Hanazaki K, Monma T, Hiraguri M, Ohmoto Y, Kajikawa S, Matsushita A, Nimura Y, Koide N, Adachi W, Amano J
Second Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
Hepatogastroenterology. 2001 Jan-Feb;48(37):188-92.
BACKGROUND/AIMS: The aim of this study was to evaluate the inflammatory or antiinflammatory cytokine response to ischemia-reperfusion during hepatectomy and to find a useful marker of injury or surgical stress during hepatic ischemia-reperfusion.
In 9 patients with liver disease who underwent hepatectomy using the Pringle maneuver, serum cytokines, including alanine transaminase, aspartate transaminase, and hyaluronic acid, were measured just prior to vascular occlusion; 5, 10 and 15 min after initial clamping; and 3 min after initial declamping.
The mean concentrations of aspartate transaminase and alanine transaminase did not significantly differ before and after ischemia-reperfusion during hepatectomy. However, mean concentrations of hyaluronic acid after ischemia-reperfusion were significantly (P < 0.03) higher than before clamping. Although there were no significant differences in the mean concentrations of IL-1 beta, IL-6, IL-8, IL-10 and TNF-alpha among, before and after ischemia-reperfusion, the mean concentrations of granulocyte colony-stimulating factor after ischemia-reperfusion and macrophage colony-stimulating factor after reperfusion were significantly (P < 0.05) higher than before clamping.
Although hepatic parenchymal cell function was maintained after ischemia-reperfusion during hepatectomy, sinusoidal endothelial cell dysfunction was found. Release of granulocyte colony-stimulating factor and macrophage colony-stimulating factor after ischemia-reperfusion were also found. These cytokines and hyaluronic acid may be useful indicators in the early phase of human ischemia-reperfusion injury during hepatectomy.
背景/目的：本研究旨在评估肝切除术中缺血再灌注时的炎性或抗炎性细胞因子反应，并寻找肝缺血再灌注期间损伤或手术应激的有用标志物。
对9例接受普林格尔手法肝切除术的肝病患者，在血管阻断前、初次夹闭后5、10和15分钟以及初次松开夹闭后3分钟测量血清细胞因子，包括丙氨酸转氨酶、天冬氨酸转氨酶和透明质酸。
肝切除术中缺血再灌注前后，天冬氨酸转氨酶和丙氨酸转氨酶的平均浓度无显著差异。然而，缺血再灌注后透明质酸的平均浓度显著高于夹闭前（P<0.03）。尽管缺血再灌注前后白细胞介素-1β、白细胞介素-6、白细胞介素-8、白细胞介素-10和肿瘤坏死因子-α的平均浓度无显著差异，但缺血再灌注后粒细胞集落刺激因子的平均浓度和再灌注后巨噬细胞集落刺激因子的平均浓度显著高于夹闭前（P<0.05）。
尽管肝切除术中缺血再灌注后肝实质细胞功能得以维持，但发现了肝窦内皮细胞功能障碍。还发现了缺血再灌注后粒细胞集落刺激因子和巨噬细胞集落刺激因子的释放。这些细胞因子和透明质酸可能是肝切除术中人类缺血再灌注损伤早期阶段的有用指标。
