门静脉及股静脉注射对导入基因在肝脏表达影响的比较

目的研究外源基因的门静脉途径和股静脉途径注射对导入基因在肝脏内表达和分布的影响。方法分别采用门静脉和股静脉的注射方法将包装好的连有目的基因的腺病毒载体导入小鼠体内。在注射后不同时间处死小鼠,分离肝脏,通过血清生化指标和HE染色检测评价两种方法对肝脏的损伤,利用免疫组织化学、Real-time PCR和Western blot等方法测定目的基因和载体标签蛋白在肝脏内的表达及分布情况。结果注射3d后,血清生化指标检测结果显示门静脉注射组丙氨酸转氨酶(alanine aminotransferase,ALT)和天冬氨酸转氨酶(aspartate aminotransferase,AST)水平明显高于股静脉注射组;HE染色结果同样表明门静脉注射组肝组织内出现炎性细胞浸润,较股静脉注射组更明显;Real-time PCR、Western blot及免疫组织化学检测均显示门静脉注射后,目的基因在肝脏内的表达明显早于股静脉注射组,但至注射后7d时两组目的基因的表达水平已无明显差异。结论与门静脉注射相比,股静脉注射外源基因对肝脏基本没有损伤,目的基因的表达虽然较晚,但也能达到门静脉注射水平。     

不解剖GLISSON鞘区域血流阻断肝脏肿瘤切除

目的:探讨不解剖Glisson鞘区域血流阻断肝脏肿瘤切除的临床应用价值。方法:回顾性分析哈尔滨医科大学附属第一医院普外科2000年6月-2013年6月对40例肝脏肿瘤患者施行的肝部分切除术的临床资料。将手术分为不解剖Glisson鞘区域血流阻断切肝组(A组)20例和第一肝门入肝血流阻断切肝组(B组)20例,比较两组术后的手术时间、术中出血量、术中输血量、术后肝功能的恢复、术后并发症以及住院时间等情况。结果:两组在手术时间方面存在明显差异。而其他指标,如术中出血量、术中输血量、术后肝功能的恢复、术后并发症以及住院时间等,A组也明显优于B组。结论:不解剖Glisson鞘区域血流阻断技术能够有效的控制术中出血,减轻肝脏缺血再灌注损伤,防止术中由门静脉介导的癌细胞肝内扩散,是一种合理的血流阻断方法。     

昆明小鼠和DBA/2小鼠尾静脉注射L1210细胞的比较研究

目的:通过尾静脉注射L1210细胞建立昆明小鼠及DBA/2小鼠的白血病模型,观察肿瘤细胞的迁移情况以及小鼠存活时间,为后续L1210细胞迁移的细胞内信号通路研究及抗肿瘤药物筛选奠定基础。方法:常规培养小鼠白血病细胞L1210系,将昆明小鼠及DBA/2小鼠随机分为对照组(A、C)和实验组(B、D),实验组尾静脉注射5×10^6L1210细胞,对照组注射等体积的PBS。昆明小鼠组饲养56d,DBA/2小鼠组饲养14d。定期测量小鼠体重并观察小鼠形态,取濒死小鼠以及最后解剖的小鼠的心、肝、脾、肺等脏器称重并测量,统计结果。结果:A、B、C、D组小鼠的平均存活天数分别为56、56、13.83±0.37、10.33±3.40d。昆明小鼠实验组脾脏明显肿大,肺脏有少量白细胞浸润,心脏和肝脏无明显变化,无死亡现象;DBA/2小鼠注射L1210细胞后第7d开始出现死亡,随着饲养时间的延长,死亡率不断上升。结论:昆明小鼠或DBA/2小鼠尾静脉注射L1210细胞均可引起肿瘤细胞的体内浸润。昆明小鼠尾静脉注射L1210细胞存活时间长,适合长期观察或周期比较长的实验;DBA/2小鼠尾静脉注射L1210细胞存活时间短,但实验现象明显。后期研究可以针对不同的研究目的和实验周期来选择合适的实验模型。     

