Liver Transplantation Ward, Department of Hepatic and Biliary Pancreatic Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China.
Eur Rev Med Pharmacol Sci. 2017 Oct;21(19):4362-4368.
To study the inflammatory factors in donor livers and its effect on recipient myocardial injury after liver transplantation recipients.
Eighteen patients who underwent orthotopic liver transplantations between January 2014 and December 2015 in our hospital were selected. A portion of the hepatic venous blood of donor's livers was preserved in heparinized tubes after partial resection. The concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), and the activity of lactate dehydrogenase (LDH) in serum were measured. The concentrations of TNF-α, IL-6, cTnI, and CK-MB, and the activity of LDH in serum from the central venous blood of recipients were measured at several time points.
Persistent myocardial injuries were found in five patients, six experienced a transient increase of cardiac markers after surgery and returned to normal levels 24 h after surgery, and the others were normal. The comparison of the levels of inflammatory factors in serum between the five donors and recipients at different stages showed that the levels of myocardial markers of the donor livers which were supplied to the five cardiac injured patients were all significantly higher than those of other donor's livers, while the levels of serum inflammatory factors in recipients showed no changes during the T0-T2 stage but increased significantly during T3-T5 (p < 0.05). The cardiac function after surgery was significantly different from that before surgery and that of the recipients without myocardial injury (p < 0.05).
Blood pressure changes before surgery may affect the levels of inflammatory factors in donor's liver and cause postoperative myocardial injury in recipients. Proper hypotensive therapy for donors before partial liver resection can prevent postoperative myocardial injury in recipients.
研究供肝组织中的炎症因子及其对肝移植受体心肌损伤的影响。
选取我院 2014 年 1 月至 2015 年 12 月期间 18 例行原位肝移植术患者，供肝切取后保存部分肝静脉血于肝素化管中，采用酶联免疫吸附法检测血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、心肌肌钙蛋白 I（cTnI）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）的浓度，于术前（T0）、术后即刻（T1）、术后 1 h（T2）、术后 3 h（T3）、术后 5 h（T4）、术后 24 h（T5）时取受体中心静脉血检测以上指标浓度。
术后 5 例患者持续存在心肌损伤，6 例患者术后出现心肌标志物短暂升高，术后 24 h 恢复正常，其余患者心肌标志物均正常。5 例供肝均供应心肌损伤患者的血清心肌标志物水平均显著高于其他供肝者，差异有统计学意义（p＜0.05），而各时间点受体血清炎症因子水平 T0-T2 时段无变化，T3-T5 时段明显升高，差异有统计学意义（p＜0.05）。术后心脏功能与术前及无心肌损伤受体比较，差异均有统计学意义（p＜0.05）。
术前血压变化可能影响供肝组织中炎症因子水平，导致受体术后心肌损伤，供肝切取前适当降压治疗可能预防受体术后心肌损伤。
