猪腹部火器伤肠管穿透后TNF-α在肝细胞凋亡中的作用  

Role of TNF-α in the mechanism of hepatocyte apoptosis induced by intestinal perforations due to abdominal firearm wound

作　　者：李泽信[1] 王霄[2] 薛会朝[1] 刘江伟[3] 张永久[3] 冯德元[3] 

机构地区：[1]新乡医学院第一附属医院普外科,河南卫辉453100 [2]新乡医学院,河南新乡453003 [3]兰州军区乌鲁木齐总医院普外科,新疆乌鲁木齐830000

出　　处：《中国现代普通外科进展》2009年第12期1030-1032,1046,共4页Chinese Journal of Current Advances in General Surgery

基　　金：兰州军区医药卫生科研基金资助项目(LXH-2005019)

摘　　要：目的:探讨TNF-α在腹部火器伤肠管穿透后肝细胞凋亡中的作用机制。方法:健康长白仔猪42只随机等分为对照组和伤后1、2、4、8、12和24h组。伤后各组建立腹部火器伤肠管穿透模型。用显色基质鲎试剂法检测各组血浆内毒素水平,用免疫组织化学图像分析法测定各组肝内TNF-α含量,采用双抗体夹心ELISA法测定各组血清TNF-α水平,同时测定肝细胞凋亡情况。结果:伤后各组血浆内毒素水平、血清TNF-α水平、肝组织TNF-α的表达及肝细胞凋亡指数均明显高于对照组(P<0.05)。血浆内毒素水平于伤后8h出现高峰,伤后12h仍维持在高峰值水平。血清TNF-α在伤后12h达到高峰(94.36±10.18)ng/L,肝内TNF-α活性和肝细胞凋亡指数均于伤后2h和12h出现2个高峰,与伤后血浆内毒素水平变化基本一致。相关分析表明,伤后肝组织TNF-α含量与血浆内毒素水平及肝细胞凋亡指数均存在正相关(P<0.05)。结论:腹部火器伤肠管穿透后内毒素血症可引起肝内和血液内TNF-α增高,介导肝细胞凋亡的发生。Objective：To study the role of TNF-αin the mechanism of hepatocyte apoptosis induced by intestinal perforations due to abdominal firearm wound. Methods：A total of 42 Chang-Bai piglets were divided randomly into 7 groups： control group and wounded 1, 2 , 4, 8, 12, 24 hour groups.The model of intestinal perforations due to abdominal firearm wound were established in wounded groups. Levels of plasma endotoxin were measured using ehromogenic limulus amehoeyte lysate test.Hepatic TNF-α content was measured with immunohistochemical staining and image analysis in all groups. Hepatocyte apoptosis indexes and serum TNF-α levels were determined at the same time. Results： Levels of plasma endotoxin, serum TNF-α, hepatic TNF-α content and hepatocyte apoptosis indexes in wounded groups were all significantly elevated compared with control group（P〈0.05）. Plasma endotoxin reached the peak in 8 h group,and it was still at the peak level in 12 h group. At the time of 12 hours, the serum concentratio n of TNF-α reached （94.36±10.18） peak. Both hepatic TNF-α content and hepatocyte apoptosis indexes appeared two peaks in 2 h group and 12 h group. Meanwhile, hepatic TNF-α activity was positive correlaed with plasma endotoxin level and hepatocyte apoptosis indexes （P〈0.05）. Conclusion：After intestinal firearm wound, endotoxemia provokes TNF-α content increase in blood and liver,which can mediate hepatocyte apoptosis.

关 键 词：腹部损伤·火器伤·肝细胞凋亡·内毒素·肿瘤坏死因子-α·猪 

分 类 号：R826.65[医药卫生—临床医学]