半肝阻断联合肝静脉阻断在复杂肝癌精准肝切除中的应用

目的:探讨半肝血流阻断联合肝静脉阻断技术在精准肝切除中的应用价值。方法:回顾性分析我科2013年1月至2014年12月共120例行半肝血流阻断联合肝静脉阻断的精准肝切除病例,作为治疗组。另选单用第一肝门阻断的复杂肝癌半肝切除患者318例为对照。结果:治疗组在控制术中出血和输血量方面优于单用半肝血流阻断的对照组,治疗组术中平均出血量为650±46 m L,平均输血量为410±76 m L,差别有统计学意义(P0.05);治疗组在平均手术时间和平均住院时间方面均少于对照组,但两组差别无统计学意义(P0.05)。结论:半肝血流阻断联合肝静脉阻断技术在复杂肝癌的精准肝切除术中合理使用能有效的减少术中出血,提高了手术安全,降低了术中输血量,最大限度保留剩余肝细胞体积,减少了缺血再灌注的损失。     

外源性H2S对糖尿病小鼠肝纤维化的作用及其机制*

目的: 探讨外源性硫化氢(H₂S)对糖尿病小鼠肝纤维化作用及其相关机制。方法: 将 C57 雄性体重为(22±2)g 24只小鼠随机分为3组(n=8):①正常对照组(Control):小鼠腹腔注射生理盐水,注射时间同实验组;②糖尿病模型组(HG):按体重(150 mg/kg)一次性腹腔注射链脲佐菌素(STZ)诱导小鼠建立糖尿病模型;③NaHS 处理组(HG + NaHS):方法同组别②,只是糖尿病模型建立后,腹腔注射NaHS(100 μmol/L·kg·d),每天一次,连续12周。HE染色检测肝细胞损伤;Masson染色检测肝纤维化;Western blot检测相关蛋白胱硫醚-β-合成酶(CBS,内源性H₂S产生的关键酶)、胶原I (Col-I)、胶原III (Col-III)和基质金属蛋白酶-9(MMP-9)的表达。结果: 与对照组比较,糖尿病模型组肝细胞损伤及肝纤维化均显著加重,CBS 蛋白表达显著减少(P＜0.01),Col-I、Col-III和MMP-9蛋白表达均显著增加(P＜0.01)。与糖尿病模型组比较,NaHS处理组肝细胞损伤及肝纤维化均显著减轻、CBS 蛋白表达显著增加、Col-I、Col-III和MMP-9蛋白表达均减少(P＜0.01)。结论: 外源性H₂S可抑制糖尿病小鼠肝纤维化,其机制与降低胶原含量和基质金属蛋白酶-9的表达相关。     

脐带间充质干细胞移植对慢性试验性肝损伤的治疗作用

目的观察脐带间充质干细胞（UC-MSC）对慢性实验性肝损伤的治疗作用并探讨其分子生物学机理。方法 50只7周龄的NOD/SCID小鼠注射四氯化碳（CCL4）制备慢性肝损伤模型后,应用随机数字表的方法随机将实验小鼠随机分成2组：模型组（25只）和UC-MSC移植组（25只）。UC-MSC移植组通过尾静脉注射移植1×106 UC-MSC,模型组注射同样体积的PBS。分别于移植后1、2、3和4周收集肝组织,应用免疫组织化学,RT-PCR和Western blot的方法分析细胞移植前后肝组织的病理生理学特征的变化。采用t检验和方差分析进行统计学分析。结果 UC-MSC移植治疗后肝组织表达人肝细胞特异性AFP,Alb,和内皮细胞特异性CD31,Flk-1。细胞移植4周后v WF标记的血管密度明显增加,同时伴有部分的肝功能改善,谷丙转氨酶（ALT）水平从（55.71±11.33）U/L减至（36.75±12.80）U/L（P〈0.05）。此外,本研究结果表明UC-MSC分泌几种重要的生长因子HGF,FGF-2,VEGF,和VEGF受体通过旁分泌的途径发挥肝组织修复的功能。结论在CCL4诱导的慢性肝损伤模型肝组织,人UC-MSC可以分化成肝细胞样细胞和内皮细胞样细胞,同时旁分泌多种细胞生长因子修复损伤的肝细胞,并伴有肝功能的改善。认为UCMSC移植或许成为将来肝脏损伤疾病一个重要的治疗选择。     

