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，在体内核磁共振波谱除了动脉酮体比（AKBR），这反映了在肝脏中的线粒体的氧化还原状态的测量。利用这些无创性的方法，评估肝脏的代谢状态，以防止脑死亡供体移植中原发性无功能肝脏。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是通过与许多其他方法评估的多个器官的评价进行比较而进一步发展的，例如体内NMR光谱法。通过对活体肝移植安全性和可靠性的认识，为今后脑死亡供体肝移植提供参考。主要研究结果如下：（1）应用多普勒超声和近红外光谱技术对活体肝移植供肝的活性进行了评价。AKBR的可靠性为 关于我们 建立。(2)同时观察了内分泌系统如胰岛素、胰高血糖素、细胞因子、淋巴细胞和血小板与肝功能的关系。(3)实验研究了肝移植术后肝脏缺血、淤血的影响及安全范围。在活体肝移植中引入门静脉移植物。(4)通过体内13 P NMR光谱评估肝缺血和功能不全中的磷能变化<31>。研究了前列腺素等化学物质的影响。(5)本文建立了一种用~ 1H-NMR对冷保存肝脏进行无创性评价的方法。(6)使用13 C-葡萄糖或13 C-丙氨酸作为示踪剂，通过体内13 C NMR光谱无创地检测肝脏中的葡萄糖和糖原代谢以及三碳酸循环<13><13><13>。在活体组织中发现这些代谢与体内~ 1 P NMR检测到的AKBR和磷酸能态高度相关<31>。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