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目的 探讨内皮细胞功能紊乱在肝缺血—再灌注损伤中的作用及左旋精氨酸对其的影响。方法 实验兔和肝癌手术患者均随机分为肝缺血—再灌注组 (n =10和n =6 )和肝缺血—再灌注 +左旋精氨酸治疗组 (n =10和n =6 ) ;分别取缺血前、缺血 4 5min(兔 )或 2 5min(患者 )和再灌注 4 5min(兔 )或 2 5min(患者 )共 3个时相点 ,用放射免疫法测定血浆透明质酸(HA) ,赖氏法检测谷丙转氨酶 (ALT)。结果 肝缺血—再灌注期间 ,实验兔和肝癌手术患者血浆HA、ALT明显升高 ,尤以再灌注 4 5min(兔 )或 2 5min(患者 )为著 (P <0 0 5或P <0 0 1)。左旋精氨酸可逆转上述指标 ,缺血时兔HA和ALT虽降低 ,但均P>0 0 5 ;患者HA虽降低 ,但P >0 0 5 ,而ALTP <0 0 1。再灌注时兔HA和ALT明显降低 ,均P <0 0 1;患者HA和ALT也显著下降 ,均P <0 0 1。结论 内皮细胞功能紊乱在肝缺血—再灌注损伤发生、发展中起重要的作用 ,左旋精氨酸通过保护内皮细胞而减轻肝缺血—再灌注损伤。
Objective To investigate the role of endothelial dysfunction in hepatic ischemia-reperfusion injury and the effect of L-arginine on it. Methods Rabbit and liver cancer patients were randomly divided into hepatic ischemia - reperfusion group (n = 10 and n = 6) and hepatic ischemia - reperfusion plus L - arginine treatment group (n = 10 and n = 6) The levels of hyaluronic acid (HbA1c) in plasma were measured by radioimmunoassay before ischemic preconditioning, ischemia for 45 min (rabbit) or 25 min (patient) and reperfusion for 45 min (rabbit) or for 25 min (HA), Lai’s method for detection of alanine aminotransferase (ALT). Results During the period of hepatic ischemia-reperfusion, the plasma levels of HA and ALT in experimental rabbits and hepatocellular carcinoma patients were significantly increased, especially at 45 min (rabbit) or 25 min (reperfusion) (P <0.05 or P <0 0 1). L-arginine could reverse the above indexes. Although the HA and ALT of rabbits in ischemia decreased, all P> 0.05; the HA decreased, but P> 0.05, but ALTP <0.01. At the time of reperfusion, HA and ALT in rabbits decreased significantly, both P <0.01; HA and ALT also decreased significantly in both groups (P <0.01). Conclusions The endothelial dysfunction plays an important role in the occurrence and development of hepatic ischemia-reperfusion injury. L-arginine can reduce the hepatic ischemia-reperfusion injury by protecting the endothelial cells.