携两性霉素B的聚氰基丙烯酸正丁酯纳米粒对大鼠肝肾功能及血液系统的影响

目的研究携载两性霉素B的聚氰基丙烯酸正丁酯纳米粒(AmB-PBCA-NP)对大鼠肝、肾及血液系统的影响。方法大鼠随机分4组,分别经尾静脉注射AmB、AmB-PBCA-NP、PBCA-NP及表面活性剂聚山梨酯-80,定时取血检测丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、尿素氮(BUN)、肌酐(Cr)及红细胞(RBC)、血红蛋白(Hb)、白细胞(WBC)、血小板(BPC)等指标。结果AmB组大鼠给药后1d、1周的RBC分别为(4.302±0.3)和(3.3±0.37)×1012/L,AmB-PBCA-NP组分别为(4.77±0.49)和(4.88±0.46)×1012/L,溶血反应明显降低;AmB组给药后ALT及AST水平明显升高,分别为1059.2±119.22、466.6±357.30μmol/L(1天)和1755±175.39、2684.2±494.74μmol/L(1周),而AmB-PB-CA-NP组、载体材料组及表面活性剂组的大鼠肝、肾功能未发生明显变化。结论AmB-PBCA-NP能够显著降低AmB对肝、肾及血液系统的毒副作用。     

红色诺卡氏菌细胞壁骨架对小鼠肝癌细胞生长的抑制效果

目的:通过构建H22荷瘤小鼠模型,观察红色诺卡氏菌细胞壁骨架(Nocardia Rubra Cell Wall Skeleton,N-CWS)对H22荷瘤小鼠肝癌细胞生长的抑制效果。方法:复苏并培养H22细胞,将H22细胞以皮下方式接种到小鼠右侧腋部,建立H22荷瘤小鼠肝癌模型,随机分为对照组(生理盐水组)、低浓度N-CWS组(400μg/m L)与高浓度N-CWS组(800μg/m L),分别灌胃1次/d,共灌胃14 d,最长接种肿瘤15 d后处死小鼠,观察肝癌细胞的大小和重量。结果:治疗组小鼠肿瘤质量明显低于对照组(1.46±0.16)g,且高浓度组小鼠肿瘤质量(0.52±0.13)g明显低于低浓度组(0.79±0.13)g,组间对比差异有统计学意义(P0.05)。在治疗第3 d起直至结束,治疗组小鼠肿瘤体积均明显低于对照组,从第5 d起直至结束,高浓度组小鼠肿瘤体积明显低于低浓度组(P0.05)。第5 d起至结束,治疗组小鼠肿瘤体积增长的变化明显缓于对照组(P0.05)。高浓度组小鼠肿瘤体积的增长在第5 d后明显缓于低浓度组(P0.05)。对照组在第9 d时,增长变化最为显著,较第7 d增加约400 mm3。低浓度组变化较稳定。高浓度组肿瘤增长明显变缓,第7 d后最为明显,后逐渐趋于缓和。结论:N-CWS可以明显抑制肿瘤生长,且高浓度N-CWS抑制肿瘤生长效果更佳。     

山丹黄参多糖对四氯化碳致小鼠急性肝损伤的影响

为了研究山丹黄参多糖对四氯化碳(CCl4)致小鼠(Mus musculus)急性肝损伤及相关酶活性的影响,对50只小鼠分别灌胃0.2 ml山丹黄参多糖(12.5、25.0、37.5 g/L)或生理盐水7 d,最后一次灌胃1 h后腹腔注射1%的CCl4橄榄油溶液0.2 ml,16 h后处死小鼠,比色法检测血浆丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)活力的变化,显微镜观察肝组织结构的变化,免疫组织化学法检测肝组织中转化生长因子-β_1(TGF-β_1)表达的变化。与正常对照组相比,实验对照组小鼠体重减轻,血浆丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)活力显著升高(P0.01),肝明显肿胀,肝组织结构不清,肝细胞出现炎性坏死,转化生长因子-β_1(TGF-β_1)阳性表达明显增强(P0.01)。与实验对照组相比,山丹黄参多糖各组小鼠体重增加,血浆丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)活力明显降低(P0.01),肝无明显肿胀,肝索清晰,炎性坏死很少,细胞结构清晰,转化生长因子-β_1阳性表达明显减少(P0.01)。表明一定剂量的山丹黄参多糖能增强机体活力,促进机体新陈代谢,降低正常细胞的凋亡,对四氯化碳造成的肝组织损伤有一定的保护作用。     

