门静脉淤血对硬化肝脏缺血再灌注的损伤作用

研究肝硬化大鼠肝缺血再灌注(HepaticIscheiaReperfusion,HIR)损伤的机制。方法用60%四氯化碳(CCl4)溶液皮下注射的方法制作肝硬化大鼠模型。随机分为四组A组假手术组(6只)，B组单纯肠系膜上静脉阻断(16只)，C组肝门阻断+门腔转流(16只)，D组肝门完全阻断40min(16只)。观察丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、透明质酸(HA)、肿瘤坏死因子(TNF)、7d存活率及肝、肺病理的变化。结果B、C、D组的7d存活率分别为5/10只、8/10只、4/10只；再灌注后4h血清TNF含量，B、C、D组分别为(0.631±0.198)u/ml、(0.596±0.223)u/ml、(0.789±0.371)u/ml，明显高于术前的(0.177±0.139)u/ml和A组的(0.315±0.182)u/ml(P＜0.01)；D组再灌注4h的AST明显高于C组(P＜0.01)；C组的AST、ALT显著高于B组(P＜0.05)；同时的HA水平，D组明显高于B组，C组显著高于A组(P＜0.01)；肝、肺组织学检查可见肝、肺的病理损害，程度以D组最重、B组次之。结论门脉淤血是导致肝硬化大鼠HIR损伤乃至死亡的主要原因。

TO INVESTIGATE THEMECHANISMS OF HIR INJURY IN CIRRH OTIC RAT LIVER

To investigate the mechanisms of HIR i njury in cirrhotic rat liver.Methods:At first,the rats with cir rhotic liver were produced by carbon tetrachloride(CCL4) injected subcutaneously . Then these rats were divided into four groups randomly.Group A(n=6) were made sh a m operation,only opened their abdomens,not cross-clamped the hepatic hila;In gro u p B(n=16),the superior mesenteric vein was occulded for 40min with arteral and p ortal hepatic inflow from the spleinic vein maintained.In group C(n=16),extracor poreal portosystemic shunt from portal vein to inferior vena cava was performed to avoid portal venous congestion during pringle's maneuver for 40min .In group D(n=16)，total hepatic ischemia with portal venous congestion was induced by pr ingle's maneuver for 40min.The 7 day survival rate、AST、ALT、HA、TNF and liver 、pulmonary histology were observed.Results:The 7 day survival rate of Group B、C、D were separately 50%、80%、40%.The level of TNF in group B 、C、D increased significantly 4hr after reperfusion,compared with it (0.177±0. 139u/ml)before operation,and in group A(0.315±0.182u/ml)(P＜0.01).TNF of Group B、C、D were separately 0.631±0.198u/ml、0.596±0.223u/ml、0.789±0.371u/ml.Th e level of AST 4hr after reperfusion in group D was higher significantly than it in group C(P＜0.01).And AST、ALT of group C were higher than those of group B (P ＜0.05).HA of group D was higher than group B,C was higher than A significantly, 4hr after reperfusion (P＜0.01).Liver and lung histology could be found the aspe ct of injure.Conclusions:The portal venous congestion was the im portant factor of HIR injury in cirrhotic rat liver.