肺泡表面张力与肿瘤坏死因子在急性低氧油酸性肺损伤时的变化  

Changes in pulmonary surface tension and tumor necrosis factor-α after oleic acid induced lung injury during acute hyposia

作　　者：崔社怀[1] 郭先健[2] 钱桂生[2] 

机构地区：[1]第三军医大学西南医院呼吸科,重庆400038 [2]第三军医大学新桥医院呼吸内科研究所,重庆400037

出　　处：《中国危重病急救医学》2000年第1期3-6,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金!资助项目(39670336)

摘　　要：目的：探讨急性低氧油酸肺损伤中肺泡表面活性物质（ＰＳ）系统改变的机制。方法：采用急性低氧肺损伤大鼠模型，分别观察血浆和支气管肺泡灌洗液（ＢＡＬＦ）中肿瘤坏死因子 α（ＴＮＦ α）的含量变化；采用人工智能的方法测定ＢＡＬＦ中表面张力的变化；用高效液相色谱测定ＢＡＬＦ中磷脂组分的改变。结果：静脉注入油酸后肺部很快出现中性粒细胞（ＰＭＮ）的聚集，１小时即可达峰值（８０．３２％ ）；ＴＮＦ α在血浆和ＢＡＬＦ中显著增加，以ＢＡＬＦ中含量增加较显著，并随病程的延长而升高〔（４ ７７３．０±４０５．１）ｎｇ／Ｌ〕；静脉注入油酸后磷脂酰胆碱（ＰＣ）含量显著降低，而磷脂酰乙醇胺（ＰＥ）含量显著升高；ＢＡＬＦ的最小表面张力（ＳＴｍ ｉｎ ）迅速上升达到峰值，滞后环面积和稳定指数（ＳＩ）则进行性下降，并维持在一个较低水平（０．３９±０．０８）。己酮可可碱（ＰＴＸ）可减轻油酸肺损伤肺部炎细胞浸润，减少ＴＮＦ α在血浆和ＢＡＬＦ中的含量。结论：急性呼吸窘迫综合征（ＡＲＤＳ）或急性肺损伤时确有ＰＣ和ＰＥ及表面张力参数的改变；ＴＮＦ α不但参与了ＡＲＤＳ的发病机制，而且损害了肺部ＰＳ系统；ＰＴＸ可明显改善动脉血氧分压，减轻肺水肿。Objective:To investigate changes in pulmonary surfactant system after oleic acid induced lung injury with acute hypoxia and their potential mechanism(s).Methods:A rat model of acute lung injury was produced by injected oleic acid into the superior vana cava.The levels of tumor necrosis factorα(TNFα) were measured both in bronchoalveolar lavage fluid(BALF) and plasma.Pulmonary surface tension was determined in BALF by KDⅡ instrument.Phosphalidylcholine (PC) and phosphatidylethanolamine (PE) levels were detected in BALF by high performance liquid chromatography.Results:TNFα levels were significantly increased in BALF and plasma,which kept gradually elevation along with the prolonged acute lung injury.PC levels were markedly decreased while PE levels significantly increased following oleic acid challenge.Also,the value of minimum surface tension kept a high level,but stable index and surface area showed persistent decrease and maintained low values.Treatment with pentoxifylline (PTX) markedly reduced pulmonary infiltration of inflammatory cells and inhibited TNFα formation both in BALF and plasma.Conclusions:Remarkable changes in PC,PE,and surface tension could be noted in animals with ARDS or acute lung injury.TNFα might not only involve in the pathogenesis of acute lung,but also impair pulmonary surfactant system.PTX can improve PaO 2 and attenuate pulmonary edema,and also decrease TNFα levels in BALF and plasma,showing beneficial effect on the treatment of acute lung injury during acute hypoxia.

关 键 词：肺损伤 油酸 低氧 表面张力 TNF-α PS 

分 类 号：R563[医药卫生—呼吸系统]