Chronic liver diseases include alcoholic fatty liver, non-alcoholic fatty liver, chronic viral hepatitis B, chronic liver failure, cirrhosis, liver cancer, etc. Liver is an important synthesis, metabolism, and storage organ of iron metabolism. When liver lesions occur, iron metabolism will be impeded, affecting the occurrence and development of various chronic liver diseases. This article reviews the characteristics of iron metabolism in different types of chronic liver diseases.

肠道菌群被认为是"新型虚拟代谢器官",广泛参与机体营养物质的消化、吸收.消化系统疾病的发生、发展与肠道菌群有着密不可分的关系,肠道菌群及其代谢物对维持肠道稳态及免疫调节之间的动态平衡发挥着重要作用.该文就肠道菌群与非酒精性脂肪性肝病、肠易激综合征、炎症性肠病和结直肠癌等常见消化系统疾病的研究进展进行了综述.

人工智能(AI)是集理论、方法、应用研究与开发于一体的新学科,其对医疗领域产生了巨大影响.目前,AI技术已广泛应用于消化系统疾病的诊疗中,其通过数据处理、模型建立和模型验证等流程辅助临床医生检测和评估病变、促进治疗及预测治疗反应和预后.该文对AI技术在部分胃肠疾病和肝脏疾病诊疗中的应用研究进展进行了综述.

Intestinal flora is closely related to the occurrence and development of intestinal diseases and plays an important role in maintaining intestinal homeostasis. In this paper, the research progress of intestinal flora and intestinal diseases, including colorectal polyps, colorectal cancer, inflammatory bowel disease, and irritable bowel syndrome, is reviewed, so as to provide references for the prevention, diagnosis, and treatment of intestinal diseases.

目的 探讨胃癌组织中乳腺癌易感基因相关蛋白1(BAP1)的表达与胃癌病人临床病理因素和预后的关系.方法 收集2012年1月至2016年1月云南省第三人民医院收治的87例手术切除的Ⅰ～Ⅲ期胃癌病人胃癌组织及其癌旁组织,应用免疫组化法检测全组胃癌和癌旁组织中BAP1蛋白的表达水平.在87例病人中选取32例,采用实时荧光定量聚合酶链反应(PCR)检测胃癌和癌旁组织中BAP1 mRNA的表达水平,分析BAP1的表达水平与临床病理特征和预后的关系.结果 免疫组化结果表明BAP1在胃癌组织和癌旁组织中的高表达率分别为39.1％和66.7％,差异有统计学意义(χ2=13.290,P=0.000).PCR检测结果显示癌组织BAP1 mRNA的表达明显低于癌旁组织[(1.195±0.470)比(3.399±0.891),t=15.320,P=0.000].BAP1的表达与胃癌病人的肿瘤分化程度、浸润深度、淋巴结转移和TNM分期关系密切(P值分别为:0.043、0.021、0.008、0.001),Kaplan-Meier分析结果表明BAP1低表达组和高表达组病人5年生存率分别为27.6％和58.2％(χ2=6.392,P=0.012),低表达组病人预后不良.Cox回归多因素分析发现肿瘤浸润深度、TNM分期、BAP1表达水平是影响胃癌病人生存预后的独立危险因素(P<0.05).结论 BAP1在胃癌组织中呈低表达,与胃癌病人的预后密切相关.

肝性脑病是急性肝功能衰竭和肝硬化的并发症之一,发病率、病死率高.近年来肝性脑病的发病机制与肠道微生态的关系受到重视,诸多研究认为肠道微生态失衡是导致肝性脑病发病的原因之一.因此,越来越多的临床研究开始着眼于肠道微生物的调节中,且疗效显著,得到了肝性脑病治疗的新突破.本文总结了近年来研究者对肝性脑病与肠道微生态关系的新观点及新的肝性脑病临床研究,探讨基于肠道微生态治疗肝性脑病的研究进展,展望未来临床研究新思路,为临床防治肝性脑病的研究提供有效参考.

