热缺血损伤对大鼠移植肝组织能量代谢及存活期的影响

目的：探讨不同热缺血时间下大鼠肝组织能量代谢变化规律,预测供肝耐受热缺血的安全时限。方法：实验动物按供肝热缺血时间分别为0、10、15、20、30、45和60min,随机分为7组。采用反相高效液相色谱法测定单纯热缺血后肝组织能量代谢指标并进行超微结构的观察。然后按各组条件分别作原位肝移植,观察移植后24、48h各组肝组织能量代谢指标的恢复性变化,并统计生存时间。结果：供肝经受热缺血损伤后,肝组织ATP含量和EC水平远逐渐下降,其中前30min下降比较急剧,以后趋向平缓。热缺血30min内肝组织ATP含量和EC水平在肝移植再复流24h后基本得到恢复,术后大鼠仍可以获长期存活。45min组,移植肝在48h后能量代谢的功能也基本恢复,虽不足以影响术后的1周存活率,但对大鼠肝移植术后的3个月存活率影响显著。60min组,肝脏能量代谢储备功能难以恢复,大鼠术后生存天数显著降低。结论：供肝组织三磷酸腺苷（ATP）含量和能荷（EC）水平以及其移植术后恢复的潜能是衡量供肝质量的重要标准。供肝热缺血损伤的时间与肝组织能量代谢功能的恢复及术后动物生存情况密切相关。

Influence of warm ischemia injury on energy metabolism and survival of liver graft in rats

OBJECTIVES: To investigate the energy metabolism and post transplantation survival of liver graft under different warm ischemia times (WIT) in rats and determine the maximum limitation of liver graft to warm ischemia. METHODS: According to WIT, the rats were randomized into 7 groups, and WIT were 0, 10, 15, 20, 30, 45, 60 minutes respectively. The indexes of energy metabolism were measured by reversed-phase high performance liquid chromatography (HPLC) and all liver graft specimens were subjected to ultrastructural observation. After orthotopic liver transplantation (OLTx), the recovery of energy metabolism of liver graft after 24, 48 hours and the rats' survival were observed. RESULTS: The levels of adenosine triphosphate (ATP) and energy charge (EC) decreased gradually after different WIT in a time-dependent manner, and especially significant within 30 minutes. The levels of ATP and EC of liver grafts were largely recovered after 24 hours of OLT within 30 minutes of warm ischemia, partially recovered after 48 hours of OLT with 45 minutes of warm ischemia and hardly recovered even after 48 hours of OLT with 60 minutes of warm ischemia. The rat survival time after OLT was not significantly different within 30 minutes of WIT, while the long-term survival was insulted with 45 and 60 minutes of WIT. CONCLUSIONS: The levels of ATP and EC after OLT may be the important criteria to evaluate the quality of liver graft. WIT of liver graft is closely related to both the recovery of hepatic energy metabolism and the liver graft survival.