大鼠肝缺血再灌注损伤对心脏能量代谢和结构的影响及其机制

目的：探讨肝缺血再灌注损伤对心脏能量代谢和结构的影响及其可能的发生机制。方法：健康雄性Wistar大鼠48只，随机分为对照组、缺血30 min组（I组）及缺血30 min再灌注即刻组、2 h组、4 h组和6 h组（I/R组、I/R 2 h组、I/R 4 h组和I/R 6 h组），每组8只。用偶氮显色法测定血清中的内毒素，用放射免疫法测定心肌组织胰岛素和胰岛素抗体，取心肌制备组织匀浆测丙二醛（MDA）、髓过氧化物酶（MPO），乳酸含量。 结果：在肝缺血再灌注损伤过程中，内毒素在I组和I/R组达到高峰，随着再灌注时间的延长逐渐下降，但仍高于对照组（P<0.05）。I组及I/R各组MDA的含量明显高于对照组，在I/R 2 h组、I/R 4 h组、I/R 6 h组差别更为明显（P＜0.05）；再灌注各组MPO活性明显高于对照组、I组（P＜0.05）；随着再灌注时间的延长，心肌组织中乳酸含量明显增加（P＜0.05），但在I/R 6 h组呈下降趋势（P＜0.05）；胰岛素的含量在I/R 4 h组和I/R 6 h组明显下降（P＜0.05）；而胰岛素抗体在各组间无显著差异（P＞0.05）。结论：肝缺血再灌注损伤过程中，肠源性内毒素吸收入血及肝脏解毒功能的降低所致的内毒素血症可能是引起心脏能量代谢和结构改变的始动环节。

Changes of cardiac energy metabolism and structure during ischemia/reperfusion injury of liver in rats

AIM: To investigate the effect and mechanism of liver ischemia/reperfusion (I/R) injury on the changes of cardiac energy metabolism and structure. METHODS: 48 healthy Wistar male rats were randomly divided into 6 groups as follows (n=8 in each group): control group (CTL), simply ischemia for 30 min without reperfusion(I group); reperfusion following ischemia for 30 min (I/R group); 2 h reperfusion following ischemia for 30 min (I/R 2 h group); 4 h reperfusion following ischemia for 30 min (I/R 4 h group) and 6 h reperfusion following ischemia for 30 min (I/R 6 h group). The level of serum endotoxin was measured. The levels of insulin and insulin antibody in heart were detected by radioimmunoassay. The contents of MDA, MPO and lactic acid in heart were also determined. RESULTS: During the process of liver I/R injury, the level of endotoxin increased in I group and I/R group and declined gradually for long time during reperfusion, but was still longer than that in CTL group (P<0.05). The level of MDA obviously increased in I group and in all reperfusion groups compared to CTL (P<0.05). The obvious significant differences among I/R 2 h group, I/R 4 h group, I/R 6 h group with CTL were observed (P<0.05). The activities of MPO obviously increased in all reperfusion groups, there was also an obvious significant difference compared with CTL and I group (P<0.05). The level of lactic acid obviously increased with prolongation in reperfusion (P<0.05), but decreased in I/R 6 h group (P<0.05). The level of insulin decreased in I/R 4 h group and I/R 6 h group (P<0.05). No difference of insulin antibody was observed among all groups (P>0.05). CONCLUSION: During the process of liver I/R injury, endotoxin is absorbed from intestine and impairment of liver detoxication leads to endotoxemia, which might play a role in the changes of the energy metabolism and structure in heart.