目的 探讨高血糖对非酒精性脂肪性肝炎(N A FLD)大鼠肝脏超微结构及细胞凋亡的影响.方法 将58只SPF级雄性大鼠采用随机数字表法分为正常组(n=10)、高血糖模型组(n=12)、复合模型组(高血糖合并NAFLD,n=12)、氨基胍组(n=12)、格列美脲组(n=12),检测各组血糖值,在电镜下观察肝脏超微结构,应用TUNEL染色法观察肝细胞凋亡情况,以酶联免疫吸附试验测定血浆基质金属蛋白酶抑制因子-1(TIMP-1)、转化生长因子β1(TGF-β1)、晚期糖基化终产物(AGEs)水平.结果 氨基胍组、格列美脲组大鼠血糖值低于高血糖模型组、复合模型组(P<0.05),且氨基胍组血糖值高于正常组(P<0.05),格列美脲组血糖值与正常组比较,差异无统计学意义(P>0.05).与正常组比较,高血糖模型组、复合模型组肝组织出现细胞超微结构改变,核周围存在脂滴,且肝细胞浆中线粒体、内质网变形;而与复合模型组比较,格列美脲组肝细胞超微结构较正常,可观察到核周围脂滴分布明显改善,线粒体及内质网形态趋于正常,而氨基胍组核周围脂滴分布、线粒体与内质网形态有所改善.肝细胞凋亡率大小:复合模型组>高血糖模型组>正常组,复合模型组、高血糖模型组>格列美脲组(P<0.05).各组血浆TIMP-1、TGF-β1、AGEs水平排序均为:复合模型组>高血糖模型组>正常组,复合模型组>氨基胍组、格列美脲组(P<0.05).结论 高血糖可能会促进NAFLD大鼠肝纤维化、肝脏超微结构改变及肝细胞凋亡,降低血糖或减少TIMP-1、TGF-β1、AGEs,有助于减轻或抑制肝脏超微结构改变及肝细胞凋亡.

背景:研究发现,肿瘤微环境可募集和吸引不同种类和分化程度的间充质干细胞至肿瘤生长部位,影响肿瘤进程.目的:分析肝癌HepG-2细胞培养液上清诱导人脐带间充质干细胞向肿瘤相关间充质干细胞的转分化,并探讨转分化后肿瘤相关间充质干细胞影响肝癌HepG-2细胞的增殖及迁移.方法:①实验1:收集肝癌HepG-2细胞培养液上清,混合等量的低糖DMEM作为培养基,培养人脐带间充质干细胞,48 h后,检测人脐带间充质干细胞肿瘤相关间充质干细胞蛋白及miR-221的表达;②实验2:收集肝癌HepG-2细胞培养液上清诱导后的人脐带间充质干细胞培养液上清,联合高糖DMEM培养肝癌HepG-2细胞,48 h后,检测细胞增殖与迁移能力;③实验3:实验组将人脐带间充质干细胞与肝癌HepG-2细胞共培养,对照组单纯培养肝癌HepG-2细胞,48 h后,检测细胞增殖与迁移能力.结果与结论:①实验1:肝癌HepG-2细胞培养液上清处理后,人脐带间充质干细胞中波形蛋白和成纤维细胞活化蛋白表达增强,miR-221表达上调;②实验2:经诱导后人脐带间充质干细胞培养液上清处理后,肝癌HepG-2细胞增殖及迁移能力显著增强;③实验3:与人脐带间充质干细胞共培养后,肝癌HepG-2细胞增殖及迁移能力显著增强;④结果表明:肝癌HepG-2细胞培养液上清可诱导人脐带间充质干细胞获得肿瘤相关间充质干细胞样表型,并且转分化后的肿瘤相关间充质干细胞可促进肝癌HepG-2细胞的增殖和迁移.

