心脏死亡器官捐献供者与尸体供者小肠移植物保存质量的比较研究

Comparative study on the preservation quality of intestinal grafts from donors of donation after cardiac death and cadaveric donors

  • 摘要:
      目的  比较心脏死亡器官捐献(DCD)供者和传统尸体供者小肠移植物的保存质量。
      方法  对2013年至2014年在北京地区获取的7例尸体供者(N组)和7例DCD供者(DCD组)的小肠移植物进行质量评估。移植物经灌注、切取, 于保存30 min和6 h采集肠组织, 行组织病理学检查及小肠移植物损伤评分(Chiu氏积分法), 采用硫代巴比妥酸法检测肠组织丙二醛(MDA)含量, 采用dUTP缺口末端标记(TUNEL)法检测肠黏膜细胞凋亡情况。
      结果  保存30 min, N组和DCD组的小肠移植物损伤评分分别为(1.46±0.81)分和(1.76±0.21)分; 保存6 h, 两组相应为(3.86±0.42)分和(4.17±0.71)分(均为P > 0.05)。与保存30 min相比, 保存6 h的N组和DCD组的小肠损伤评分明显增加(均为P < 0.05)。保存30 min, N组和DCD组的小肠移植物肠组织中MDA含量分别为(100±10) pmol/mg、(110±13) pmol/mg (P > 0.05);保存6 h, N组和DCD组的MDA含量分别为(170±18) pmol/mg和(310±29) pmol/mg, 同一保存时间两组比较差异有统计学意义(P < 0.05)。与保存30 min相比, 两组小肠移植物切取保存6 h肠组织中的MDA含量明显增加(均为P < 0.05)。保存30 min, N组和DCD组的小肠移植物肠黏膜细胞凋亡数量分别为(9.78±2.56)个和(15.78±2.84)个(P > 0.05);保存6 h, N组和DCD组相应为(31.32±1.38)个和(53.42±1.95)个, 两组比较差异有统计学意义(P < 0.05)。两组小肠移植物肠黏膜细胞凋亡数量保存6 h后较保存30 min时明显增加(均为P < 0.05)。
      结论  DCD供者与传统尸体供者的小肠移植物的保存质量相当, 提示DCD供者小肠移植物有可能应用于临床小肠移植。

     

    Abstract:
      Objective  To compare the preservation quality of intestinal grafts from donors of donation after cardiac death (DCD) and cadaveric donors.
      Methods  Quality of intestinal grafts from 7 cadaveric donors(group N) and 7 DCD donors(group DCD) in Beijing from 2013 to 2014 was evaluated. The grafts were preserved after perfusion and resection, and then intestinal tissue was collected 30 min and 6 h later. Meanwhile, histopathological examination and intestinal graft injury score (Chiu's integral method) were performed. The content of malondialdehyde (MDA) in intestinal tissue was detected by thiobarbituric acid assay, and the apoptosis of intestinal mucosa cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method.
      Results  Intestinal graft injury scores for group N and DCD were (1.46±0.81) and (1.76±0.21) respectively at 30 min after preservation, and (3.86±0.42) and(4.17±0.71), respectively at 6 h after preservation(both in P > 0.05). Compared with the preservation of 30 min, intestinal graft injury scores increased significantly in both groups at 6 h after preservation (both in P < 0.05). The contents of MDA in intestinal tissue of the small intestinal graft in group N and DCD were(100±10)pmol/mg and (110±13) pmol/mg, respectively at 30 min after preservation (P > 0.05), and (170±18) pmol/mg and (310±29) pmol/ mg, respectively at 6 h after preservation, of which the difference was statistically significant between the two groups at the same time(P < 0.05). Compared with the preservation of 30 min, the contents of MDA increased significantly in both groups at 6 h after preservation (both in P < 0.05). The number of apoptotic intestinal mucosal cells in small intestinal grafts for group N and DCD was (9.78±2.56) and (15.78±2.84), respectively at 30 min after preservation (P > 0.05), and (31.32±1.38) and (53.42±1.95), respectively at 6 h after preservation, of which the difference was statistically significant between the two groups (P < 0.05). Compared with the preservation of 30 min, the number of apoptotic intestinal mucosal cells in small intestinal grafts increased significantly in both groups at 6 h after preservation(P < 0.05).
      Conclusions  Preservation quality of small intestinal grafts in DCD donors is roughly equivalent to that in traditional cadaveric donors, which suggests that small intestinal grafts in DCD donors may be used in clinical intestinal transplantation.

     

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