[1]季锡清,李朝龙,杨进城,等.血流阻断的缺血预处理技术在肝癌切除术中的应用[J].南方医科大学学报,2004,(01):66-68,71.
 JI Xi-qing,LI Chao-long,YANG Jin-cheng,et al.Application of ischemic preconditioning before hepatic vascular exclusion for resection of hepatocellular carcinoma[J].Journal of Southern Medical University,2004,(01):66-68,71.
点击复制

血流阻断的缺血预处理技术在肝癌切除术中的应用()
分享到:

《南方医科大学学报》[ISSN:1673-4254/CN:44-1627/R]

卷:
期数:
2004年01期
页码:
66-68,71
栏目:
出版日期:
2004-01-01

文章信息/Info

Title:
Application of ischemic preconditioning before hepatic vascular exclusion for resection of hepatocellular carcinoma
作者:
季锡清 李朝龙 杨进城 刘兴国 王孟龙 林智琪 林建华
第一军医大学南方医院肝胆血管外科, 广东, 广州, 510515
Author(s):
JI Xi-qing LI Chao-long YANG Jin-cheng LIU Xing-guo WANG Meng-long LIU Zhi-qi LIN Jian-hua
Department of Hepatobil iary Surgery, Nanfang Hospital, First Military Medical University, Guangzhou 510 515, China
关键词:
缺血预处理肝癌原发性肝切除血流阻断凋亡Fas-mRNA表达Caspase-3
Keywords:
ischemic preconditioninghepatocellular carcinoma primaryhepatectomyvascular exclusionapoptosisFas-mRNA expressionCa spase-3
分类号:
R657.31
摘要:
目的 探讨缺血预处理(ischemic preconditioning, IP)在血流阻断的伴有肝硬化的肝癌切除中的保护作用机制及临床应用价值。方法 将本院手术切除的34例原发性肝癌患者随机分为2组,IP组18例,肝门阻断切肝前先给予缺血5 min、灌注5 min的缺血预处理;对照组16例,单纯肝门阻断切肝,2组手术由同一组医师完成。比较2组患者手术前后肝功能的变化和肝灌注1 h时肝组织Fas-mRNA表达、Caspase-3活性变化和细胞凋亡的情况。结果 术后1、3、7 d,IP组的血清天门冬氨酸氨基转移酶、丙氨酸氨基转移酶水平明显低于对照组(t=6.985, P<0.01);术后3、7 d,IP组的总胆红素明显低于对照组(t=3.447, P<0.05);术后1 d,IP组的白蛋白高于对照组(t=3.360, P<0.05)。术后1 h,IP组肝组织Fas-mRNA表达、Caspase-3活性和细胞凋亡均明显低于对照组(t=3.771, P<0.05)。结论 IP对肝癌患者入肝血流阻断肝切除术后的肝功能有良好的保护作用,其保护机制是通过下调Fas-mRNA表达和抑制Caspase-3的活性,从而抑制肝细胞凋亡,该技术简便易行值得临床推广应用。
Abstract:
Objective To assess the value of clinical application of i sc hemic preconditioning (IP) before hepatic vascular ex-clusion for resection of h epatocellular carcinoma (HCC) accompanied by cirrhosis and explore the possible mechanism under-lying the protective effect of this maneuver.Methods Thirty-four consecutive patients with resectable HCC were randomized into IP group to receive IP with a 5-min ischemia followed by 5-min perfusion before hepatic vascula r exclusion and the con-trol group with simply hepatic vascular exclusion. The liver function, hepatic Fas mRNA expression, caspase-3 activity, apop-tosis of th e hepatocytes were compared between the two groups.Results In the IP group, the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on p ostoperative day 1, 3 and 7 were all significantly higher than those of the con trol group (t=6.985, P<0.01). The total bilirubin levels were also higher in the former group on postoperative day 3 and 7 (t=3.447, P<0.05). The IP group had h igher albumin levels on postoperative day 1 than the control group (t=3.360, P<0 .05). After 1 hour’s reperfusion, the hepatic mRNA expression of Fas, caspase-3 activity and apoptotic sinusoidal endothelial cells were all significantly hig her than those of the control group (t=3.771, P<0.05).Conclusions IP has a prot ective effect on liver function after hepatic resection with hepatic vascular e xclusion in HCC patients, possibly due to the inhibition of hepatocyte apoptosi s by down-regulating hepatic Fas mRNA expression and caspase-3 activity, and is a convenient technique applicable in such operations as hepatic transplants and hepatectomy.