This study aimed to investigate the transdifferentiation of human umbilical cord mesenchymal stem cells (hUCMSCs) into cancer-associated mesenchymal stem cells (CA-MSCs) after incubation with condition medium (CM) from liver cancer HepG-2 cells, and the biobehaviors (proliferation and migration) of these CA-MSCs were further evaluated. The supernatant of HepG-2 cells was collected and mixed with equal volume of low glucose DMEM. The resultant medium was used to treat hUCMSCs for 48 h. The expression of CA-MSCs related proteins and miR-221 was detected in cells. The supernatant of induced hUCMSCs was mixed with equal volume of high glucose DMEM, and the resultant medium was used treat HepG-2 cells for 48 h and the proliferation and migration of HepG-2 cells were evaluated. Moreover, HepG-2 cells were co-cultured with hUCMSCs and then the proliferation and migration of HepG-2 cells were assessed. After incubation with the supernatant from HepG-2 cells, hUCMSCs showed significantly elevated expression of vimentin, fibroblast activation protein (FAP) and miR-221. The supernatant of induced hUCMSCs was able to significantly increase the proliferation and migration of HepG-2 cells. Following co-culture, the proliferation and migration of HepG-2 cells increased dramatically. These findings suggest that the supernatant of HepG-2 cells is able to induce the phenotype of CA-MSCs and the supernatant of CA-MSCs may promote the proliferation and migration of HepG-2 cells. These findings provide experimental evidence for the cellular remodeling in tumor microenvironment and the safety of clinical use of hUCMSCs.

目的 比较埃索美拉唑为主的联合用药方案治疗非甾体类抗炎药物(NSAIDs)导致的消化性溃疡并发出血的临床疗效及相关的不良反应.方法 选择2012年1月-2015年6月云南省第三人民医院消化内科收治的496例因服用NSAIDs并经急诊胃镜检查证实为消化性溃疡并发出血的患者作为研究对象,所有患者按照随机表法分为2组:埃索美拉唑治疗组280例(应用埃索美拉唑针剂联合白眉蛇毒血凝酶粉针剂及口服或鼻饲冻干粉血凝酶治疗),奥美拉唑治疗组216例(应用奥美拉唑针剂联合白眉蛇毒血凝酶粉针剂及口服或鼻饲冻干粉血凝酶治疗).比较2组的临床疗效、临床症状消失时间以及不良反应发生率.结果 2组临床总有效率分别为97.85％、88.88％.埃索美拉唑治疗组显著高于奥美拉唑治疗组,差异具有统计学意义(P＜0.05);2组临床症状平均消失时间分别为(3.2±1.5)d、(4.8±1.3)d,埃索美拉唑治疗组时间明显短于奥美拉唑治疗组,差异具有统计学意义(P＜0.05);2组患者不良反应发生率差异无统计学意义(P＞0.05).结论 埃索美拉唑联合白眉蛇毒血凝酶、冻干血凝酶粉治疗NSAIDs致消化性溃疡出血的临床疗效优于奥美拉唑联合用药方案,止血效果明确,可有效地缓解患者病情,并缩短患者入住重症监护病房(ICU)的时间,是较理想的急诊救治处置措施.

Objective To investigate the clinical therapeutic effect and safety of autologous bone marrow mesenchymal stem cells (BMSC)transplantation through proper hepatic artery in patients with decompensated liver cirrhosis.Methods 4,12,24,48,there were significant improvements in ALT,Alb,TBiL,PT and MELD (F =6.172,9.795,10.961 , 11 .198,19.652,P =0.000,respectively)than those at baseline.In control group,some parameters,including ALT,Alb and TBiL,had significant improvement (F =5.594,13.664,12.612,P =0.000,respectively),while other parameters, including PT and MELD,did not changed before and after therapy.At week 48,ALT,Alb,TBiL,PT and MELD showed significant differences between transplantation and control groups (t =5.477,8.830,6.371 ,11 .362,9.426,P <0.05, respectively).No significant differences were observed in incidence of HCC and mortality (χ2 =4.815、6.286,P <0.05, respectively).Additionally,no severe adverse effects occured in patients during and after transplantation.Conclusion Autologous BMSC transplantation through proper hepatic artery for decompensated liver cirrhosis is a safe and effective therapy,which could be a bridging or a complementary treatment.

