Koti Rahul S, Seifalian Alexander M, Davidson Brian R
University College London and Royal Free Hospital NHS Trust, London, UK.
Dig Surg. 2003;20(5):383-96. doi: 10.1159/000072064. Epub 2003 Jul 2.
Ischemic preconditioning refers to the endogenous mechanism of protection against a sustained ischemic insult following an initial, brief ischemic stimulus. Ischemia-reperfusion injury of the liver is a major cause of morbidity and mortality in liver surgery and transplantation and ischemic preconditioning is a promising strategy for improving the outcome of liver surgery. The preconditioning phenomenon was first described in a canine model of myocardial ischemia-reperfusion injury in 1986 and since then has been shown to exist in other organs including skeletal muscle, brain, kidneys, retina and liver. In the liver, the preconditioning effect has been demonstrated in rodents and a recent study has demonstrated human clinical benefits of preconditioning during hemihepatectomies. Ischemic preconditioning has been described as an adaptive response and although the precise mechanism of hepatoprotection from preconditioning is unknown it is likely to be a receptor-mediated process. Several hypotheses have been proposed and this review assesses possible mechanisms of ischemic preconditioning and its role in hepatic surgery and liver transplantation. The future lies in defining the mechanisms of the ischemic preconditioning effect to allow drug targeting to induce the preconditioning response.
缺血预处理是指机体在经历初始短暂缺血刺激后，产生的一种针对持续缺血损伤的内源性保护机制。肝脏缺血再灌注损伤是肝脏手术和肝移植中发病和死亡的主要原因，而缺血预处理是改善肝脏手术预后的一种有前景的策略。预处理现象于1986年在犬心肌缺血再灌注损伤模型中首次被描述，此后已证实在包括骨骼肌、脑、肾、视网膜和肝脏在内的其他器官中也存在。在肝脏中，预处理效应已在啮齿动物中得到证实，最近的一项研究表明，在半肝切除术中进行预处理对人类临床有益。缺血预处理被描述为一种适应性反应，尽管缺血预处理肝脏保护的确切机制尚不清楚，但很可能是一个受体介导的过程。已经提出了几种假说，本综述评估了缺血预处理的可能机制及其在肝脏手术和肝移植中的作用。未来在于明确缺血预处理效应的机制，以便通过药物靶向诱导预处理反应。
