Noninvasive evaluation of the liver in brain dead donors to prevent primary non-functioning liver in transplantation : an application of ^<13>C in vivo NMR spectroscopy.

在本研究中，除了测量反映肝脏线粒体氧化还原状态的动脉酮体比（AKBR）外，还应用了体内核磁共振光谱。使用这些非侵入性方法，评估肝脏的代谢状态，以防止脑死亡供者移植的原发性无功能肝脏。AKBR也是反映全身代谢状态的重要参数。我们的氧化还原理论通过与许多其他方法（如体内核磁共振光谱）评估的多器官评估进行比较进一步发展。提高了活体亲属肝移植的安全性和可靠性，为今后脑死亡供体肝移植提供了有益的信息。主要结果如下：(1)采用多普勒超声和近红外光谱技术评价活体亲属肝移植中移植物的生存能力。AKBR的可靠性得到了进一步的验证。(2)结合AKBR检测胰岛素、胰高血糖素、细胞因子、淋巴细胞、血小板等内分泌系统与肝功能的关系。(3)通过实验研究肝移植缺血充血的影响及安全限度。介绍了门静脉移植在活体亲属肝移植中的应用。(4)采用体内^<31>P核磁共振波谱法评估肝脏缺血和功能不全时磷能的变化。研究了前列腺素等化学物质的作用。(5)建立了采用^1H-NMR对冷保存肝脏进行无创评价的方法。(6)采用体内^<13>C-葡萄糖或^<13>C-丙氨酸作为示踪剂，采用^<13>C-葡萄糖或^<13>C-丙氨酸，无创检测肝脏中的葡萄糖和糖原代谢以及三羧酸循环。这些代谢被发现，在活组织中，与AKBR和磷能状态高度相关，通过体内^<31>P NMR检测。我们开始将这些方法应用于临床病例，将第二个射频通道引入临床磁共振机。少

In the present study, in vivo NMR spectroscopy was applied besides the measurements of arterial ketone body ratio (AKBR) , which reflects the redox state of mitochondria in the liver. Using these noninvasive methods, metabolic state of the liver was evaluated to prevent the primary non-functioning liver in transplantation from brain dead donors. AKBR is also an important parameter reflecting the systemic metabolic states. Our Redox theory was further developed by comparing with the evaluation of multiple organs assessed by many other methods, such as in vivo NMR spectroscopy. The knowledge was increased the safety and reliability of the living related liver transplantation and it will present useful information for the liver transplantation from brain dead donors in the near future. The main results are as follows :(1) The viability of the graft in living related liver transplantation was evaluated by Doppler ultrasonography and near infrared spectroscopy. The reliability of AKBR was e … More stablished.(2) The relationship of endocrinical system, such as insulin and glucagon, cytocaines, lymphocytes and platelets to liver function was examined in connection with AKBR.(3) Effects and safety limits of ischemia and congestion of the liver in transplantation was experimentally investigated. A portal vein graft was introduced in living related liver transplantation.(4) Phosphoenergetic changes in liver ischemia and insufficiency was assessed by in vivo ^<31>P NMR spectroscopy. Effects of chemicals such as prostaglandin was examined.(5) An non-invasive evaluation of cold-preserved liver using ^1H-NMR was established.(6) Glucose and glycogen metabolism, and tricarbonic acid cycle in the liver was non-invasively detected by in vivo ^<13>C NMR spectroscopy using ^<13>C-glucose or ^<13>C-alanine as a tracer. These metabolisms were found, in living tissues, to be highly correlated to AKBR and phosphoenergetic state detected by in vivo ^<31>P NMR.We started to apply these methods on clinical cases introducing second RF channel to a clinical MR machine. Less