课题背景:目前肝移植处于较成熟的阶段，手术存活率极高，但是移植后的相关并发症严重影响预后，肺部损伤（肺部感染、肺功能衰竭）就是其中之一。

应用要点:文章在借鉴大鼠自体肝移植模型的基础上，进一步提出检测移植后大鼠肺部相关指标，以证实肺损伤的存在，并初步阐述肺损伤的产生机制。文章结果证实，肝脏移植术后肺部确实存在急性损伤，碱性磷酸酶对其具有保护作用。

同行评价:文章通过建立大鼠自体原位肝移植模型，观察肝移植术后肺部急性损伤情况及碱性磷酸酶对其的干预作用。结果证实碱性磷酸酶对肝移植术后肺部急性损伤具有保护作用。文章立题科学，设计合理，有一定学术意义。

摘要
目的: 肝移植术后并发症不仅包括肝脏本身的损害，亦能导致肝外多个器官功能衰竭，其中肺脏是较易且较早受累的器官。文章通过建立大鼠自体原位肝移植模型，观察肝移植术后肺部急性损伤情况及碱性磷酸酶的干预作用。
方法:①实验于2007-05/10在南方医科大学附属南方医院实验动物中心、消化内科实验室完成，动物实验方法符合动物伦理学要求。②选用SD大鼠24只，按随机数字表法分为对照组、自体原位肝移植组和碱性磷酸酶组，每组8只。后两组建立大鼠自体原位肝移植模型，对照组开腹后游离肝叶后即关腹，碱性磷酸酶组于肝脏恢复血供前5 min自舌静脉注入碱性磷酸酶。③手术结束后2 h检测肺组织髓过氧化物酶活性、丙二醛含量、肺组织表面活性蛋白A含量及肺组织干湿重比值，并行肝脏、肺脏病理检查。
结果:大鼠24只全部进入结果分析。①自体原位肝移植组、碱性磷酸酶组肺组织中髓过氧化物酶活性、丙二醛含量均高于对照组（P﹤0.01），碱性磷酸酶组肺组织中髓过氧化物酶活性、丙二醛含量均低于自体原位肝移植组（P﹤0.01）。②碱性磷酸酶组、自体原位肝移植组肺组织表面活性蛋白A含量较对照组低，而碱性磷酸酶组较自体原位肝移植组有所升高。③自体原位肝移植组、碱性磷酸酶组肺组织干湿重比值均低于对照组（P﹤0.01），碱性磷酸酶组肺组织干湿重比值高于自体原位肝移植组（P﹤0.05）。④病理结果显示，肝移植后大鼠肝、肺组织受到明显损害，而碱性磷酸酶能减轻损伤程度。
结论:肝移植术后肺部确实存在急性损伤，而碱性磷酸酶对其具有保护作用。
关键词:肝移植；肺/损伤；碱性磷酸酶；疾病模型，动物

周陈杰，周杰．碱性磷酸酶对大鼠自体原位肝移植后急性肺损伤的保护作用[J].中国组织工程研究与临床康复，2008，12(5):805-808 [www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-805(ps).pdf]

Protective effect of alkaline phosphatase on acute lung injury after orthotopic autologous liver transplantation in rats

Abstract

AIM：The complications following liver transplantation consist of the liver damage and the function failure of other organs, among which lung is the most prone and the earliest affected lesion. By establishing an autologous orthotopic liver transplantation (OLT) model in rats, this study was to investigate the acute lung injury after liver transplantation and the role of alkaline phosphatase (AP) in protection of the injury.
METHODS: ①The experiments were performed in the Test Animal Center and Digestion Laboratory, Nanfang Hospital, Southern Medical University from May to October in 2007. All the proposals were in accordance with the ethical standard of animals.②Twenty-four SD rats were randomly divided into three groups: sham-operation control group, autologous OLT group and AP group, each containing 8 animals. Autologous OLT models were induced in OLT group and AP group, while control group, the abdomen was only opened and then closed besides the liver lobes were isolated. Lingual vein injection of AP was given in AP group 5 minutes before the blood supply of the liver restored.③The concentration of myeloperoxidase (MPO), malondialdehyde (MDA) and surfactant protein A (SP-A) in lung tissue were respectively examined in each group, lung dry-to-wet weight ratio was also measured. Furthermore, hepatic and lung pathological sections were observed.
RESULTS: All the 24 rats were involved in the result analysis.①Compared to control group, the concentration of MPO and MDA in lung tissue were significantly increased in OLT group and AP group (P < 0.01), but they were lower in the group that pretreated with AP than in the group with autologous OLT group (P < 0.01).②The concentration of SP-A in lung tissue and lung dry-to-wet weight ratios were markedly decreased in the control group (P < 0.01), while they were significantly increased in the group pretreated with AP compared with the OLT group (P < 0.05).③Pathological examination showed that liver and lung damage were less severe in the group pretreated with AP after the liver transplantation.
CONCLUSION: Acute lung injury happens after liver transplantation, and AP plays a protective role in the injury.

Zhou CJ, Zhou J. Protective effect of alkaline phosphatase on acute lung injury after orthotopic autologous liver transplantation in rats.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(5):805-808(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-805(ps).pdf]