探讨不同原发病受体在肝移植围手术期氧化应激的变化特点。

本前瞻性研究对象为2012年5月至2013年3月在中山大学附属第三医院行原位肝移植的30例患者。根据原发病不同将患者分为肝细胞肝癌（肝癌）组、乙型病毒性肝炎（乙肝）后肝硬化组（肝硬化组），慢性重型肝炎组（慢重肝组）。肝癌组13例，其中男9例，女4例；年龄24~62岁，中位年龄45岁。肝硬化组8例，其中男5例，女3例；年龄28~65岁，中位年龄43岁。慢重肝组9例，其中男6例，女3例；年龄30~60岁，中位年龄42岁。所有患者均签署知情同意书，符合医学伦理学规定。采用气管插管全身麻醉，术式均采用改良背驮式原位肝移植术。分别检测术前麻醉后（T1）、新肝期1 h（T2）、新肝期3 h（T3）及新肝期24 h（T4）4个时间点的血清丙二醛（MDA）、羟自由基（·OH）、谷胱甘肽S转移酶（GST）、总抗氧化能力（TAOC）。氧化应激指标数据采用M（Q₂₅，Q₇₅）表示，3组的氧化应激指标比较采用Kruskal-Wallis秩和检验。

在T1、T2、T3时，肝癌组MDA分别为70（33，123）、64（34，125）、75（40，140）μmol/L，肝硬化组分别为33（24，42）、32（31，41）、43（30，52）μmol/L，慢重肝组分别为94（69，528）、65（54，311）、92（53，312）μmol/L，慢重肝组最高，肝硬化组最低，3组差异有统计学意义（Z=9.45，9.36，8.92；P<0.05）。T3时，肝癌组、肝硬化组、慢重肝组的·OH分别为1617（1330，2179）、2715（2192，3025）、1744（1568，2429）kU/L，肝硬化组最高，肝癌组最低，3组差异有统计学意义（Z=7.29，P<0.05）。T2时，肝癌组、肝硬化组、慢重肝组GST分别为297（256，317）、433（381，480）、367（278，545）kU/L，肝硬化组最高，肝癌组最低，3组差异有统计学意义（Z=9.26，P<0.05）。T1、T2、T3、T4时，肝癌组T-AOC分别为8（5，12）、6（5，10）、8（5，11）、11（6，14）kU/L，肝硬化组分别为6（5，11）、8（5，12）、13（7，14）、6（6，14）kU/L，慢重肝组分别为15（9，20）、11（9，18）、15（12，22）、25（20，31）kU/L，慢重肝组在各时点均最高，3组差异均有统计学意义（Z=10.48，6.59，11.42，11.68；P<0.05）。

肝移植围手术期机体发生氧化应激反应，不同原发病引起的氧化损伤程度不同，慢性重型肝炎患者的氧化损伤程度比肝癌及乙肝后肝硬化患者更重。

To explore the characteristics of oxidative stress changes in recipients of different primary diseases during perioperation of liver transplantation.

Thirty patients who underwent orthotopic liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from May 2012 to March 2013 were enrolled in this prospective study. According to different primary diseases, the patients were divided into hepatocellular carcinoma (HCC) group, hepatitis B cirrhosis (cirrhosis) group, chronic severe hepatitis(CSH) group. There were 13 cases in HCC group with 9 males, 4 females, 24-62 years old and median age of 45 years old. There were 8 cases in cirrhosis group with 5 males, 3 females, 28-65 years old and median age of 43 years old. There were 9 cases in CSH group with 6 males, 3 females, 30-60 years old and median age of 42 years old. The informed consents of all patients were obtained and the ethical committee approval was received. All the patients underwent modified piggyback orthotopic liver transplantation under general anesthesia with tracheal intubation. The malondialdehyde (MDA), hydroxyl free radical (·OH), glutathione s-transferase (GST) levels and total antioxidant capacity (T-AOC) were examined at 4 time points: pre-operation and after induction (T1), 1 h after reperfusion (T2), 3 h after reperfusion (T3) and 24 h after reperfusion (T4). The indexes of oxidative stress in three groups were expressed in M[Q₂₅, Q₇₅] and were compared by Kruskal-Wallis rank sum test.

The MDA levels at T1, T2, T3 were 70(33, 123), 64(34, 125), 75(40, 140)μmol/L respectively in HCC group, were 33(24, 42), 32(31, 41), 43(30, 52)μmol/L respectively in cirrhosis group and were 94(69, 528), 65(54, 311), 92(53, 312)μmol/L respectively in CSH group. The MDA level was the highest in CSH group and the lowest in cirrhosis group, and significant differences were observed among three groups (Z=9.45, 9.36, 8.92; P<0.05). The ·OH level at T3 were 1617(1330, 2179), 2715(2192, 3025), 1744(1568, 2429)kU/L respectively in HCC group, cirrhosis group and CSH group. The ·OH level at T3 was the highest in cirrhosis group and the lowest in HCC group, and significant difference was observed among three groups (Z=7.29, P<0.05). The GST levels at T2 were 297(256, 317), 433(381, 480), 367(278, 545)kU/L respectively in HCC group, cirrhosis group and CSH group. The GST level at T2 was the highest in cirrhosis group and the lowest in HCC group, and significant difference was observed among three groups (Z=9.26, P<0.05). The T-AOC at T1, T2, T3, T4 were 8(5, 12), 6(5, 10), 8(5, 11), 11(6, 14)kU/L respectively in HCC group, were 6(5, 11), 8(5, 12), 13(7, 14), 6(6, 14) kU/L respectively in cirrhosis group and were 15(9, 20), 11(9, 18), 15(12, 22), 25(20, 31)kU/L respectively in CSH group. The TAOC at all time points were the highest in CSH group (Z=10.48, 6.59, 11.42, 11.68; P<0.05).

Oxidative stress reaction occurs during the perioperation of liver transplantation. The different degree of oxidative damage is caused by different primary diseases. The oxidative damage is more severe in patients with chronic severe hepatitis than patients with HCC and hepatitis B cirrhosis.