活血化瘀注射液Ⅰ号对大鼠肾脏低温保存时超微结构及移植肾功能的影响

目的观察活血化瘀注射液Ⅰ号(HHI-1)是否具有延长肾脏低温保存时间、减轻肾脏损伤的作用.方法将HHI-I加入大鼠肾脏的保存液(乳酸钠林格液)中作为HHI-I组,单纯乳酸钠林格液作为对照组,分别低温保存大鼠肾脏.观察保存的各个时点肾脏超微结构的变化;将在两种不同保存液中保存达3 h后进行大鼠肾脏移植,观察移植后24 h肾功能的变化.结果大鼠肾脏低温保存24 h HHI-I组未出现明显的器质性损伤;对照组于保存8h出现明显的器质性损伤.分别于保存液中保存3 h后进行大鼠肾脏移植,HHI-I组术后24 h血肌酐明显低于对照组(P<0.01).结论 HHI-I可以减轻单纯低温保存时肾脏超微结构的改变、延长移植物低温保存的时间、改善大鼠肾脏移植效果、促进移植肾功能尽快恢复.     

异搏定对大鼠肾脏低温保存时超微结构及移植肾功能的影响

本实验通过在ＨＣＡ保存液中，加入异搏定（ＶＰ）５ｍｇ／ｄｌ（试验组）与单纯ＨＣＡ液（对照组）分别低温保存大鼠肾脏。观察肾脏的超微结构，并建立肾移植模型，测定早期肾功能，以探讨ＶＰ对大鼠肾脏低温保存的影响。结果鼠肾保存０～４８小时，实验组未出现明显的器质性损伤；对照组于３６小时出现明显的器质性损伤。实验组的损伤轻于对照组。二组于６小时已出现差别。保存６小时后，建立肾移植模型，实验组血肌酐较对照组明显降低，差异有显著性（Ｐ＜０．０１）。表明ＶＰ在热冷缺血过程中，对肾脏有保护作用，并促进肾功能早期恢复。     

活血化瘀注射液Ⅰ号对肾脏缺血/再灌注时ICAM-1与P-selectin表达的影响

目的：观察活血化瘀注射液I号(HH—I)对肾脏缺血再灌注损害时粘附分子ICAM-1、P—Selectin表达影响的保护作用。方法：先建立大鼠肾脏缺血模型，随机分为正常对照组、缺血组(缺血1h)、再灌注组(缺血1h、再灌注1h)、丹参组和HHI—I组，后两组在再灌注组的基础上分别给不同的中药。观察各组实验大鼠肾脏组织超氧化物歧化酶(SOD)、丙二醛(佃A)，以及内皮素-1(ET—1)、肾脏血流量(RBF)的变化；并观察光镜下肾脏组织学改变，同时免疫组化检查肾脏细胞间粘附分子-1(ICAM-1)和P-选择素(P—Selectin)的表达水平。结果：再灌注组的病理损害在各组中最重，而HHI—I和丹参组的病变明显减轻。同正常组相比，再灌注组肾脏组织SOD活力下降、MDA含量上升，RBF，ICAM-1、P—Selectin表达水平升高。HHI—I组和丹参组肾脏ICAM-1、P—Selectin表达水平低于再灌注组。结论：HHI—I减轻肾脏缺血／再灌注的病理损害，维持肾脏SOD活力，增加RBF、减少MDA含量的机制很可能是降低ICAM-1、P-selectin在肾脏的表达。     

活血化瘀注射液对大鼠肠系膜活体微循环作用的观察

目的：观察血活化瘀注射液（HHI-I）对大鼠肠系膜活体微循环的影响。方法：将观察到的毛细血管后静脉微循环现象记录于录象带留作分析。观察指标包括白细胞滚动数、粘附数、平均血流速度和壁切率。结果：HHI-I及丹参注射液对生理状态下的肠系膜微循环无作用,急性胰腺炎（AP）使微循环各指标明显恶化,于AP造模的同时给予HHI-I可防止微循环障碍,丹参注射液无类似作用。结论：HHI-I降低AP时的白细胞滚动及粘附数增加,能增加血流速及壁切率。     

