肺复张手法对急性肺损伤大鼠肺泡上皮细胞屏障功能的影响  

Effect of recruitment maneuver on alveolar epithelium barrier in rat with acute lung injury

作　　者：李娜[1] 邱海波[1] 杨毅[1] 郭凤梅[1] 陈永铭[1] 李家琼[1] 沈菊芳[1] 

机构地区：[1]东南大学附属中大医院危重病医学科,东南大学急诊与危重病医学研究所,南京210009

出　　处：《中国危重病急救医学》2007年第2期90-94,I0002,共6页Chinese Critical Care Medicine

基　　金：江苏省社会发展计划项目（BS2004023）;江苏省六大人才高峰基金资助项目（1190000009）;教育部跨世纪优秀人才支持计划基金（NCET-04-0476）

摘　　要：目的 观察肺复张手法对急性肺损伤（ALI）大鼠肺泡上皮细胞屏障功能的影响。方法雄性清洁级SD大鼠48只，静脉注射脂多糖（LPS）复制ALI模型，随机分为对照组、ALI模型组（ALI组）、小潮气量（VT）通气组（LV组）和肺复张联合小VT通气组（SI组）。采用控制性肺膨胀（SI）实施肺复张手法。机械通气4h后，观察肺组织病理学改变；采用末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法（TUNEL）检测肺泡上皮细胞凋亡情况；用重力法测定血管外肺水（EVLW）含量；用单核素示踪技术测定肺泡上皮细胞通透性改变；用逆转录-聚合酶链反应（RT—PCR）检测肺组织肺泡表面活性蛋白-C（SP—C）mRNA表达；用酶联免疫吸附法（ELISA）检测支气管肺泡灌洗液（BALF）中白细胞介素-6（IL-6）和IL-10浓度。结果 光镜下，SI组肺组织损伤程度轻于ALI组和LV组。LV组凋亡肺泡上皮细胞散在分布，SI组凋亡上皮细胞明显减少。与对照组相比，ALI组、LV组及SI组肺损伤评分和EVLW均显著升高；与ALI组比较，LV组和SI组肺损伤评分显著降低，SI组肺损伤评分及EVLW显著低于LV组（P均〈0．05）。与对照组相比，ALI组、LV组及SI组肺组织SP—C mRNA表达均显著降低，而SI组肺组织SP—C mRNA表达显著高于LV组（P〈0．05），但与ALI组比较差异无显著性。ALI组、LV组和SI组BALF中IL-6和IL-10浓度均显著高于对照组（P均〈0．05），SI组IL-6浓度显著低于LV组（P〈0．05）。各组肺泡上皮细胞通透性间比较差异均无显著性。结论 肺复张手法可以减轻ALI肺组织病理损伤，增加肺泡上皮细胞SP—C mRNA的合成，下调肺部炎症反应，改善肺泡上皮细胞屏障功能。Objective To evaluate the influence of recruitment maneuver （RM） on alveolar epithelium barrier in rat with acute lung injury （ALI）. Methods The ALI rats model were replicated by lipopolysac- charide iv injection. Sustained inflation （SI）, as a method of RM, was applied by airway pressure of 30 cm H2O for 30 seconds. Forty- eight male SD rats were randomly divided into four groups., normal group, ALI group, low tidal volume （VT） group （LV group） and low VT＋SI group （SI group）. After 4 hours of mechanical ventilation, lung injury was evaluated by Smith lung injury score. Extravascular lung water （EVLW） was measured by gravimetric method. Alveolar epithelium apoptosis was detected by terminal deoxynucleotidyltransferase -mediated dUTP biotin nick end labeling （TUNEL）. mRNA expression of surfactant protein （SP）-C was assessed by reverse transcription polymerase chain reaction （RT- PCR）. Interleukin （IL -6） and IL- 10 levels in bronchoalveolar lavage fluid （BALF） were measured by enzyme- linked immunosorbent assay （ELISA）. Results Injury degree of lung tissues in SI group was lighter than those of ALl and LV groups under microscope. A few of apoptotic epithelial cells were observed in SI group （all P〈0. 05） . Compared with LV group, apoptotic epithelial cells were decreased in number in SI group. Smith lung injury score and EVLW in ALI, LV and SI group were higher than those in the control group. Smith lung injury score in ALI group was significantly higher than the score in SI and LV group （both P〈0. 05）. Smith lung injury score and EVLW of SI group were significantly lower than those of LV group （both P〈0. 05）. There was no significant difference in EVLW between SI and ALI group. The SIP -C mRNA expression was significantly lowered in ALI, LV and SI groups compared with that in control group （all P〈0. 05）. The SP- C mRNA expression in SI group was stronger than LV group significantly （P〈0. 05）, but not significant when compare

关 键 词：肺损伤 急性 肺复张 上皮细胞 炎症 

分 类 号：R686[医药卫生—骨科学]