胰岛移植术后立即经血液介导的炎症反应机制

目的初步探讨胰岛移植术后立即经血液介导的炎症反应(instant blood-mediated in-flammatory reaction,IBMIR)的发生机制。方法Wistar大鼠,雌雄不限,体重为250～300g,分离、纯化胰岛,建立体外循环模型,于37℃下循环反应60min后加入胰岛800当量模拟IBMIR,分别于循环前、加入胰岛前、加入胰岛后5min、15min、30min、60min后留取血液行血常规检测,用酶标法检测血浆凝血酶-抗凝血酶复合物(thrombin-antithrombin complex,TAT),并用酶联免疫吸附法检查血浆补体3a(C3a)含量。循环60min后取过滤残余血栓和组织行形态学检查。结果加入胰岛体外循环60min后血液中的血小板几乎全部耗竭,白细胞及单核细胞减少亦较为明显,但淋巴细胞比例变化不明显。血浆中的TAT、C3a含量随循环时间延长而增加。循环60min后的过滤残余的血栓块和组织中胰岛数量较少,结构破坏严重,被膜不完整,胰岛周围被微血栓包绕,大量中性粒细胞浸润。结论凝血反应、补体激活和白细胞激活可能是导致IBMIR的重要机制。

Mechanism of instant blood mediated inflammatory reaction in islet transplantation

Objective To investigate the possible mechanism of instant blood mediated inflammatory reaction （IBMIR） after islet transplantation.Methods A extracorporeal circulation model under 37℃ condition was established on Wistar rats and 800 Eq isolated islet was administrated systematically to mimic IBMIR after sixty minutes circulation.The blood samples were obtained at different time point （before circulation,before islets administration and 5 min,15 min,30 min,60 min after islets administration） for hematologic analysis.At the same time,the concentration of TAT and C3a were measured.After circulation,HE staining was performed on the filtered residual thrombus and tissue.Results The number of blood platelet,white blood cell,mononuclear cells were significantly decreased after 60 min （P 0.05）.The concentration levels of TAT and C3a were significantly increased.The residual thrombus and tissue had few islet cells with severe structural damage and an incomplete capsule,and islet were surrounded by microthrombus.Conclusion IBMIR may be induced by platelet consumption,activation of the coagulation and complement cascade systems,and leukocyte infiltration.