参考文献/References:

[1] 冀亚琦,朱平,童健,等.缺血预适应对未成熟大鼠心肌线粒体及能量代谢的影响[J].第一军医大学学报,2001,21(1):22-4.Ji YQ,7hu P,Tong J,et al.Protective effects ofischemicpreconditioning 0n mitochondria and energy metabolism in immature rat myocardial cells against subsequentischemia and reperfusion[J].J First Mil Med Univ/Di Yi Jun YiDa Xue Xue Bao,2001,21(1):22-4.
[2] Fan YD,Leroux RG,Praet M,et al.Evaluation ofgraft viability in heterotopic auxiliarylivertransplantationinthe rat[J].JInv Surg,1999,12(6):327-34.
[3] 欧阳伟,钱学贤,李志梁,等.降钙素基因相关肽在整体大鼠心肌缺血预适应中的作用及其与ATP敏感钾通道的关系[J].第一军医大学学报,2001,21(1):25-8.Ouyang YW,Qian XX,Li ZL,et al. Role of calcitonin gene-related peptide in myocardial ischemic preconditioning and its relation with ATP-sensitive K+ channel in intact rats[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2001,21(1):25-8.
[4] Yamamoto S,Yang G,Zablocki D,et al. Activation of Mstl causes dilated cardiomyopathy by stimulating apoptosis without compensatory ventricular myocyte hypertrophy[J]. J Clin Invest,2003,111(10):1463-74.
[5] Gho BC,Shoemarker RG,van Dendoel MA,et al. Myocardial protection by brief ischemia in non-cardiac tissues[J]. Circulation,1996,94:2193-200.
[6] Nisson B. Preconditioning protects against ischemia reperfusion injury of the liver[J]. J Gastrointest Surg,2000,4(1):44-9.
[7] Clavien PA,Yadav S,Sindram D,et al. Protective effects of ischemic preconditioning for liver resection performed under hepatic blood inflow occlusion in humans[J]. Ann Surg,2000,232(2):155-62
[8] 欧阳伟,钱学贤,李志梁.失血预适应对大鼠心肌缺血-再灌注损伤的保护作用[J].第一军医大学学报,2003,23(1):65-7.Ouyang YW,Qian XX,Li ZL. Protective effects of preconditioning phlebotomy against myocardial ischemia-reperfusion injury in rat[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2003,23(1):65-7.
[9] Marcde P,Mingyao L,Thomas KW,et al. Ischemia reperfusion induced lung injury[J]. Am Res Critil Care Med,2003,167(4):490-512.
[10] Marcelo DG,Douglas VC,Marise RM,et al. Ischemic preconditioning of renal tissue:Identification of early up-regulated genes[J].Nephron.Basel,2003,93(3):107-17.
[11] 汪群力,王钢,王华民,等.腺苷、二氮嗪及缺血预处理对缺血再灌注损伤肢体的作用[J].第一军医大学学报,2002,22(7):617-9.Wang QL,Wang G,Wang HM,et al. Effect of pretreatment with adenosine,diazoxide or ischemic preconditioning on ischemiareperfusion injury in the limbs of rats[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2002,22(7):617-9.
[12] Pring P,Changxu S,Jun Z,et al. Formation of protein kinase C (epsilon)-Lek signaling modules confers cardioprotection[J]. Clin Invest,2002,109(5):499-507.
[13] 孙永建,王前,裴国献,等.热应激预处理对大鼠肢体缺血再灌注后血清丙二醛、超氧化物歧化酶的影响[J].第一军医大学学报,2002,22(6):506-8.Sun YJ,Wang Q,Pei GX,et al. Changes of serum MDA and SOD levels in isehemia-reperfusion injuries of the limbs in rats preconditioned with heat stress[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2002,22(6):506-8.
[14] 申洪.免疫组织化学染色定量方法研究[J].中国组织化学与细胞化学杂志(Chin Histochemist Cytochemst),1995,4(1):89- 91.
[15] Takehara T,Hayashi N,Mita E,et ad. Delayed Fas-mediated hepatocyte apoptosis during liver regeneration in mice:hepatoprotective role of TNFα[J]. Heapatology,1998,27(6):1643-51.
[16] Gao W,Bentley R,Madden J,et al. Apoptosis ofsinusoidal cells is a critical mechanism of preservation injury in rat liver transplantation[J]. Hepatology,1998,27(45):1652-60.
[17] Kohli V,Madden J,Bentley R,et al. Calpain mediated ischemic injury of the liver through modulation ofapoptosis and necrosis[J].Gastroenterology,1999,116(2):168-78.

