Pesonen E J, Linder N, Raivio K O, Sarnesto A, Lapatto R, Höckerstedt K, Mäkisalo H, Andersson S
Children's Hospital, University of Helsinki, Helsinki, Finland.
Gastroenterology. 1998 May;114(5):1009-15. doi: 10.1016/s0016-5085(98)70321-x.
BACKGROUND & AIMS: Oxygen free radicals, generated by xanthine oxidase (XO) and activated leukocytes, are involved in reperfusion injury in experimental liver transplantation. The roles of XO and neutrophil activation during reperfusion in clinical liver transplantation were studied.
In 10 patients undergoing liver transplantation, we assessed plasma concentrations of circulating XO by enzyme-linked immunosorbent assay (ELISA), the purine metabolites hypoxanthine, xanthine, and urate by high-performance liquid chromatography, lactoferrin by ELISA, and malondialdehyde fluorometrically up to 48 hours postoperatively.
During reperfusion after portal vein declamping, elevated plasma concentrations of XO (52.1 ng/mL [range, 8.0-440.1]), hypoxanthine (81.62 micromol/L [48.2-108.7]), xanthine (21.01 micromol/L [8.7-22.3]), and lactoferrin (532.6 ng/mL [370.4-1326.6]) were observed compared with the preoperative levels (0 ng/mL [0-12], 1.88 micromol/L [0.62-3.15], 0.95 micromol/L [0-0.41], and 164.3 ng/mL [73.7-334.1], respectively; all P < 0.05). No changes occurred in urate or malondialdehyde. After portal vein declamping, XO, hypoxanthine, and xanthine levels were substantially greater in the hepatic than portal vein (all P < 0.05). Marginal transhepatic differences occurred in lactoferrin.
Reperfusion during liver transplantation is associated with liberation of xanthine oxidase, hypoxanthine, and xanthine from the liver into the circulation. During reperfusion, intravascular neutrophil activation takes place in the hepatic circulation.
由黄嘌呤氧化酶（XO）和活化白细胞产生的氧自由基参与了实验性肝移植中的再灌注损伤。本研究旨在探讨XO和中性粒细胞活化在临床肝移植再灌注过程中的作用。
对10例接受肝移植的患者，采用酶联免疫吸附测定（ELISA）法评估循环中XO的血浆浓度，采用高效液相色谱法测定嘌呤代谢产物次黄嘌呤、黄嘌呤和尿酸，采用ELISA法测定乳铁蛋白，采用荧光法测定丙二醛，观察时间至术后48小时。
门静脉开放后再灌注期间，与术前水平相比（分别为0 ng/mL [0 - 12]、1.88 μmol/L [0.62 - 3.15]、0.95 μmol/L [0 - 0.41]和164.3 ng/mL [73.7 - 334.1]；均P < 0.05），观察到血浆中XO（52.1 ng/mL [范围，8.0 - 440.1]）、次黄嘌呤（81.62 μmol/L [48.2 - 108.7]）、黄嘌呤（21.01 μmol/L [8.7 - 22.3]）和乳铁蛋白（532.6 ng/mL [370.4 - 1326.6]）浓度升高。尿酸或丙二醛无变化。门静脉开放后，肝脏中XO、次黄嘌呤和黄嘌呤水平显著高于门静脉（均P < 0.05）。乳铁蛋白在肝脏和门静脉之间存在微小差异。
肝移植再灌注与肝脏中黄嘌呤氧化酶、次黄嘌呤和黄嘌呤释放入循环有关。再灌注期间，肝循环中发生血管内中性粒细胞活化。