大鼠原位肾脏移植模型的显微外科技巧

目的 探讨建立稳定、可靠的大鼠原位肾脏移植模型的显微外科手术技巧。方法供体手术经腹主动脉以4℃乳酸钠林格注射液对供肾进行原位灌洗。受体手术采用将供肾的血管与受体的同名的血管作端端吻合的大鼠原位左肾移植。结果 共施行大鼠原位肾脏移植手术120例，手术成功率为91．5％；非干预组中，同系移植大鼠1个月存活率为82．9％。结论 肾动、静脉和输尿管的重建均采用端端吻合法而无须阻断腹主动脉和下腔静脉，大大减少了对受体循环系统的影响。该模型稳定性强、重复性好，适合于移植免疫的基础研究。     

活血化瘀注射液等对急性胰腺炎大鼠血清一氧化氮浓度的影响

目的：于急性胰腺炎（ＡＰ）大鼠观察了活血化瘀注射液（ＨＨＩ－Ｉ）等对血清一氧化氮（ＮＯ）浓度的影响。方法：大鼠ＡＰ应用胆胰管内逆行注射牛磺酸钠溶液的方法引起。收集对照与治疗各组的血标本并应用ＮＯ测定试剂盒分别测定治疗前后的血清ＮＯ浓度。结果：丹参注射液（４例）未能降低ＡＰ所致的血清ＮＯ升高（Ｐ＜０．０５）,赤芍注射液（４例）能维持血清ＮＯ于疾病前水平（Ｐ＞０．０５）,而ＨＨＩ－Ｉ（６例）则使之明显降低（Ｐ＜０．０５）,复方ＨＨＩ－Ｉ（ＨＨＩ－ＩＣＯ,６例）降低血清ＮＯ的作用更强（Ｐ＜０．０１）。结论：ＨＨＩ－Ｉ等对ＡＰ大鼠血清ＮＯ的升高有明显降低作用。     

移植肾功能延迟恢复对长期存活的影响

目的 探讨移植肾功能延迟恢复对肾移植受者人／肾长期存活的影响。方法 回顾分析５７３例肾移植中发生的７０例移植肾功能延迟恢复受者的人／肾存活情况及其相关危险因素。结果 ７０例患者总的１、３、５年人存活率分别为７７．１％、４７．６％、３７．５％,肾存活率分别为７１．４％、４０．５％、１５．０％,明显低于同期未发生肾功能延迟恢复的受者,但未合并排斥反应的移植肾功能延迟恢复者存活率并不受影响,合并排斥反应     

脂质过氧化抑制剂对大鼠肾脏低温保存和移植的保护作用

目的：探讨脂质过氧化反应对肾脏低温保存和移植的影响及其作用机制。方法：对大鼠肾脏低温保存和移植前进行脂质过氧化抑制预处理,观察移植肾脏功能和形态的变化,肾组织丙二醛（MDA）含量及白细胞介素－2（IL－2）、细胞间粘附分子－1（ICAM－1）、诱导型一氧化氮合酶（iNOS)的表达水平。结果：与对照组相比,治疗组肾脏形态和功能的异常均减轻,IL－2、ICAM－1、iNOS的表达水平和MDA含量明显降低,结论脂质过氧化抑制剂可减轻细胞脂质过氧化反应,对移植肾脏的形态和功能起到保护作用。     

肾组织移植对慢性肾功能衰竭大鼠促红细胞生成素的调节作用

目的研究鼠婴肾组织移植于肾包膜下对促红细胞生成素的调节作用,为临床应用治疗肾性贫血提供理论依据。方法以Wistar雄性大鼠建立慢性肾功能衰竭动物模型为受体,将鼠婴肾组织块多点植入受体肾包膜下。治疗期间用EPO酶联免疫(ELISA)试剂盒测定血清EPO水平;观察肾组织病理改变,用免疫组化方法检测EPO在移植物中的表达。结果①60d时D组血清促红细胞生成素(1.768±0.140)mu/mL高于B组(1.160±0.324)mu/mL(P<0.01),与C组(2.329±0.125)mu/mL也有差异(P<0.05)。②移植后60d,移植物的体积由1mm3增至3-4mm3大小,表面血管网丰富,光镜下见肾小球、肾小管结构正常;③移植物EPO免疫组化,发现移植物EPO着色颗粒主要分布于肾皮质的肾小管,明显多于病例对照组大鼠肾组织(P<0.05)。结论通过对移植物的形态观察和功能测定,证明肾组织移植是一种有效的治疗手段,有可能为慢性肾性贫血提供一种新的途径。     

