Obermaier R, von Dobschuetz E, Drognitz O, Hopt U T, Benz S
Department of General and Visceral Surgery, Albert-Ludwigs-University, Hugstetter Strasse 55, 79106 Freiburg, Germany.
Langenbecks Arch Surg. 2004 Nov;389(6):511-6. doi: 10.1007/s00423-003-0443-x. Epub 2004 Jan 9.
Ischemic preconditioning (IPC) has been shown to protect several organs from ischemia-reperfusion injury. Postischemic microvascular dysfunction is considered to be the key mechanism of early graft pancreatitis after transplantation. The aim of the study was to determine whether brief ischemia and reperfusion before prolonged ischemia followed by reperfusion is protective in respect to microcirculatory derangement in postischemic pancreatitis.
In an in-situ model of ischemia-reperfusion was induced in the isolated pancreatic tail segment. Wistar rats were randomized to one group ( n=7/group) with 2-h ischemia and reperfusion (I/R) and another group with 10-min ischemia and 10-min reperfusion (IPC) before the prolonged ischemia time. Microcirculation was observed for 2 h by intravital-fluorescence microscopy that analyzed functional capillary density and leukocyte adherence in postcapillary venules. Histological damage was quantified by a semiquantitative score (edema, vacuolization, PMN infiltration, necrosis).
IPC resulted in a significant improvement of functional capillary density (248+/-20 vs 372+/-8 cm(-1), P<0.001), a significant reduction in leukocyte adherence in postcapillary venules (476+/-79 vs 179+/-15 cells/mm(2), P<0.001) and in significantly lower histological damage (score 9+/-0.8 vs 5+/-1.4, P<0.001), when compared with the ischemia-reperfusion group.
IPC reduces pancreatic inflammatory reaction by preservation of postischemic microcirculation. Therefore, it might become a useful procedure before organ procurement in pancreas transplantation.
缺血预处理（IPC）已被证明可保护多个器官免受缺血再灌注损伤。缺血后微血管功能障碍被认为是移植后早期移植胰腺胰腺炎的关键机制。本研究的目的是确定在长时间缺血后再灌注之前进行短暂缺血和再灌注是否对缺血后胰腺炎的微循环紊乱具有保护作用。
在离体胰尾段诱导缺血再灌注原位模型。将Wistar大鼠随机分为两组（每组n = 7），一组进行2小时的缺血再灌注（I/R），另一组在长时间缺血前进行10分钟缺血和10分钟再灌注（IPC）。通过活体荧光显微镜观察微循环2小时，分析毛细血管后微静脉中的功能性毛细血管密度和白细胞黏附情况。组织学损伤通过半定量评分（水肿、空泡化、中性粒细胞浸润、坏死）进行量化。
与缺血再灌注组相比，IPC导致功能性毛细血管密度显著改善（248±20 vs 372±8 cm⁻¹，P<0.001），毛细血管后微静脉中的白细胞黏附显著减少（476±79 vs 179±15 个细胞/mm²，P<0.001），组织学损伤显著降低（评分9±0.8 vs 5±1.4，P<0.001）。
IPC通过保留缺血后微循环减轻胰腺炎症反应。因此，它可能成为胰腺移植器官获取前的一种有用方法。