小鼠肝纤维化中内质网应激分子的表达与作用

[目的]利用高脂饲料和异种血清诱导建立肝纤维化模型,检测内质网应激分子在该纤维化模型中的作用及机制。[方法]收集各组小鼠血清进行ALT检测,对小鼠肝组织进行HE和Masson染色观察肝组织的结构变化以及胶原纤维状况,并分别用Western和RT-PCR检测组织内CRT、GRP78、TLR2等基因的表达。[结果]与正常对照组(48.8±6.1 U/L)相比高脂饲料饮食组(139.7±13.4 U/L)、腹腔注射异种血清组(72.8±7.2U/L)以及高脂饲料联合腹腔异种血清注射组(193.0±14.1 U/L)血清ALT显著升高(p0.05);镜下也观察到肝细胞脂肪变性,大量的胶原纤维产生;肝组织内GRP78和TLR2基因mRNA水平、CRT蛋白水平均升高(p0.05)。[结论]高脂饲料和异种血清诱导建立的肝纤维化模型显示内质网应激与肝纤维化的发生发展密切相关。     

Monitoring of Systemic and Hepatic Hemodynamic Parameters in Mice

The use of mouse models in experimental research is of enormous importance for the study of hepatic physiology and pathophysiological disturbances. However, due to the small size of the mouse, technical details of the intraoperative monitoring procedure suitable for the mouse were rarely described. Previously we have reported a monitoring procedure to obtain hemodynamic parameters for rats. Now, we adapted the procedure to acquire systemic and hepatic hemodynamic parameters in mice, a species ten-fold smaller than rats. This film demonstrates the instrumentation of the animals as well as the data acquisition process needed to assess systemic and hepatic hemodynamics in mice. Vital parameters, including body temperature, respiratory rate and heart rate were recorded throughout the whole procedure. Systemic hemodynamic parameters consist of carotid artery pressure (CAP) and central venous pressure (CVP). Hepatic perfusion parameters include portal vein pressure (PVP), portal flow rate as well as the flow rate of the common hepatic artery (table 1). Instrumentation and data acquisition to record the normal values was completed within 1.5 h. Systemic and hepatic hemodynamic parameters remained within normal ranges during this procedure.This procedure is challenging but feasible. We have already applied this procedure to assess hepatic hemodynamics in normal mice as well as during 70% partial hepatectomy and in liver lobe clamping experiments. Mean PVP after resection (n= 20), was 11.41±2.94 cmH₂O which was significantly higher (P<0.05) than before resection (6.87±2.39 cmH₂O). The results of liver lobe clamping experiment indicated that this monitoring procedure is sensitive and suitable for detecting small changes in portal pressure and portal flow rate. In conclusion, this procedure is reliable in the hands of an experienced micro-surgeon but should be limited to experiments where mice are absolutely needed.     

胸段硬膜外阻滞对家猪肝缺血再灌注时微循环的影响

目的：探讨胸段硬膜外阻滞对家猪肝缺血再灌注时微循环的影响。方法：14只健康幼年家猪,随机分为两组：硬膜外组（E组）和对照组（C组）,每组7只。基础麻醉后,进行气管插管机械通气,侧卧位行胸段硬膜外穿刺（T8-9）置管。经腹正中切口暴露肝脏,分离肝十二肠韧带,游离肝左动脉及门静脉左支备用。E组给予0．5％布比卡因0．75mL／节段（阻滞T5-T12脊神经）,C组给予相同容积的生理盐水。硬膜外给药15min后,夹闭肝左动脉及门静脉左支45min,然后开放肝左动脉及门静脉左支进行再灌注4h。分别在缺血前（TO）,缺血末（T1）,再灌注1h（T2）,2h（T3）,4h（T4）采血样用于测定AST,ALT,NO,ET-1,TNF-α,IL-1β和ATP。实验结束后取肝脏组织样本测定MDA和观察肝脏病理变化。结果：E组各时点MAP水平低于C组,有统计学差异（P〈0．05）;pH值以及PaC02两组间无明显差异;E组各时点AST,ALT,ET-1,TNF-α,IL-1β浓度低于C组,有统计学差异（P〈0．05）,NO及ATP浓度高于C组,有统计学差异（P〈0．05）;MDA含量c组高于E组,有统计学差异（P〈O．05）。光镜下可见E组肝组织损伤程度轻于C组。结论：胸段硬膜外阻滞可以增加肝脏能量的生成,纠正NO／ET的失衡,减少促炎介质的生成,从而改善微循环障碍的程度减轻肝缺血再灌注损伤。     