Objective To evaluate the early evaluations of bedside index for severity in acute pancreatitis(BISAP)plus serum procalcitionin(PCT)in predicting the severity and prognosis of acute pancreatitis(AP).Methods A total of 230 cases of AP were prospectively analyzed.The levels of amylase, serum glucose,serum calcium,PCT and D-dimer in 24 hours were measured.According to the evaluation standard,the scores of BISAP were obtained.Mild acute pancreatitis (MAP),moderately severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP),death toll and their proportion were compared in different BISAP score.Correlation analyses were conducted for BISAP scores and laboratory indices,PCT and different scoring systems.The evaluative value of BISAP plus serum PCT and other scoring systems in SAP were compared.Results With rising BISAP scores,both severity and mortality increased in acute pancreatitis(P <0.01).BISAP scores were positively correlated with PCT,D-dimer and serum glucose(r =0.445,0.321,0.269,all P <0.01)and negatively correlated with serum calcium(r =-0.335,P <0.01). PCT was positively correlated with APACHEⅡ,Ranson,BISAP and CTSI scores(r =0.427,0.382,0.451, 0.402,all P <0.01).When PCT was included into the BISAP scores,the area under the curve(AUC)of predicting SAP was 0.883 and the AUC of predicting death was 0.919.So BISAP score plus serum PCT had a good predictive value for the severity of AP and death.Conclusion In clinical practice,the simple BISAP scoring system can predict the severity of AP,and BISAP score plus PCT has a better predictive value for AP.

Objective To discuss the diagnostic value of Crohn disease ( CD) activity with multi-slice CT enterogrgphy( MSCTE) .Methods MSCTE examination data of 68 cases of CD patients confirmed by clinical,endoscopy and pathology in the tenth people′s hospital of Shanghai from January 2014 to June 2015 were analyzed.According to the Harvey-Bradshaw index,all of CD patients were divided into the active phase group and remission phase group.Imaging findings of the two groups were compared.The relationships between MSCTE findings and C reactive protein( CRP)/erythrocyte sedimentation( ESR) of CD patients were analyzed.Results The wall thickness(8.2 ±2.6) mm and enhancement degree(112.8 ±16.4) HU in active phase group were higher than the wall thickness(5.4 ±1.6) mm and enhancement degree(93.5 ±17.2) HU in the remission phase group(P<0.01).The incidences of intestinal wall stratification enhancement,comb sign,swollen lymph nodes, phlegmon, intestinal fistula, intestinal stenosis in active phase group ( 88.5%, 72.1%,77.0%, 45.9%, 26.2%, 65.6%) were significantly higher than those in remission phase group (29.6%,18.5%,25.9%,0,3.7%,37.0%) ( P <0.05).The incidence of intestinal wall homogeneous enhancement in remission phase group ( 70.4%) were significantly higher than that in active phase group <br> (11.5%)(P<0.05).There was no significant difference in the incidence of abscess between the two groups ( P >0.05 ) .CRP was correlated with the wall thickness, enhancement degree, abnormal mesentery vascularity,lymph node enlargement,phlegmon and intestinal fistula( P<0.05) .ESR was correlated with the wall enhancement degree,abnormal mesentery vascularity,lymph node enlargement,phlegmon and intestinal fistula(P <0.05).Conclusion MSCTE can adequately demonstrate mural abnormalities and assess the presence of extramural complications, which is helpful in evaluating the activity of CD.The relationships between CRP,ESR and MSCTE findings need further research.

