肠道缺血后不同时间再灌注和淋巴管结扎对肠道和肺组织的影响  

Impact of Different Reperfusion Period and Lymph Duct Ligation on Blood and Tissue after Intestinal Ischemia in Rats

作　　者：何桂珍[1] 崔晓雨[1] 王玉康[1] 董良广[1] 陈雪峰[1] 

机构地区：[1]中国医学科学院/北京协和医学院北京协和医院肠外肠内营养科,100730

出　　处：《医学研究杂志》2013年第4期26-30,共5页Journal of Medical Research

基　　金：国家自然科学基金资助项目(30940069)

摘　　要：目的比较肠道缺血60min后,不同的再灌注时间及淋巴管结扎对肠道形态、内毒素和炎性因子等影响。方法 SD大鼠60只,体重250±20g,随机分成6组(n=10):对照组(blank);sham组;缺血60min再灌注120min(I/R-3h)组;缺血60min再灌注72h(I/R-72h)组;缺血60min再灌注120min和淋巴管结扎(I/R+L-3h)组;缺血60min再灌注72h和淋巴管结扎(I/R+L-72h)组。I/R-3h和I/R+L-3h组在复灌120min后取材;I/R-72h和I/R+L-72h组在复灌72h后取材。结果肠道缺血60min再灌注120min时,大鼠肠黏膜可见缺血、坏死。再灌注72h后,空肠和回肠的绒毛高度和厚度都显著增加(P<0.05),淋巴管结扎组的空肠黏膜厚度显著高于缺血组(P<0.05)。I/R-3h及I/R+L-3h组的内毒素、DAO、ICAM-1和I/R-3h的D-乳酸和TNF-α水平显著高于其他4组(P<0.05),肠道再灌注120min时,NO显著增加(P<0.05),肺凋亡的结果显示I/R-3h组的肺细胞凋亡显著高于其他各组。结论肠道缺血60min再灌注120min可导致肠屏障损伤,细菌及其毒素移位和肺损伤,再灌注72h后,肠道形态,D-乳酸及NO仍高于正常。肠淋巴干结扎能减轻缺血再灌注引起的远隔组织器官的损伤。Objective To investigate the impact of different reperfusion period and lymph duct ligation on intestinal morphology, en- dotoxin and inflammatory cytokines after isehemia for 60min in rats. Methods Sixty Sprague - Dawley male rats, weighing 250 ＋ 20g,were randomly divided into six groups （n = 10） ：blank, sham, I/R - 3h, I/R -72h, I/R ＋ L -3h, and I/R ＋ L -72h group. All rats were subjected to 60min ischemia by clamping the SMA and followed by reperfusion for 120rain in I/R - 3h and I/R ＋ L - 3h group and reperfusion for 72h in I/R - 72h and I/R ＋ L - 72h group. The rats in I/R ＋ L - 3h and I/R ＋ L - 72h group were both treated with intes- tinal lymph duet ligation prior to isehemia. Results In I/R - 3h and I/R ＋ L - 3h group,intestinal mucosa showed isehemia and necrosis. In I/R - 72h and I/R ＋ L - 72h group, the jejunum and ileum villus height and thickness were significantly increased （ P 〈 0.05） and je- junal mucosal thickness in I/R ＋ L- 72h group was obviously higher than I/R -72h group （P 〈 0.05 ）. Endotoxin, DAO and ICAM -1 in I/R - 3h and I/R ＋ L - 3h group were much increased compared with other 4 groups （P 〈 0.05 ）. The endotoxin, D - lactate and TNF - cdevel in I/R - 3h were markedly increased compared with I/R ＋ L - 3h group （ P 〈 0.05 ）. NO levels in I/R - 3h and I/R ＋ L - 3h group were significantly increased （P 〈 0.05）. NO in I/R ＋ L - 72h group returned to normal after reperfusion for 72h, whereas in I/R -72h group it was higher than the sham and blank group （P 〈0.05）. The lung cell apoptosis in I/R -3h group was obviously higher compared with other groups （P 〈 0.05）. Conclusion The intestinal ischemia 60min and reperfusion 120min could lead to intestinal bar- rier dysfunction, bacterial and endotoxin translocation and acute lung injury. After 72h reperfusion the intestinal morphology, D -lactate and NO levels were still higher than normal. Lymph duet ligation could attenuate distant tissue injury caused by intestinal is

关 键 词：肠道缺血再灌注 淋巴管结扎 内毒素 D-乳酸肺损伤 

分 类 号：R743.31[医药卫生—神经病学与精神病学]