自制多器官保存液对草犬肾脏低温保存的实验研究

目的 研究自制上海多器官(SMO)液对草犬肾脏低温保存的效果。方法 采用草犬肾脏非循环离体灌注模型，比较SMO液、Uw液和高渗枸椽酸盐嘌呤溶液(HC-A)对草犬肾脏保存后，其形态学及生物化学的改变，并进行肾脏移植，观察移植后肾功能恢复情况。结果 SMO液保存72h之内，肾脏的形态学无明显改变，其各项生化功能SMO组明显优于HC-A组(P＜0．05)；与Uw液组比较，肾脏线粒体呼吸控制率(RCR)、皮质ATP含量两组间差异有显著性(P＜0．05)；保存48、72h后保存液PH值，SMO组明显高于Uw组(P＜0.05)。结论 SMO液保存犬肾72h效果明显优于HC-A液，与UW液相当。     

Duration of Donor Brain Death and its Influence on Kidney Graft Function

Short- and long-term rates of success after cadaveric kidney transplantation are significantly inferior to those from living related or unrelated donors. The major difference between cadaveric and living donation is brain death. In the present study we analyzed the influence of duration of brain death on short- and long-term graft function after cadaveric kidney transplantation. The interval between declaration of donor brain death and the beginning of the cold ischemia time before graft explantation was defined as duration of brain death (DBD). The influence of DBD on incidence of primary graft function and on duration of delayed kidney graft function as well as on kidney graft survival was analyzed in 1106 patients transplanted in one center and confirmed in a validation study of a second series of 752 kidney graft recipients from another transplant center. Kidney grafts harvested from donors with longer DBD (>470 min) exhibited a significantly higher incidence of primary graft function and a significantly better graft survival rate in comparison to kidneys from donors with a shorter DBD (<470 min). The tendency of these results could be confirmed in an independent validation study; however, the differences were not statistically significant. Although the dramatic hemodynamic and immunological changes in brain-dead donors may impair the quality of a potential kidney transplant, a longer duration of donor brain death did not deteriorate early and long-term kidney graft function.     

Predictive Capacity of Pre-Donation GFR and Renal Reserve Capacity for Donor Renal Function After Living Kidney Donation

Kidney transplantation from living donors is important to reduce organ shortage. Reliable pre-operative estimation of post-donation renal function is essential. We evaluated the predictive potential of pre-donation glomerular filtration rate (GFR) (iothalamate) and renal reserve capacity for post-donation GFR in kidney donors. GFR was measured in 125 consecutive donors (age 49 +/- 11 years; 36% male) 119 +/- 99 days before baseline GFR (GFRb) and 57 +/- 16 days after donation (GFRpost). Reserve capacity was assessed as GFR during stimulation by low-dose dopamine (GFRdopa), amino acids (GFRAA) and both (GFRmax). GFRb was 112 +/- 18, GFRdopa 124 +/- 22, GFRAA 127 +/- 19 and GFRmax 138 +/- 22 mL/min. After donation, GFR remained 64 +/- 7%. GFRpost was predicted by GFRb(R2 = 0.54), GFRdopa(R2 = 0.35), GFRAA(R2 = 0.56), GFRmax(R2 = 0.55)and age (R2 = -0.22; p < 0.001 for all). Linear regression provided the equation GFRpost = 20.01 + (0.46*GFRb). Multivariate analysis predicted GFRpost by GFRb, age and GFRmax(R2 = 0.61, p < 0.001). Post-donation renal function impairment (GFR < or = 60 mL/min/1.73 m2) occurred in 31 donors. On logistic regression, GFRb, body mass index (BMI) and age were independent predictors for renal function impairment, without added value of reserve capacity. GFR allows a relatively reliable prediction of post-donation GFR, improving by taking age and stimulated GFR into account. Long-term studies are needed to further assess the prognostic value of pre-donation characteristics and to prospectively identify subjects with higher risk for renal function loss.     