目的 探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的临床特点及诊治体会.方法 收集2009年1月-2015年1月云南省第三人民医院收治的17例AIP患者的临床资料,男11例,女6例,年龄36～ 64岁.综合临床症状、影像学特点、血清学检查结果、诊断性治疗、组织病理学特点等探讨AIP的诊治.结果 AIP主要临床表现为不同程度梗阻性黄疸和上腹痛;CT结果提示胰腺弥漫性肿大11例,胰头局灶性肿大3例,胰腺局灶性占位7例;血清IgG4升高13例(76.5％),CA19-9升高6例(35.3％),CEA升高3例(17.6％).根据胰外病变、影像学、血清学及组织穿刺活检结果确诊11例(64.7％),糖皮质激素诊断性治疗确诊3例(17 6％),手术探查确诊3例(17.6％).行胆总管空肠吻合术1例,胰十二指肠切除术1例,胰体尾联合脾切除术1例.病理检查显示胰腺导管周围纤维结缔组织增生,伴大量淋巴细胞、浆细胞浸润.除1例无症状的患者外,所有诊断明确的患者均接受正规的糖皮质激素治疗(口服泼尼松)后痊愈.随访时间3～58个月,4例(23.5％)复发,经大剂量糖皮质激素治疗后症状缓解.结论 AIP缺乏特异性的临床症状,早期诊断困难,误诊率高.临床医师应综合临床表现、影像学、血清学及组织病理学检查结果等进行确诊,避免不必要的手术治疗.

弥漫性食管痉挛（ diffuse esophageal spasm，DES）临床少见，是一种以食管不协调收缩运动为动力学特点的原发性食管运动障碍性疾病。其发病原因目前尚不十分清楚，临床症状缺乏特异性，诊断较为困难，内镜下治疗国内少见报道。2015年8月，我院收治DES 1例，通过长隧道内镜技术治疗，取得良好的近期疗效，现报告如下。

BACKGROUND:Human umbilical cord mesenchymal stem cel s (hUC-MSCs) can secrete a variety of factors involved in the regulation of tumor proliferation, metastasis and angiogenesis. Probably, interleukin-6 (IL-6) is one of the most important inflammatory factors. OBJECTIVE:To explore the effect of hUC-MSCs on the proliferation and migration of HepG-2 hepatocyte carcinoma cel s via the IL-6/STAT3 signaling pathway. METHODS:IL-6 expression levels in hUC-MSCs and HepG-2 cel s were determined by ELISA. STAT3 and p-STAT3 expression levels were determined by western blot assay. Transcription levels of PCNA, CyclinD1 and STAT3 genes were measured by RT-PCR. HepG-2 cel proliferation was analyzed by flow cytometry and cel counting kit-8 assays. The migration capacity of HepG-2 cel s was evaluated through a scratch test and Transwel assays. RESULTS AND CONCLUSION:The IL-6 level in the hUC-MSCs was significantly higher than that in the HepG-2 cel s (P<0.05). Both the hUC-MSC conditioned culture medium and IL-6 could be used for STAT3 activation. The addition of an IL-6 neutralizing antibody significantly weakened the activation of STAT3 in HepG-2 cel s by the hUC-MSCs-conditioned culture medium. In the presence of the IL-6 neutralizing antibody or the STAT3 inhibitor, AG490, the mRNA expression levels of HepG-2 proliferation-related genes (PCNA, CyclinD1 and Survivin) were significantly reduced. The proliferation and migration capacity of HepG-2 cel s were also significantly decreased by this treatment. Taken together, hUC-MSCs can secrete IL-6 to activate the STAT3 signaling pathway, thereby promoting the proliferation and migration of HepG-2 cel s.