Arterial blood ketone body ratio as an indicator of the no-return point in hepatic inflow occlusion without venous shunt in dogs

The effects of hepatic inflow occlusion without venous shunt on the viability of the liver were investigated with respect to liver energy metabolism in dogs, subjected to portal triad cross-clamping (Pringle's maneuver) for 10, 30 and 60 min. The concentrations of ketone bodies and the arterial blood ketone body ratio (KBR) were decreased markedly by hepatic inflow occlusion, but recovered upon recirculation. The initial velocity of KBR recovery was 0.150/min after 10-min clamping, 0.140/min after 30-min clamping and 0.032/min after 60-min clamping. KBR recovery was delayed when hepatic inflow occlusion exceeded 30 min, which indicates that hepatic inflow occlusion for 60 min causes severe inhibition of energy generation in liver mitochondria. These findings indicate that the safety period for hepatic inflow occlusion without venous shunt is between 30 and 60 min in dogs, and that mortality can be predicted by measuring the initial velocity of KBR recovery upon recirculation.     

Hepatic neovascularization after partial portal vein ligation: novel mechanism of chronic regulation of blood flow

The present study was undertaken to investigate hepatic microcirculatory response following partial portal vein ligation (PPVL) in rats. Portal pressure was markedly increased 2-6 wk after PPVL, but no significant reduction in sinusoidal perfusion and hepatocellular injury were detected. However, marked neovascularization was observed in PPVL rats using intravital microscopy and scanning electron microscopy (SEM). Extremely high red blood cell velocity (2,000-4,900 microm/s) was seen in these vessels. Injection of fluorescein sodium via the carotid artery revealed that the neovessels originated from the hepatic arterial vasculature. This was further confirmed by clamping the common hepatic artery and phenylephrine injection from the carotid artery. These vessels maintained sufficient flow after massive sinusoidal shutdown elicited by the portal infusion of endothelin receptor B agonist IRL-1620. SEM also showed extensive neovascularization at the hilum. Additionally, clamping the portal vein decreased sinusoidal perfusion only by 9.5% in PPVL, whereas a 71.2% decrease was observed in sham. These results strongly suggest that the liver maintains its microcirculatory flow by vascular remodeling from the hepatic arterial vasculature following PPVL.     

脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析

目的:探讨脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响,并分析患者术后门静脉血栓形成的危险因素。方法:选择2016年1月-2017年12月在我院进行脾切除及贲门周围血管离断术的96例肝硬化门静脉高压患者,于术前、术后1d、3d、7d采用彩色多普勒超声对患者的肝脏血流动力学指标进行动态监测。统计术后7d内患者门静脉血栓的发生率,并将患者分为血栓组(n=28)和无血栓组(n=68),对两组患者的一般资料、手术指标、彩色多普勒超声监测指标等进行单因素分析,并采用Logistic多因素回归分析门静脉血栓形成的危险因素。结果:患者在术前、术后1d、3d、7d时的门静脉内径、最大流速、血流量呈逐渐降低的趋势,肝动脉内径、最大流速、血流量呈逐渐升高的趋势,且各时间点间两两比较差异有统计学意义(P0.05)。术后7d内有28例患者出现门静脉血栓,发生率为29.17%。血栓组和无血栓组患者在性别、年龄、体质量指数、手术时间、术前门静脉流速比较差异无统计学意义(P0.05);血栓组患者Child-Pugh分级为B级比例、术中出血量、脾质量、腹水量、术前门静脉内径均高于无血栓组,术后门静脉内径、术后门静脉流速均低于无血栓组(P0.05)。经Logistic多因素回归分析显示,患者术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素(P0.05)。结论:行脾切除及贲门周围血管离断术的肝硬化门静脉高压患者术后进行肝脏血流动力学监测,有助于患者术后的疗效判断,且术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素。     

