中性粒细胞弹性蛋白酶在重度脑损伤继发性肺损伤中的作用研究  

Study of neutrophil elastase on secondary lung injury induced by severe traumatic brain injury

作　　者：权明桃[1] 施久军[2] 罗祎[2] 范学良[3] 江智霞[2] 

机构地区：[1]遵义医学院附属医院神经科,贵州563003 [2]遵义医学院附属医院护理部 [3]约翰·霍普金斯大学

出　　处：《中国急救医学》2011年第7期625-628,共4页Chinese Journal of Critical Care Medicine

基　　金：基金项目：贵州省教育厅自然科学研究项目（No.黔教科2008035）;贵州省国际科技合作项目[No.黔科合外G字（2009）700117号]

摘　　要：目的探讨中性粒细胞弹性蛋白酶（neutrophilelastase，NE）在重度脑损伤继发性肺损伤中的作用。方法sD雄性大鼠50只，随机分为对照组（n=10）和损伤组（n=40），损伤组又分为2h、6h、24h和48h组，每组10只。分别测定各组大鼠脑组织含水量，血浆及支气管肺泡灌洗液（bronchoalveolarlavagefluid，BALF）中NE含量；BALF中白蛋白浓度；光学及电子显微镜观察肺组织，耙改变。结果6h、24h和48h三组大鼠的脑组织含水量均明显增高，与对照组比较，差异有统计学意义（P〈0．01）；在肉眼、光学、电子显微镜下，损伤组部分大鼠肺组织可见不同程度的充血水肿、中性粒细胞浸润、线粒体肿胀及绒毛消失等；脑损伤2h血浆及灌洗液中NE含量开始升高，灌洗液中NE升高水平较血浆中NE明显；支气管肺泡灌洗液中白蛋白在伤后6h开始升高，与对照组比较，差异有统计学意义（P〈0．05）；NE变化水平与白蛋白、脑组织含水量均呈正相关（P〈0．05）。结论重度脑损伤可导致不同程度的肺组织损伤，NE是脑损伤继发肺损伤的重要原因之一，早期监测血中NE含量可间接衡量肺损伤情况。Objective To investigate the effects of neutrophil elastase（NE）on acute lung injury （ALI） induced by the severe brain injury （SBI）. Methods Fifty male SD rats were randomly divided into control group （n = 10） and injury group （n =40）. Injury group were randomly divided into 2, 6, 24 and 48 h, 10 for each group. The levels of NE were measured in plasma and bronchoalveolar lavage fluid （BALF） by ELISA and the albumin concentration was detected by the immune turbidimetry. The pathological changes of lung tissues were observed by optical and electron microscope. Results The rats＇ water contents of the brain were increased significantly in the 6, 24, 48 h groups, there was statistical significance compared with the control group （P 〈 0. 01 ）. Histomorphology, the histological changes of the lung tissues showed the signs of various degrees of hyperemia, edema, polymorphonuclear neutrophils（PMN） infiltration, mitochondrial swelling, villi disappearing; The levels of NE in BALF and plasma increased after 2 h, and the levels of NE were higher in BALF than in plasma. The albumin concentration in 6 h group increased significantly, there was statistical significance compared with the control group （P 〈 0. 05）. There was a positive correlation between the content of NE and the albumin concentration of BALF, the water in the brain tissue （P 〈 0. 05）. Conclusion There are some different levels of lung injury after severe brain injury. NE may be one of the important reasons of the secondary lung injury induced by severe brain damage. Early monitoring of plasma NE content maybe predict indirectly lung injury.

关 键 词：重度脑损伤 继发性肺损伤 中性粒细胞弹性蛋白酶(NE) 

分 类 号：R691.3[医药卫生—泌尿科学]