Fang Haoshu, Liu Anding, Chen Xulin, Cheng Wenhui, Dirsch Olaf, Dahmen Uta
1Department of Pathophysiology, Anhui Medical University, Hefei, 230032 China.
2Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Friedrich-Schiller-University Jena, Drackendorferstraße1, 07747 Jena, Germany.
J Inflamm (Lond). 2018 Nov 15;15:21. doi: 10.1186/s12950-018-0197-4. eCollection 2018.
High levels of serum lipopolysaccharide (LPS) were observed in sepsis patients with liver injury and high mortality. However, the role of liver in modulation LPS induced inflammatory injury was ill investigated. In the present study, the severity of LPS induced inflammatory response was observed after liver resection or portal branch occlusion to decreasing functional liver mass. The local and systemic damage was observed to investigate the role of liver in modulation inflammatory injury.
First, 30%, 70%, and 90% partial hepatectomy (PH) were performed, and serum TNF-α, survival rate, and hepatic LPS uptake was observed. Second, LPS-exposure of the functional liver mass was decreased by selectively blocking the RL prior to LPS-injection, which was given 30 min before a 70% PH, and the inflammatory response was compared in the occluded and the non-occluded liver. The control group was subjected to LPS injection 30 min prior to liver resection without blocking the RL transiently. The serum TNF-α, ALT, AST, creatinine levels, and urea levels, survival rate, hepatic LPS uptake, and hepatic inflammatory cytokines was observed.
The decreasing of functional liver mass after 90%, 70%, and 30% PH was associated with decreased serum TNF-α, survival rate, and increased hepatic LPS uptake after LPS injection. Occluding the right lobes (RL) prior to LPS administration reversed the liver injury caused by 70% PH, indicated by 100% survival rate and decreased liver and kidney injury, and systemic inflammatory response. The induction of inflammatory response in occluding liver lobes were lower than un-occluding liver lobes.
The severity of the LPS-induced systemic inflammatory injury is determined by functional liver volume. This observation suggests that the liver is the central organ for the initiation of the inflammatory response, and is involved in causing a severe SIRS with systemic damage and death.
在伴有肝损伤且死亡率高的脓毒症患者中观察到血清脂多糖(LPS)水平升高。然而,肝脏在调节LPS诱导的炎症损伤中的作用尚未得到充分研究。在本研究中,通过肝切除或门静脉分支结扎以减少功能性肝质量后,观察LPS诱导的炎症反应的严重程度。观察局部和全身损伤以研究肝脏在调节炎症损伤中的作用。
首先,进行30%、70%和90%的部分肝切除术(PH),并观察血清肿瘤坏死因子-α(TNF-α)、生存率和肝脏LPS摄取情况。其次,在注射LPS前30分钟通过选择性阻断右叶(RL)来减少功能性肝质量对LPS的暴露,在70%肝切除术前30分钟给予LPS,比较结扎和未结扎肝脏中的炎症反应。对照组在肝切除术前30分钟注射LPS,不短暂阻断RL。观察血清TNF-α、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐水平和尿素水平、生存率、肝脏LPS摄取以及肝脏炎症细胞因子。
90%、70%和30%肝切除术后功能性肝质量的减少与LPS注射后血清TNF-α降低、生存率降低以及肝脏LPS摄取增加有关。在给予LPS前结扎右叶可逆转70%肝切除术所致的肝损伤,表现为100%的生存率以及肝脏和肾脏损伤及全身炎症反应减轻。结扎肝叶中炎症反应的诱导低于未结扎肝叶。
LPS诱导的全身炎症损伤的严重程度由功能性肝体积决定。这一观察结果表明,肝脏是炎症反应起始的中心器官,并参与导致伴有全身损伤和死亡的严重全身炎症反应综合征(SIRS)。