【摘要】 目的探讨新型双肾常温机械灌注保存(normothermic machine perfusion,NMP)系统对边缘供肾保存质量的意义及相关机制,为其临床应用奠定理论基础。方法选取小型猪10只随机分为2组,实验组(n=5):热缺血30 min后切取双侧供肾,使用NMP装置常温保存7 h后行自体肾移植术;对照组(n=5):热缺血30 min后切取双侧供肾,UW液低温保存7 h后行自体肾移植术。在各时间点比较两组动物术后移植肾血清肌酐水平、炎症因子表达、凋亡、肾皮质微循环血流、术后7 d生存率等指标。结果两组均成功在经过30 min热缺血和7 h保存后,进行自体肾移植,手术成功率均为100%。NMP保存过程压力及流量稳定,尿量逐渐增加。病理提示实验组保存1～7 h空泡变性、水样变性明显减轻,对照组各时间点供肾损伤逐渐加重,出现滴状变性、空泡变性及肾小管扩张损害。移植后24 h,与对照组相比,实验组血肌酐水平明显降低,肾组织ET-1及caspase-3水平明显降低,肾皮质血流明显改善(P <0.05)。两组术后7 d存活率无统计学差异(P> 0.05)。结论双肾NMP保存,可明显减轻肾保存损伤及缺血/再灌注损伤,其保护机制涉及降低肾组织ET-1表达及改善供肾微循环,降低caspase-3水平减轻缺血/再灌注损伤。更多还原

【Abstract】 Objective To discuss the significance and mechanism of normothermic machine perfusion(NMP) for the preservation of marginal donor kidney. Methods A total number 10 small pigs were randomly divided into two groups,experimental group(n = 5):bilateral donor kidneys were preserved after 30 min of warm ischemia,and autologous kidney transplantation were performed after 7 h preservation with NMP device;control group(n = 5):bilateral donor kidneys were preserved after 30 min of warm ischemia,and autologous kidney transplantation were performed after 7 h preservation with UW solution. At each time point,serum creatinine level,renal inflammatory cytokine expression,apoptosis, renal cortical microcirculation changes and survival rate were compared between the two groups. Results The kidneys in both groups were preserved and transplanted,and the success rate of surgery was 100%. During the period of kidney preservation, the pressure and blood flow were stable. At 24 h after transplantation,the serum creatinine level in the experimental group was significantly lower than that in the control group. The levels of ET-1 and caspase-3 in the renal tissue were decreased markedly,and the blood flow in the renal cortex was increased significantly(P < 0.05). There was no significant difference in survival rate between two groups(P > 0.05). Conclusions NMP preservation could significantly reduce preservation damage and ischemia-reperfusion injury. The protective mechanism may result from reducing the expression of ET-1 in renal tissue and improving the microcirculation of the donor kidney,and reducing the level of caspase-3 to reduce ischemia-reperfusion injury.更多还原