腹腔血流阻断动脉介入化疗对肝脏影响的实验性研究

目的观察腹腔内区域性血流阻断动脉内介入化疗(stop-flow)对肝脏的影响及其可能机制。方法将12只健康雌性幼猪随机分为两组,一组行腹腔血流阻断动脉内介入化疗(SFC组),另一组为单纯腹腔血流阻断(SF组)。应用RT-PCR检测肝脏组织白介素(IL)-8及ICAM-1mRNA表达;Westernblot检测核转录因子(NF)-κBP65亚基在细胞核内表达;测定外周静脉血丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)以及观察肝脏组织形态学改变,以评价阻断前及阻断区域血流循环再通后不同时间段肝脏损伤程度。结果Stop-flow(血流阻断时间为20min)引起阻断区域血流循环再通30min时肝脏组织细胞核内NF-κBP65亚基表达升高,IL-8及ICAM-1mRNA转录活性增强,但于再通后3h、6h逐渐减弱。血清ALT及AST于术后48h内轻度升高,并在升高24h后达到高峰(ALT为89.9U/L及93.2U/L,AST为185.5U/L及217.0U/L),术后1周恢复至术前水平。组织学改变表现为阻断区域血流循环再通后早期肝细胞小泡性脂肪变性伴轻度PMN浸润,肝小叶结构未见明显破坏,上述各种改变在SF组及SFC组之间差异无统计学意义。结论Stop-flow腹腔血流阻断20min引起的肝脏损害是自限且可逆的,不会引起肝脏结构和功能的严重损害。

Study of hepatic injury during stop-flow chemotherapy

OBJECTIVE: To observe the hepatic injury following stop- flow chemotherapy and investigate the potential mechanisms. METHODS: Twelve healthy hybrid female pigs were randomly divided into two groups as stop- flow group (SF) and stop- flow chemotherapy (SFC) group. The expression of IL- 8 and ICAM- 1 mRNA in hepatic biopsies was detected by RT- PCR, and the expression of NF- kappa B P65 subunit in nuclei was assessed by Western blot analysis. The levels of ALT and AST, and histopathologic alterations were examined to evaluate the hepatic function at different time before and after stop- flow procedure. RESULTS: The expression of NF- kappa B P65 subunit, IL- 8 and ICAM- 1mRNA increased at 30 min after stop- flow procedure, and gradually decreased at 3 h and 6 h after stop- flow procedure. The levels of ALT and AST decreased after reaching the peak at 24 h after stop- flow procedure, but recoved one week after stop- flow procedure. Cytoplasmic microvascular steatosis developed with appreciable neutrophils infiltration after early stop- flow procedure without significant destroy occurred in the structure of hepatic lobule. No significant difference of various parameters above occurred between SF and SFC groups. CONCLUSION: The hepatic injury following stop- flow procedure was self-limited and reversible. There is no severe destroy of hepatic structure and disfunction during stop- flow chemotherapy.