Pulitano Carlo, Joseph David, Sandroussi Charbel, Verran Deborah, Ho Phong, Debiasio Ashe, Luongo Adriano, McCaughan Geoffrey W, Shackel Nicholas A, Crawford Michael
Centenary Research Institute, University of Sydney, Sydney, NSW, Australia.
Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Liver Transpl. 2017 Apr;23(4):527-536. doi: 10.1002/lt.24721.
Despite the growing data supporting the role of microcirculation in regulating liver function, little of this knowledge has been translated into clinical practice. The aim of this study is to quantify hepatic microcirculation in vivo using sidestream dark field (SDF) imaging and correlate these findings with hepatic blood flow, hemodynamic parameters, and soluble mediators. Postreperfusion hepatic microcirculation was assessed using SDF imaging. Hepatic microcirculation measurements included functional sinusoidal density (cm/cm ), sinusoidal diameter (μm), red blood cell velocity (μm/second), volumetric blood flow (pl/second), and flow heterogeneity (FH) index. The serum concentrations of endothelin 1 (ET-1) and other inflammatory markers were analyzed with Luminex technology. Portal venous and hepatic artery flows were measured using a flowmeter. Twenty-eight patients undergoing cadaveric liver transplantations have been included in this study. Early allograft dysfunction (EAD) occurred in 7 (25%) patients and was associated with microcirculatory dysfunction. Low arterial and portal flow, high dose of inotropes, cold ischemia time, steatosis, and high ET-1 levels were all associated with impaired microcirculation. The time interval between portal venous and hepatic arterial reperfusion significantly correlated with the changes of the liver grafts' microcirculation. EAD patients tended to have higher serum levels of ET-1 on postoperative days 1, 2, 5, and 7 (all P < 0.01). Serum levels of ET-1 correlated significantly with microcirculation parameters. In conclusion, postreperfusion hepatic microcirculation is a determinant of organ dysfunction after liver reperfusion and could be used to identify very early patients at risk of EAD. Liver Transplantation 23 527-536 2017 AASLD.
尽管越来越多的数据支持微循环在调节肝功能中的作用，但这些知识很少被转化为临床实践。本研究的目的是使用侧流暗场（SDF）成像在体内量化肝微循环，并将这些发现与肝血流、血流动力学参数和可溶性介质相关联。使用SDF成像评估再灌注后肝微循环。肝微循环测量包括功能性肝血窦密度（cm/cm）、肝血窦直径（μm）、红细胞速度（μm/秒）、容积血流量（pl/秒）和血流异质性（FH）指数。使用Luminex技术分析内皮素1（ET-1）和其他炎症标志物的血清浓度。使用流量计测量门静脉和肝动脉血流。本研究纳入了28例接受尸体肝移植的患者。7例（25%）患者发生早期移植物功能障碍（EAD），且与微循环功能障碍相关。低动脉和门静脉血流、高剂量的血管活性药物、冷缺血时间、脂肪变性和高ET-1水平均与微循环受损相关。门静脉和肝动脉再灌注之间的时间间隔与肝移植微循环的变化显著相关。EAD患者在术后第1、2、5和7天的血清ET-1水平往往较高（均P < 0.01）。ET-1血清水平与微循环参数显著相关。总之，再灌注后肝微循环是肝再灌注后器官功能障碍的决定因素，可用于早期识别有EAD风险的患者。《肝脏移植》2017年第23卷第527 - 536页，美国肝脏病研究协会。
