:
The effection of different ischemic preconditioning methods on the ex<x>pression of autophagy and liver ischemia-reperfusion injury after hepatectomy
作者:
郭浩 王云 王亦秋 拾锦 刘斌
徐州医科大学附属医院普外科,江苏 徐州 221002;徐州市中心医院肿瘤外科,江苏 徐州 221000
关键词:
肢体缺血预处理 肝门缺血预处理 缺血再灌注损伤 肝切除 自噬
DOI:
10.3969/j.issn.2096-3882.2020.11.006
文献标志码:
A
摘要:
目的 探讨肝切除患者术前应用肢体缺血预处理,术中应用肝门缺血预处理,诱导肝脏组织自噬信号,进而减轻肝切除患者缺血再灌注造成的肝损伤.方法 选择2016年6月—2019年6月行肝切除的肝细胞癌患者共160例.对照组:实施正常肝切除手术;实验组1:实施术前肢体缺血预处理+正常肝切除手术;实验组2:实施术中肝门缺血预处理+正常肝切除手术;实验组3:实施术前肢体缺血预处理+术中肝门缺血预处理+正常肝切除手术,每组40例.监测患者肝损害,检测患者肝组织中自噬蛋白、凋亡蛋白变化,并比较患者术中情况、术后并发症发生率及住院时间等.结果 肝功能:实验组患者术后肝功能指标均较对照组下降,实验组3较实验组1和2效果更加明显(P<0.05).自噬蛋白:实验组患者肝脏组织的自噬蛋白水平高于对照组,实验组3较实验组1和2自噬蛋白表达更加明显.凋亡蛋白:实验组较对照组凋亡蛋白表达降低,其中实验组3最低(P<0.05).肝脏苏木精-伊红染色:各实验组患者肝脏均显示不同程度坏死、脂肪变性等,其中实验组3患者肝脏苏木精-伊红染色评分最低(P<0.05).术中相关情况4组比较差异无统计学意义,实验组平均住院日明显短于对照组,而实验组之间比较差异无统计学意义.各实验组术后并发症发生率比较差异无统计学意义,但均优于对照组(P<0.05).结论 术前肢体缺血预处理联合术中肝门缺血预处理可以诱导患者肝脏组织中自噬信号,在一定程度上缓解肝切除患者缺血再灌注造成的肝损伤,且对肝功能损害的缓解效果较单独术前肢体缺血预处理及单独术中肝门缺血预处理更加明显,为临床减轻肝切除术后患者肝功能损伤提供了新思路.
Abstract:
Purpose To discuss the application of limb ischemic preconditioning before liver resection and the hepatic portal ischemic preconditioning induce autophagy to reduce liver ischemia reperfusion (IR) injury in patients with hepatectomy. Methods One hundred and sixty liver cancer patients with hepatectomy in our department were chosen from June 2016 to June 2019. 40 cases with normal liver resection was as the control group; 40 cases undergoing limb ischemia preconditioning before liver resection were as the experimental group 1; 40 cases undergoing hepatic portal ischemic preconditioning before liver resection were as the experimental group 2; and 40 cases undergoing limb ischemia preconditioning and hepatic portal ischemic preconditioning before liver resection were as the experimental group 3. Liver damage (liver HE staining and liver function analysis) were monitored before and after operation; autophagy and apoptotic protein in liver tissue was detected by western blotting, and the intraoperative condition, postoperative complication rate as well as the hospital stay were compared. Results Liver function: the values in the experimental groups was lower than the control group, and the values in the experimental group 3 was significantly lower than the experimental group 1 and 2; Autophagy protein:The ex<x>pression of autophagy protein was more higher in the experimental groups than the control group, and it was the most highest in the experimental group 3. Apoptotic protein: the values of apoptotic protein in the three experimental groups was lower than that in the control group, and it was the most lowest in the experimental group 3; Liver HE staining:it showed more degrees of necrosis, fatty degeneration in the experimental groups compared with the control group, and the liver HE staining scores was lower in the experimental group 3 than the experimental group 1 and 2; No significant difference of the intraoperative bleeding and hospitalization time were showed in all the groups; and no significant difference of the postoperative complications were showed in all the experimental groups. Conclusion Limb ischemic preconditioning or hepatic portal ischemic preconditioning could induce autophagy to alleviate the liver IR injury in patients with hepatectomy, and the limb ischemic preconditioning combined with the hepatic portal ischemic preconditioning has a more significant effect on liver function remission than limb ischemic preconditioning and hepatic portal ischemia preconditioning alone, which benefit for the protection of liver injury in patients with hepatectomy and provides a new way to reduce the liver IR injury in clinical.
更新日期/Last Update: 2020-12-15