目的:探讨生长抑素联合乌司他丁治疗重症急性胰腺炎的临床疗效和安全性.方法:将2013年6月至2015年6月期间云南省第三人民医院消化内科收治的96例重症急性胰腺炎患者,随机将其分成对照组和乌司他丁治疗组,每组各48例患者,对照组除常规治疗外给予生长抑素持续静脉滴注,乌司他丁组给予生长抑素联合乌司他丁联合治疗.治疗结束后,比较两组患者治疗总有效率,血清学相关指标及临床指标改善情况,并发症发生情况.结果:乌司他丁治疗组患者治疗总有效率(79.2％)明显高于对照组患者(64.6％)(P＜0.05);乌司他丁治疗组患者腹痛缓解时间、胃肠减压时间、中转手术率、住院时间及病死率[(3.2±0.5)d,(7.3±2.2)d,4.2％,(15.8±1.5)d,6.3％]均明显低于对照组患者[(4.9±0.6)d,(11.5±3.1)d,10.4％,(24.7± 2.1)d,12.5％](P均＜0.05);乌司他丁治疗组患者治疗后血清淀粉酶、白细胞、C反应蛋白以及白细胞介素6 [(140.2±49.1)U/L,(5.2± 1.0)× 109/L,(6.3± 3.4)mg/L,(24.3±4.2)ng/L]均明显低于对照组患者[(430.6± 60.2)U/L,(10.2±2.2)×109/L,(16.3±5.2)mg/L,(40.3±5.9)ng/L](P均＜0.05);乌司他丁治疗组患者并发症ARDS、急性肾功能衰竭、休克发生率(14.6％,12.5％,25.0％)明显低于对照组患者(35.4％,22.9％,39.6％)(P均＜0.05).结论:生长抑素联合乌司他丁治疗重症急性胰腺炎疗效显著,能够明显改善患者的血清及临床指标,减少并发症的发生率,值得临床推广应用.

目的 探讨成年居民血清糖化血红蛋白(HbA1C)水平与非酒精性脂肪性肝病(NAFLD)的关系.方法 调查符合入选条件的12381名年龄18岁及其以上的昆明市社区居民,测定其腰围、体质指数(BMI)、血压、空腹血糖、血脂谱、γ-谷氨酰转肽酶(γ-GT)和HbA1c,并行上腹部B超检查.按HbA1C水平的四分位数进行分层,分为Q1～Q4组(HbA1C水平分别为:Q1组≤5.2％,5.2％＜Q2组≤5.4％,5.4％＜Q3组≤5.6％,Q4组＞5.6％),分析各组NAFLD患病率及临床特征,并采用Logistic多元回归分析NAFLD患病的危险因素.结果 在本组被调查人群中,NAFLD患病率为27.2％,其中男性为31.9％,女性为21.0％,男性患病率较女性高(P＜0.001);Q1、Q2、Q3、Q4组NAFLD患病率分别为18.5％(534/2883)、22.8％(555/2436)、25.6％(840/3285)、38.1％(1440/3777),即随着血HbA1C水平的升高,NAFLD患病率逐渐升高;3369例NAFLD患者收缩压、TC、LDL-C、空腹血糖均随着HbA1c水平的升高而递增;Logistic多元回归分析显示高HbA1C水平为NAFLD患病的危险因素(0R=1.67,95％CI 1.15～2.43,P=0.007).结论 血HbA1C是NAFLD患病的危险因素,且两者都与血脂代谢紊乱联系紧密.