相似文献/References:

[1]陈耿臻,韩慧,许铭炎,等. 重组腺病毒ADV-TK 基因的构建及其对肝癌细胞的杀伤作用[J].南方医科大学学报,2010,(08):1887.
 CHEN Geng-zhen,HU Hui,XU Ming-yan,et al. Construction of recombinant adenovirus containing TK gene and its effect against human liver cancer cells[J].Journal of Southern Medical University,2010,(01):1887.
[2]凌志海,孙权权,张耀伟,等.吉西他滨增强肝癌HepG2细胞体外辐射敏感性的机制研究[J].南方医科大学学报,2011,(12):1993.
[3]陈建发,李宇华,陈引香,等.Apollon siRNA提高肝癌细胞化疗敏感性的实验研究[J].南方医科大学学报,2011,(10):1701.
[4]潘明新,张翌,李爱辉,等.蛋白激酶C和丝裂原活化的蛋白酶家族对缺血预处理肝脏的保护作用及其机制[J].南方医科大学学报,2006,(08):1188.
 PAN Ming-xin,ZHANG Yi,LI Ai-hui,et al.Protective effect of protein kinase C and mitogen-activated protein kinases and its mechanism in liver ischemic preconditioning[J].Journal of Southern Medical University,2006,(01):1188.
[5]杨义明,杜钢军,林海红.沙利度胺治疗肝癌的实验研究[J].南方医科大学学报,2005,(08):925.
 YANG Yi-ming,DU Gang-jun,LIN Hai-hong.Experimental study of thalidomide for treatment of murine hepatocellular carcinoma[J].Journal of Southern Medical University,2005,(01):925.
[6]王素珍,孟维静,安洪庆,等.基于倾向指数匹配法的肝癌病人疗效评价[J].南方医科大学学报,2012,(09):1234.
[7]阳洁,覃贵慧,陈军泽.慢病毒介导shRNA靶向下调Cx26表达对人高侵袭性肝癌细胞上皮间质转化及侵袭的影响[J].南方医科大学学报,2014,(12):1743.
[8]肖芦山,邹雪晶,胡威,等.microRNA-107在肝癌中的表达及临床意义[J].南方医科大学学报,2016,(07):974.
[9]玉艳红,原彤彤,黄力毅,等.外周血单核细胞hFgl2蛋白表达与不同临床类型肝病的关系[J].南方医科大学学报,2013,(03):436.
[10]戴小珍,熊新,王兰,等.CXCR7-shRNA慢病毒载体对人肝癌细胞生长及侵袭能力的抑制作用[J].南方医科大学学报,2013,(07):994.

备注/Memo

备注/Memo:
收稿日期:2003-6-23。
基金项目:广东省计划攻关项目(02B30204)
作者简介:季锡清(1968- ),男,第一军医大学在读硕士研究生,主治医师.电话:020-61641114-87180
更新日期/Last Update: 1900-01-01