The Prognostic Value of Renal Resistance During Hypothermic Machine Perfusion of Deceased Donor Kidneys

Vascular renal resistance (RR) during hypothermic machine perfusion (HMP) is frequently used in kidney graft quality assessment. However, the association between RR and outcome has never been prospectively validated. Prospectively collected RR values of 302 machine‐perfused deceased donor kidneys of all types (standard and extended criteria donor kidneys and kidneys donated after cardiac death), transplanted without prior knowledge of these RR values, were studied. In this cohort, we determined the association between RR and delayed graft function (DGF) and 1‐year graft survival. The RR (mmHg/mL/min) at the end of HMP was an independent risk factor for DGF (odds ratio 21.12 [1.03–435.0]; p = 0.048) but the predictive value of RR was low, reflected by a c‐statistic of the receiver operator characteristic curve of 0.58. The RR was also found to be an independent risk factor for 1‐year graft failure (hazard ratio 12.33 [1.11–136.85]; p = 0.004). Determinants of transplant outcome are multifactorial in nature and this study identifies RR as an additional parameter to take into account when evaluating graft quality and estimating the likelihood of successful outcome. However, RR as a stand‐alone quality assessment tool cannot be used to predict outcome with sufficient precision.     

安胎养血合剂对大鼠移植肾Fas/FasL基因表达及细胞凋亡的影响

目的：研究中药安胎养血合剂对移植肾肾小管上皮细胞凋亡及Fas/FasL基因表达的影响，探讨其免疫抑制作用的机制。方法：建立大鼠肾移植模型，随机分为3组，每组12对。分别为对照组：（Wistar→Wistar大鼠），给予生理盐水灌胃；生理盐水组：（SD→Wistar大鼠），给予生理盐水灌胃；安胎养血合剂组：（SD→Wistar大鼠），给予安胎养血合剂灌胃。于术后第5d处死动物取肾脏组织，通过TUNEL法检测凋亡指数和RT-PCR检测Fas/Fas-L的mRNA表达。结果：用TUNEL检测移植肾脏凋亡指数，生理盐水组凋亡细胞最多，对照组中凋亡细胞极少见，安胎养血合剂组和生理盐水组肾脏细胞凋亡指数比较差异有显著意义（P＜0.05）。生理盐水组肾小管上皮细胞Fas-L的mRNA表达显著增高，安胎养血合剂组Fas-L的mRNA表达显著减少，与生理盐水组之间比较有显著差异（P＜O.05）。结论：安胎养血合剂可以通过下调移植肾脏肾小管上皮细胞Fas-L的mRNA表达，来减少移植肾的细胞凋亡，起到免疫抑制剂的作用。     

男性肾移植受者手术前后的勃起功能状况及动脉吻合方式对其影响

目的:评价男性肾移植受者手术前后的勃起功能状况及不同动脉吻合方式对勃起功能的影响。方法:选取22～60岁、移植后存活1年以上、血清肌酐9个月内维持在200μmol/L以下的已婚男性肾移植受者55例,其中采用供肾动脉与髂内动脉端端吻合的39例,供肾动脉与髂外动脉端侧吻合的16例。运用IIEF-5对患者移植前及移植后3、6、9个月的勃起功能进行调查,并评价移植所采用的动脉吻合方式对其影响。其中25例分别在移植前和移植后1个月检测其垂体性激素的变化。结果:肾移植术后3、6、9个月患者的IIEF-5评分与术前比较,差异有显著性(P<0.05);IIEF-5评分肾移植术后6个月、9个月患者与术后3个月比较,差异有显著性(P<0.05);术前血液透析时间在12个月以内的患者IIEF-5评分高于血液透析时间在12个月以上的患者(P<0.05);移植后9个月髂外动脉端侧吻合者的勃起功能好于髂内动脉端端吻合者,差异具有显著性(P<0.05);移植术后1个月患者的垂体激素水平与移植前差异有显著性(P<0.05)。结论:肾移植后,患者的勃起功能及垂体激素水平得到了改善,而采用髂外动脉与供肾动脉吻合的患者勃起功能恢复要好于采用髂内动脉与供肾动脉吻合的患者。