乌司他丁对亲属活体肝移植患儿肾脏保护作用的临床观察
Effects of ulinastatin preconditioning combined with postconditioning on kidney injury of pediatric patients undergoing living donor liver transplantation and the underlying mechanism
目的 观察乌司他丁预处理联合后处理对亲属活体肝移植术患儿肾损伤的影响,并探讨其可能机制.方法 择期行亲属活体肝移植术患儿40例,按照随机对照表分为乌司他丁组和对照组各20例.乌司他丁组将2万U/kg乌司他丁用生理盐水稀释至1万U/ml,分别于切皮前即刻和门静脉开放前5min各使用1/2剂量;对照组以等量生理盐水代替.分别于切皮前即刻(T0)、无肝期30min(T1)、新肝期3h(T2)、术毕(T3)及术后24h(T4)时采集中心静脉血样和尿样,采用ELISA法检测血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-18;采用比色法检测血清肌酐(Cr)、尿素氮(BUN);采用免疫比浊法检测血清和尿β2-微球蛋白(β2-MG)浓度.结果 与T0比较,两组血清T2~4时点Cr、BUN、β2-MG和尿β2-MG浓度增高(P<0.05或0.01);与对照组比较,乌司他丁组T2~4时点血清Cr、BUN、β2-MG和尿β2-MG浓度降低(P<0.05或0.01).与T0时点比较,两组T2~4时点TNF-α、IL-6和IL-18水平增高(P<0.05或0.01);与对照组比较,乌司他丁组T2~4时点血清TNF-α、IL-6、IL-18水平降低(P<0.05或0.01).结论 乌司他丁联合处理可在一定程度上减轻亲属活体肝移植术患儿围手术期肾损伤,其机制可能与抑制炎症因子的过度释放有关.
更多Objective To investigate the effects of ulinastatin preconditioning combined with postconditioning on kidney injury of pediatric patients undergoing living donor liver transplantation (LDLT) and the underlying mechanism.Methods Forty pediatric patients with biliary atresia,scheduled for LDLT,were randomly divided into two groups (n =20 each):the ulinastatin group and the control group using a random number table.Ulinastatin (20 000 U/kg) was diluted into 10 000 U/mL with normal saline,and it was then injected intravenously in 2 parts (1/2 was given before skin incision;1/2 at 5 min before portal vein declamping) in the ulinastatin group.In the control group,the equal volume of normal saline was given instead of ulinastatin.Blood samples and urine specimens were taken from the central vein immediately before skin incision (T0,baseline),at 30 min of anhepatic period (T1),at 1 h of neohepatic period (T2),at the end of surgery (T3),and 24 h after surgery (T4) for the determination.The concentrations of serum and urine β2-microglobulin (β2-MG) were measured using an immunonephelometric method.The levels of serum TNF-α,IL-6 and IL-18 were measured using an ELISA method.The serum concentrations of creatinine (Cr) and blood urea nitrogen (BUN) were measured using a colorimetry method.Results The serum Cr,BUN,β2-MG and urine β2-MG concentrations were higher at T2-4 than at T0 in the two groups (P<0.05 or 0.01).As compared with the control group,the serum Cr,BUN,β2-MG and urine β2-MG concentrations were significantly decreased in the ulinastatin group (P<0.05 or 0.01).The serum levels of TNF-α,IL-6 and IL-18 were higher at T2 4 than at T0 in the two groups (P<0.05 or 0.01).As compared with the control group,the serum levels of TNF-α,IL-6,and IL-18 were significantly decreased in the ulinastatin group (P<0.05 or 0.01).Conclusion Ulinastatin preconditioning combined with postconditioning can alleviate kidney injury in pediatric patients undergoing LDLT to some extent,which may be related to inhibiting the excessive release of inflammatory factors.
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