肠淋巴途径在大鼠重症急性胰腺炎致全身炎症反应中的作用  

The role of mesenteric lymph in pathogenesis of systemic inflammatory response syndrome and systemic complications following severe acute pancreatitis in rats

作　　者：邹忠东[1] 张再重[1] 王烈[1] 王瑜[1] 郑国华[2] 

机构地区：[1]南京军区福州总医院普通外科、南京军区普通外科研究所,福建350025 [2]福建中医学院统计学教研室

出　　处：《中国危重病急救医学》2010年第4期206-209,共4页Chinese Critical Care Medicine

基　　金：福建省自然科学基金项目（2006J0372）

摘　　要：目的通过肠系膜淋巴管结扎（MLDL）阻断肠淋巴液回流，观察肠淋巴途径在大鼠重症急性胰腺炎（SAP）致全身炎症反应中的作用。方法将24只雄性SD大鼠按随机数字表法分为模型组、结扎组和假手术组，每组8只。采用胰胆管逆行注入牛黄胆酸钠溶液制备SAP合并多器官损伤模型；MLDL于制模前进行。术后24h测定血中二胺氧化酶（DAO）、D-乳酸、肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）和内毒素水平及胰腺、肺脏、肝脏组织髓过氧化物酶（MP0）活性。处死大鼠取材，光镜下观察小肠组织形态学变化；培养肠系膜淋巴结细菌并计算细菌移位率。结果与假手术组比较，模型组血中DAO、D-乳酸、TNF—α、IL-6和内毒素水平均显著升高[DAO：（0．64士0．17）kU／L比（0．37±0．07）kU／L，D-乳酸：（8．16±1．79）ng／L比（3．24±1．00）ng／L，TNF—α：（65．21±13．38）ng／L比（22．16±5．04）ng／L，IL-6：（7．95±1．83）ng／L比（4．26±1．23）ng／L，内毒素：（O．068±0．019）kEU／L比（0．033±0．009）kEU／L3，肠系膜淋巴结细菌移位率显著提高（75．0％比o），胰腺、肺脏、肝脏MPO活性显著升高[胰腺：（5．14±1．24）U／g比（2．88±0．75）U／g，肺脏：（9．07±2．52）U／g比（4．38±1．29）U／g，肝脏：（6．36±1．63）U／g比（3．19±0．96）U／g，均P〈0．01]；与模型组比较，结扎组血中DAO[（0．50±0．13）kU／L]、D-乳酸[（6．23±1．25）ng／L]、TNF-α（（48．50±13．23）ng／L]、IL-6[（6．06土1．64）ng／L3和内毒素[（0．048±0．014）kEU／L3均显著降低，肠系膜淋巴结细菌移位率（12．5％）显著减少，胰腺、肺脏、肝脏MPO活性[胰腺：（4．01±1．05）U／g，肺脏：（6．58±1．96）U／g，肝脏：（4．64±1．34）U／g3显著下降（P〈0．05或P〈0．01）。结论MLDL可以降低SAP大鼠肠道细菌和�Objective To observe the effect of mesenterie lymph duct ligation （MLDL） on systemic inflammatory response syndrome （SIRS） and systemic complications in severe acute pancreatitis （SAP） in rats. Methods Twenty-four Sprague-Dawley （SD） male rats were randomly divided into sham operation group, SAP group, and SAP＋MLDL group, with 8 rats in each group. Sham operation group underwent laparotomy only. SAP complicated with multiple organ injury model was reproduced by retrograde injection of sodium tauroeholate into the pancreatic duct in SD rats. In SAP＋MLDL group MLDL was performed before reproduction of SAP. Rats were sacrificed at 24 hours after operation. The terminal ileums were collected for examination under light microscope. The samples of pancreas, lung and liver were collected for measuring the level of myeloperoxidase （MPO）. The mesenteric lymph nodes were harvested for standard bacteriologic culture. The blood levels of diamine oxidase （DAO）, D-lactate, endotoxin, tumor necrosis faetor-α （TNF-α） and interleukin-6 （IL-6） were also measured. Results The blood levels of DAO （（0. 64±0. 17） kU/L vs. （0. 37±0. 07） kU/L], D-lactate （（8. 16±1. 79） ng/L vs. （3.24±1. 00） ng/L], endotoxin （（0.068±0.019） kEU/L vs. （0.033±0.009） kEU/L], TNF-α [（65.21±13.38） ng/L vs. （22.16±5.04） ng/L] and IL-6 （（7.95±1.83） ng/L vs. （4.26 ± 1.23） ng/L] in SAP group were increased significantly comparing with those in sham operation group （all P〈0.01）. The contents of pulmonary tissue （（9.07±2.52） U/gvs. （4. 38±1.29） U/g], pancreatic [（5.14±1.24） U/g vs. （2.88±0.75） U/g] and liver [（6.36±1.63） U/g vs. （3.19±0.96） U/g] MPO were increased significantly in SAP group comparing with those in sham operation group （all P〈0. 01）. The rate of bacterial translocation to mesenteric lymph nodes in SAP group was significantly higher than that of the sham operation group （75.0% vs. 0, P〈 0.01）. Compared to S

关 键 词：胰腺炎 急性 肠系膜淋巴管结扎 微循环 肠屏障功能障碍 全身炎症反应综合征 

分 类 号：R576[医药卫生—消化系统]