远程缺血预处理对肝切除患者肝脏缺血再灌注损伤的影响：一项随机对照试验

远程缺血预处理对肝切除患者肝脏缺血再灌注损伤的影响：一项随机对照试验

贵州医科大学     麻醉与心脏电生理课题组

翻译：陈锐  编辑：张中伟  审核：曹莹

罂 粟 摘 要  

背景：动物模型研究表明，远程缺血预处理（RIPC）可以保护肝脏免受肝脏缺血再灌注损伤（HIRI）。本研究的目的是探索RIPC是否可以降低接受肝切除术的患者的HIRI。

方法：120 例患者被随机分配到三组：不接受预处理的对照组、缺血预处理（IPC）组和 RIPC 组。在IPC组中，肝十二指肠韧带被阻断10分钟，然后在肝切除前再灌注10分钟。RIPC组的患者接受了三个周期的 5分钟缺血，然后进行5分钟的右臂再灌注。术前和术后检测丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和肿瘤坏死因子样弱凋亡诱导物（TWEAK）。

结果：共有105名患者完成了试验：对照组39名，IPC组32名，RIPC组34名。与对照组相比，IPC组与PIRC组中血清 ALT和AST水平显着降低。（IPC组：ALT：507.0±401.3 vs. 1040.7±649.5 IU/L，P<0.001；AST：495.8±369.4 vs. 935.9±640.7 IU/L，P = 0.001），（RIPC组：ALT：680.8±291.5 vs. 1040.7±649.5 IU/L，P=0.002；AST：661.7±290.6 vs. 935.9±640.7 IU/L，P=0.014）在术后第一天。与对照组相比，IPC 组的 TWEAK 显着降低（IPC 57.99±17.8对比对照组 76.13±12.4 ng/L，P=0.025）。TWEAK 值在RIPC和IPC组之间没有差异（RIPC 64.84±14.2 vs.IPC 57.99±17.8 ng/L，P=0.385）。

结论：RIPC可减轻肝切除术后肝脏缺血再灌注损伤。

原始文献来源：Wu G, Chen M, Wang X, Kong E, Yu W, Sun Y, et al. Effect of remote ischemic preconditioning on hepatic ischemia-reperfusion injury in patients undergoing liver resection: a randomized controlled trial. Minerva Anestesiol 2020;86:252-60. DOI:10.23736/S0375-9393.19.13838-2

英文原文   

Effect of remote ischemic preconditioning on hepatic ischemia-reperfusion injury in patients undergoing liver resection: a randomized controlled trial

Abstract

Background: Studies in animal models have shown that remote ischemic preconditioning(RIPC) could protect theliver from hepatic ischemia-reperfusion injury (HIRI). The aim of this study was to examine whether RIPC could reduce HIRI in patients undergoing liver resection.

Methods: A total of 120 patients were randomly assigned to three groups: a control group receiving no conditioning, an ischemic preconditioning (IPC) group, and an RIPC group. In the IPC group, the hepatoduodenal ligament was blocked for 10 min followed by 10 min of reperfusion prior to hepatic resection. Patients in the RIPC group received three cycles of 5-min ischemia followed by 5-min reperfusion to the right arm. Alanine transaminase (ALT), aspartate transaminase (AST), and tumor necrosis factor-like weak inducer of apoptosis (TWEAK) were examined before and after surgery.

Results: A total of 105 patients completed the trial: 39 in the control group, 32 in the IPC group, and 34 in the RIPC group. In comparison to the control, serum ALT and AST levels significantly decreased in the IPC (ALT: 507.0±401.3vs.1040.7±649.5IU/L,P<0.001; AST: 495.8±369.4 vs. 935.9±640.7 IU/L, P=0.001) and RIPC (ALT: 680.8±291.5 vs. 1040.7±649.5 IU/L, P=0.002; AST: 661.7±290.6 vs. 935.9±640.7 IU/L, P=0.014) groups on the first postoperative day. In comparison to the control, TWEAK significantly decreased in the IPC group (IPC 57.99±17.8 vs. control 76.13±12.4 ng/L, P=0.025) after surgery. TWEAK did not differ between the RIPC and IPC groups (RIPC 64.84±14.2 vs. IPC 57.99±17.8 ng/L, P=0.385).

Conclusions: RIPC could reduce hepatic ischemia-reperfusion injury after liver resection.

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