目的 评价经颈静脉肝内门体分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)治疗门静脉高压症上消化道出血的中远期疗效.方法 回顾性分析昆明医科大学第二附属医院肝病中心2008年1月至2013年1月间99例因肝硬化门静脉高压症上消化道出血行TIPS手术治疗的患者.其中43例行单纯TIPS治疗(TIPS组),56例行TIPS联合组织胶定位栓塞治疗(TIPS+ GCVE组).测量、计算术前、术后两组患者直接门静脉压力(PVP)、门静脉压力梯度(PPG).TIPS组、TIPS+ GCVE组术前与术后PVP、PPG比较应用f检验;随访期间TIPS组和TIPS+ GCVE组患者未发生上消化道再出血率、生存率和支架通畅率分析应用Kaplan-Meier法,进一步组间比较应用Log-rank检验.结果 TIPS组、TIPS+GCVE组术前PVP分别为(35.2±3.1)和(35.3±3.6)mm Hg(1 mm Hg=0.133 kPa),术后PVP分别为(21.9±2.8)和(22.7±3.1)mm Hg;TIPS组、TIPS+ GCVE组术前PPG分别为(25.8±3.2)和(25.5±2.3)mm Hg,术后PPG分别为(11.6±1.7)和(12.8±1.5)mm Hg.两组患者术后PVP、PPG均较术前下降,且差异均有统计学意义(TIPS组:t=15.772、15.722,均P=0.000;TIPS+ GCVE组:f=31.069、31.096,均P=0.000);而术前、术后两组PVP差异均无统计学意义.术前两组PPG差异无统计学意义,而术后TIPS+ GCVE组PPG高于TIPS组,且差异有统计学意义(f=-4.726,P=0.000).术后随访1～54个月,平均(36.3±11.1)个月.TIPS组患者术后6、12、24、48个月累积未发生上消化道再出血率分别为90.7％、86.0％、76.7％和65.1％,而TIPS+ GCVE组患者分别为98.2％、92.6％、89.3％和85.7％,两组比较差异有统计学意义(x2=5.987,P=0.014);TIPS组患者术后6、12、24和48个月累积支架通畅率分别为95.3％、88.4％、79.1％和72.1％,TIPS+ GCVE组患者分别为92.9％、87.5％、82.1％和78.6％,两组比较差异无统计学意义(x2=0.736,P=0.328);TIPS组患者术后6、12、24和48月累积生存率分别为93.0％、88.4％、83.7％和72.1％;TIPS+ GCVE组患者分别为94.6％、92.9％、87.5％和80.4％,两组比较差异无统计学意义(x2=2.18,P =0.094).结论 TIPS联合GCVE治疗门静脉高压症上消化道出血,疗效肯定,再出血率低,是一种安全、有效的治疗方法.

目的:观察同种异体骨髓间充质干细胞(bone marrow mesenchymal stem cells,BMSCs)移植对大鼠肝脏缺血-再灌注损伤(hepatic ischemia reperfusion injury,HIRI)的修复作用并对其可能的治疗机制进行探讨.方法:将健康雌性清洁级SD大鼠的股骨骨髓进行分离、培养、鉴定获得BMSCs;选取60只SD大鼠建立大鼠HIRI模型.动物模型建立后,将90只SD大鼠随机分为BMSCs移植组(n=30,予以尾静脉注射BMSC悬液1 mL,1.0×107/mL),HIRI组(n=30,予以尾静脉注射L-DMEM 1 mL),另设空白对照组(n=30,予以尾静脉注射生理盐水1 mL).分别于移植后的1、2、3 wk于各组随机选取5只大鼠取血检测丙氨酸转氨酶(alanine transanminase,ALT)、天冬氨酸转氨酶(aspartate transaminase,AST)、超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-18 (interleukin-18,IL-18)水平;移植后2 wk对肝组织行HE染色,观察移植后肝组织的形态学变化;利用RT-PCR法及Western blot法检测肝细胞生长因子(hepatocyte growth factor,HGF)及α-平滑肌蛋白(alphasooth muscle actin,α-SMA)在肝组织中的表达水平.结果:移植后1 wk,BMSCs移植组、HIRI组的血清ALT、AST、MDA、TNF-α和IL-18水平明显高于对照组,SOD活性明显低于对照组,差异均有统计学意义(均P＜0.05);移植后2、3 wk,BMSCs移植组ALT、AST、MDA、TNF-α和IL-18水平与HIRI组比较明显下调,SOD活性明显升高(均P＜0.05),但与对照组相比SOD活性仍偏低(P＜0.05).HE染色后发现,BMSCs移植组大鼠肝细胞变性、坏死及纤维化程度较HIRI组均有明显减轻(P＜0.05).RT-PCR法检测得知,与HIRI组比较,BMSCs移植组中HGF基因表达水平明显升高,而α-SMA的基因表达水平明显下降(均P＜0.05).Western blot法检测得知,与HIRI组比较,BMSCs移植组中HGF蛋白表达水平明显升高,而α-SMA的蛋白表达水平明显下降(均P＜0.05).结论:同种异体BMSCs移植能有效减轻大鼠HIRI,其机制可能是通过降低血清TNF-α、IL-18水平和调节肝脏中HGF及α-SMA的表达水平.