N-乙酰半胱氨酸预处理对肝脏缺血再灌注损伤的保护作用

摘要

Objective To probe the protective effects of N-acetylcysteine (NAC) preconditioning on hepatic ischemia reperfusion injury. Methods Eighteen patients undergone hepatic haemangioma resection were allocated randomly into three groups (n=6): control group (CO), NAC preconditioning group (PR) injected with NAC 120 mg/kg before hepatic inflow occlusion (T0), NAC postconditioning group (PO) with NAC injected after hepatic vascular release. Serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined separately before skin incision (T0), at 1 h (T1) and 6 h (T2) after hepatic vascular re-lease. Malondialdehyde (MDA) contents and the activities of nuclear factor-KB (NF-kB) in liver tissue were detected at 1 h after hepatic vascular release. Results The serum levels of ALT and AST at 1 h (T1) and 6 h (T2) after hepatic vascular release increased markedly as compared to those before hepatic inflow occlu-sion (T0) in all three groups. Compared with that of CO group, the contents of MDA were lower in both PR and PO groups (P<0.05), while the reduced binding activity of nuclear factor-kB in liver tissue was only observed in PR group (P<0.01), but not in PO group. Conclusion NAC preconditioning can protect hepatic ischemia and reperfusion injury, mainly by inhibiting the trigger of the activation of nuclear factor-kB.%目的 探讨N-乙酰半胱氨酸(N-acetylcysteine,NAC)预处理对肝脏缺血再灌注损伤的保护作用.方法 18 例肝血管瘤手术患者随机分为3 组(n=6):对照组(C0)、NAC 预处理组(PR)和NAC 后处理组(PO),其中PR和PO 组分别于肝门阻断前和开放后给予NAC 120 mg/kg.三组患者均于切皮前(T0)、肝门阻断开放后1 h(T1)及6 h(T2)抽血检测谷丙转氨酶活性(ALT)和谷草转氨酶(AST)水平,并于肝门阻断开放后1 h(T1)取肝组织测定丙二醛(MDA)含量及核因子κB(NF-κB)活性.结果 肝门阻断开放后1 h(T1)和6 h(T6),各组的ALT 和AST 水平均明显高于肝门阻断前(T0)水平(P<0.01);与对照组相比,PR 和PO 组的MDA 含量在肝门阻断开放后1 h(T1)明显减少(P<0.01),但NF-κB 的活性仅在PR 组显示有明显的降低(P<0.01).结论 NAC 预处理可有效防治肝脏缺血再灌注损伤,其机制与抑制再灌注后NF-κB 的启动激活有关.