文章摘要
詹传飞,饶建华,丁文斌,张 杰,戴佳敏,孙 瑜,钱晓峰.短期禁食预处理对肝脏部分切除术后缺血再灌注损伤保护作用的临床研究[J].南京医科大学学报,2017,(2):207~211,246
短期禁食预处理对肝脏部分切除术后缺血再灌注损伤保护作用的临床研究
Protective effects of short-term fasting on hepatic ischemia/reperfusion Injury
投稿时间:2016-05-17  
DOI:10.7655/NYDXBNS20170215
中文关键词: 短期禁食  肝癌  肝切除术  缺血/再灌注损伤
英文关键词: short-term fasting  liver cancer  hepatectomy  ischemia/reperfusion injury
基金项目:国家自然科学基金项目面上项目(81273262)
作者单位
詹传飞 南京医科大学第一附属医院肝脏外科/肝脏移植中心,国家卫生和计划生育委员会活体肝移植重点实验室,江苏 南京 210029 
饶建华 南京医科大学第一附属医院肝脏外科/肝脏移植中心,国家卫生和计划生育委员会活体肝移植重点实验室,江苏 南京 210029 
丁文斌 南京医科大学第一附属医院肝脏外科/肝脏移植中心,国家卫生和计划生育委员会活体肝移植重点实验室,江苏 南京 210029 
张 杰 南京医科大学第一附属医院肝脏外科/肝脏移植中心,国家卫生和计划生育委员会活体肝移植重点实验室,江苏 南京 210029 
戴佳敏 南京医科大学第一附属医院肝脏外科/肝脏移植中心,国家卫生和计划生育委员会活体肝移植重点实验室,江苏 南京 210029 
孙 瑜 南京医科大学第一附属医院肝脏外科/肝脏移植中心,国家卫生和计划生育委员会活体肝移植重点实验室,江苏 南京 210029 
钱晓峰 南京医科大学第一附属医院肝脏外科/肝脏移植中心,国家卫生和计划生育委员会活体肝移植重点实验室,江苏 南京 210029 
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中文摘要:
      目的:对拟通过肝血流阻断切除肿瘤的患者预先给予短期(24 h)禁食预处理,观察其对术后发生的肝脏缺血/再灌注(ischemia reperfusion,I/R)损伤的保护作用。方法:采用前瞻性随机对照研究,收集2015年10月至2016年5月南京医科大学第一附属医院收治的肝功能Child-Pugh分级均为A级?拟行肝脏部分切除术的80例患者,按随机数余数法分为实验组(术前禁食24 h?禁饮8 h)和对照组(常规术前禁食?禁饮),再将两组患者按肿瘤直径及阻断时间分组,于术前和术后(1?3?7 d)测定血清丙氨酸转氨酶(ALT)?天门冬氨酸转氨酶(AST)?总胆红素(TBil)?直接胆红素(DBil)?总蛋白?白蛋白(ALB)水平。结果:术后两组患者ALT?AST?TBil?DBil明显升高,实验组患者术后1?3?7 d血清ALT水平明显低于对照组,有统计学差异(P < 0.05),实验组患者术后1?3 d的TBil?DBil均不同程度的低于对照组(P < 0.05)。两组患者术后3?7 d总蛋白及白蛋白无明显统计学差异(P > 0.05)。两组患者术后并发症发生率无明显统计学差异(P > 0.05)。无论肿瘤直径是否<5 cm,无论阻断时间是否<20 min,实验组术后(1?3 d)ALT水平都较对照组降低(P < 0.05)。结论:入肝血流阻断肝部分切除术可造成一定程度的肝脏缺血再灌注损伤;短期禁食可能通过抑制肝脏缺血再灌注损伤后炎症因子的释放?增加抗炎因子产生?增加自噬效应,减轻肝组织损伤,从而保护肝脏缺血再灌注损伤。
英文摘要:
      Objective:To observe the protective effects of short-term(24 h)fasting pretreatment on hepatic ischemia/reperfusion injury patients undergoing excision of partial liver after occlusion of hepatic blood flow. Methods:A prospective randomly controlled study was conducted. Eighty patients with liver tumor classified as Child-Pugh class A undergoing hepatectomy were enrolled in the First Affiliated Hospital of NJMU from November 2015 to May 2016. The patients were randomized into control group and experimental group(each patient received a 24 hour-fasting,8 hour-fasting for water).Those patients then were divided into subgroups according to tumor size and time of clamping porta hepatis. Complete hepatic functions were determined before and after operation(1,3,7 d). Results:Compared with those indexes before operation,the postoperative levels of afalanine transaminase(ALT),aspartate transaminase (AST),total bilirubin (TB) and direct bilirubin (DB) in control and the experimental groups were both significantly elevated. ALT in the experimental group after operation(1,3,7 day)was significantly lower than that in control group(P < 0.05). Although TB and DB in the experimental group after operation(1,3 day) were lower than those in the control group(P < 0.05). No statistical significance were found in total protein,albumin and the rate of vomplication between the two groups(P > 0.05). It was significant that postoperative levels of ALT(1,3 day) in the experimental group were lower than those in the control group regardless of tumor size and time of clamping porta hepatis(P < 0.05). Conclusion:Hepatic I/R injury may occur in patients undergoing resection of tumor with occlusion of hepatic blood flow. Short-term fasting pretreatment may inhibit the release of serum pro-inflammatory cytokines and increase anti-inflammatory factor productions and the effects of autophagy,thereby alleviate hepatic I/R injury.
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