腹内高压对肠黏膜屏障功能损伤的影响  

Intra-abdominal high pressure induces intestinal barrier dysfunction in rats

作　　者：赵晓琴[1] 陈英[1] 邝晓聪[1] 陈强[1] 覃桦[1] 蒙永毅[1] 叶永康[1] 

机构地区：[1]广西医科大学第一附属医院重症监护中心,广西壮族自治区南宁市530021

出　　处：《世界华人消化杂志》2013年第34期3790-3798,共9页World Chinese Journal of Digestology

基　　金：广西自然科学基金资助项目;No.2010GXNSFA013139~~

摘　　要：目的:研究不同程度腹内高压对大鼠肠黏膜屏障功能的影响及可能机制.方法:将45只成年♂SD大鼠随机分为对照组、腹内压10和20 mmHg组,每组15只.运用氮气气腹法制作大鼠腹内高压动物模型,两气腹组各按维持气腹第1、2、4小时分为3组,每组5只SD大鼠,解除气腹后术后24 h用分光光度计测量各组动物不同小肠段蓝色葡聚糖2000浓度的情况,检测肠黏膜组织匀浆中丙二醛(malondialdehyde,MDA)、还原型谷胱甘肽(reduced glutathione,GSH)、超氧化物歧化酶(superoxide dismutase,SOD),血浆中二胺氧化酶(diamine oxidase,DAO)和D-乳酸含量,光镜及电镜下观察肠组织病理形态学变化,以上各组设有相应对照组,对照组不充入氮气.结果:(1)腹内压(intra-abdominal pressure,IAP)为10和20 mmHg组大鼠肠道转运功能明显减弱;(2)两组气腹组肠黏膜SOD、GSH水平及MDA含量与相应对照组比较无显著差异(P>0.05);(3)血浆D-乳酸与相应对照组比较差异无显著变化;血浆DAO值在IAP 10 mmHg组与相应对照组比较差异无显著变化,IAP 20mmHg组与对照组有明显改变(P<0.05);(4)在光镜下看,对照组术后肠道黏膜未见明显损害.IAP 10 mmHg组肠黏膜绒毛上皮细胞结构完整,排列整齐,小肠黏膜上皮下间隙偶尔增大提示小肠绒毛毛细血管充血,IAP 20 mmHg组观察到不同程度的肠黏膜上皮细胞改变,小肠黏膜淤血,黏膜上皮水肿,上皮下细胞间隙扩张,部分肠黏膜绒毛顶端上皮细胞变性、坏死、自绒毛脱落,部分绒毛顶端破损,一些腺体显示不清;(5)电镜超微结构分析显示IAP 10 mmHg下肠壁绒毛细胞间紧密连接(tight junction,TJ)轻度肿胀,IAP 20 mmHg下部分视野可见微绒毛变钝,绒毛倒伏,线粒体结构不清.结论:(1)腹内压为10和20 mmHg的N2气腹可导致SD大鼠肠道转运功能明显减弱;(2)20 mmHg N2气腹使血浆DAO活性增强,肠黏膜屏障功能损伤;而10 mmHg气腹不影响血浆DAO活性和肠黏膜屏障功�AIM： To study the effect of different degrees of intra-abdominal high pressure on intestinal mu- cosal barrier dysfunction and to explore the pos- sible mechanisms involved. METHODS： Forty-five adult male SD rats were rapdornly divided into a normal control group, a 10 mrnHg and a 20 mrnHg group （n = 15 for each）. Nitrogen pneumoperitoneum was induced to generate intra-abdorninal high pressure in animal rnodels. The two pneu- moperitoneum groups were further dividedinto three subgroups （five rats in each sub- group） for testing when pneumoperitoneum was maintained for 1, 2 and 4 h, respectively. Twenty-four hours after the relief of pneumo- peritoneum, a spectrophotometer was used to measure the concentration of blue dextran 2000 in different segments of the small intes- tine. Malondialdehyde （MDA）, reduced gluta- thione （GSH） and superoxide dismutase （SOD） in intestinal tissue homogenates, as well as plasma diamine oxidase （DAO） and D-lactic acid were measured. Morphological changes in the intestinal tissue were observed by light microscopy and electron microscopy. RESULTS： Compared to the control group, intestinal transit was significantly delayed, but intestinal SOD, GSH and MDA levels and plasma D-lactate level showed no significant changes in the two high intra-abdominal pres- sure groups （all P 〉 0.05）. Plasma DAO level did not differ significantly between the 10 mmHg group and control group, but was sig- nificantly different between the 20 mmHg and control groups （1412.93 ± 1397.19 vs 542.41 ± 314.93, P 〈 0.05）. Under the light microscope, postoperative intestinal mucosa showed no damage in the control group; however, mild （increase in small intestinal subepithelial gaps and villus capillary congestion） and severe （varying degrees of intestinal mucosal changes, small intestinal mucosal congestion and edema, expansion of small intestinal subepithelial gaps, and intestinal villus degeneration, necrosis or loss） pathological changes were observed in the 10 a

关 键 词：气腹 腹内压 肠蠕动功能 肠黏膜屏障 氧 化应激 

分 类 号：R459.7[医药卫生—急诊医学]