免疫吸附特异性清除循环肿瘤坏死因子-α对内毒素休克时心脏损伤的保护作用  

The protective effect of specific removal of circulating tumor necrosis factorα by immunoadsorption on cardiac injury during endotoxic shock

作　　者：龙海波[1,2] 林跃萍[1,2] 张训[1,2] 侯凡凡 

机构地区：[1]第一军医大学南方医院肾内科 [2]龙海波现在第一军医大学珠江医院肾内科

出　　处：《中国危重病急救医学》1999年第8期477-480,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金

摘　　要：目的：探讨免疫吸附特异性清除循环肿瘤坏死因子α（ＴＮＦα）对内毒素休克时心脏损伤的影响及其可能机制。方法：给新西兰白兔一次性静注大肠杆菌内毒素（ＬＰＳ）８．０×１０９ＣＦＵ／ｋｇ，１小时后经抗ＴＮＦα单克隆抗体亲和免疫吸附柱进行血液灌流２小时，观察平均动脉压（ＭＡＰ），血浆ＴＮＦα活性和丙二醛（ＭＤＡ）含量，血清天冬氨酸转氨酶（ＡＳＴ）、乳酸脱氢酶（ＬＤＨ）和α羟丁酸脱氢酶（ＨＢＤＨ）以及全血谷胱甘肽过氧化物酶（ＧＳＨＰｘ）活力变化。注射ＬＰＳ后２４小时取心脏行组织病理检查。结果：免疫吸附治疗后，动物低血压状态明显改善；血浆ＴＮＦα水平迅速下降，ＭＤＡ含量明显降低；全血ＧＳＨＰｘ活力显著提高；血清ＡＳＴ、ＬＤＨ和ＨＢＤＨ明显下降；心肌充血、多形核粒细胞浸润及心肌细胞变性坏死均明显减轻。Objective:To evaluate the protective effect and mechanism of specific removal of circulating tumor necrosis factorα (TNFα) by immunoadsorption on cardiac injury during endotoxic shock.Methods:40 New Zealand white rabbits were injected intravenously with lipopolysaccharide (LPS,Escherichia coli O 111 B 4,8 0×10 9 CFU/kg) and then randomly divided into two groups:①control group ( n =25):without immunoadsorption treatment;②perfusion group ( n =15):hemoperfusion was performed through a column containing immunoadsorbent produced by attachment of antiTNFα monoclonal antibody to agarose beads.Hemoperfusion was started at first hour after LPS infusion and sustained for 2 hours with blood flow rate at 5 ml/min.Results:Mean arterial pressure was increased significantly and circulating TNFα was removed rapidly and effectively after immunoadsorption treatment.Serum levels of aspartate transaminase,lactate dehydrogenase and alphahydrobulyric dehydrogenase were significantly decreased in the perfusion group.From 6th to 24th hour after injecting lipopolysaccharide(LPS),malondialdehyde levels of plasma were lower and blood glutathione peroxidase activities were higher in the perfusion group when compared with that in the control group.At 24th hour after infusion of LPS,the degree of myocardial congestion,degeneration or necrosis of myocardium were ameliorated significantly in the perfusion group.Conclusions:Specific removal of circulating TNFα by immunoadsorption could attenuate the LPSinduced cardiac injury during endotoxic shock.

关 键 词：内毒素休克 肿瘤坏死因子 心脏 免疫吸附 

分 类 号：R631.4[医药卫生—外科学]