16层螺旋CT灌注成像对肝硬化血流状态的评估及与肝硬化程度的相关性研究

目的:探讨16层螺旋CT灌注成像对肝硬化血流状态的评估价值及其与肝硬化程度的相关性。方法:选取2014年1月至2016年1月于我院接受诊治的肝硬化患者126例作为肝硬化组,根据Child-Pugh分级分为A组(Child A级,n=35例)、B组(Child B级,n=50例)、C组(Child C级,n=41例)。另选取同期于我院接受体检的健康人员100例作为对照组。应用16层螺旋CT对受试者肝脏、脾脏、主动脉以及门静脉的层面进行CT动态增强扫描,对比CT灌注参数,采用Pearson相关性分析分析CT灌注参数与肝硬化病情严重程度的关系。结果:肝硬化组肝动脉灌注量(HAP)、肝动脉灌注指数(HPI)、肝脏血流量(TBV)以及平均通过时间(MTT)均明显高于对照组,而门静脉灌注量(PVP)、总肝灌注量(TLP)均明显低于对照组(P0.05)。A组患者HAP、HPI均明显高于C组,而PVP与TLP均明显低于C组,差异有统计学意义(P0.05);两组TBV、MTT比较无统计学差异(P0.05);而A组与B组相比以及B组与C组相比,各项CT灌注参数均无统计学差异(P0.05)。肝硬化患者病情严重程度与HAP、HPI均呈正相关关系(P0.05),而与PVP、TLP均呈负相关关系(P0.05)。结论:16层螺旋CT灌注成像对肝硬化血流状态具有一定的评估价值,且CT灌注参数的水平变化与肝硬化患者病情严重程度存在密切相关。     

Diminished hyperaemic response of the hepatic artery to portal venous occlusion (the buffer response) in Asian hybrid minipigs: a comparison of the response to that observed in dogs

The hyperaemic response of the hepatic artery to portal vein occlusion (the buffer response) and the action of exogenous adenosine upon hepatic artery blood flow was studied in Asian hybrid minipigs as a potential alternative experimental model to that previously developed in dogs. Adenosine produced a dose-dependent hepatic artery vasodilatation, but of lesser extent than that observed in dogs. A greatly diminished buffer response was observed in the pigs compared to that seen in dogs, and could not be replicated consistently. The adenosine uptake inhibitor dipyridamole did not potentiate responses to adenosine or the buffer response. It is concluded that the minipig is an unsuitable alternative model for the study of the hepatic artery buffer response.Abbreviations bw body weight - DPD dipyridamole - GDV gastroduodenal vein - HA hepatic artery - PV portal vein - PVO portal venous occlusion - PVP portal venous pressure - SE standard error     

Vagus nerve is involved in lack of blood reflow into sinusoids after rat hepatic ischemia

Although recovery of microcirculation is an important determinant for ischemia-reperfusion injury, little information is available about hepatic blood flow after ischemia. To examine regulatory mechanisms of postischemic hepatic microcirculation, we studied the sinusoidal blood flow after portal triad clamping of rat livers for 5, 15, or 30 min. Hepatic tissue blood flow and erythrocyte blood flow in sinusoids were measured using a laser-Doppler flowmeter and an intravital microspectroscope, respectively. There was a time of no blood flow (lag time) in sinusoids after declamping, dependent on the ischemic time. Cholinergic blockade agents eliminated the lag time, whereas nerve stimulation at the hiatus esophagus or on the hepatoduodenal ligament during reperfusion prolonged it. Chemical denervation with 10% phenol or surgical denervation on the hepatoduodenal ligament eliminated the lag time. The prolongation of lag time by nerve stimulation was completely abrogated by truncal vagotomy. These results suggest that the cholinergic vagus nerve is involved in causing the lag time of sinusoidal blood flow in hepatic ischemia-reperfusion.