高渗盐水复苏缺血小肠对小肠免疫屏障和系统炎性反应综合征的影响  

Hypertonic Saline Resuscitation for Ischemic Intestine and its Impact on Immune Function of Intestine Mucosal Barrier and SIRS

作　　者：张森森[1] 朱振新[2] 吴洪坤[1] 周琳[1] 仲人前[1] 

机构地区：[1]第二军医大学附属长征医院实验诊断科,上海200003 [2]第二军医大学附属长征医院胃肠外科,上海200003

出　　处：《中国实验诊断学》2014年第2期187-191,F0003,共6页Chinese Journal of Laboratory Diagnosis

基　　金：黎介寿院士肠道屏障专项研究基金课题(LJS_201009)

摘　　要：目的本研究拟证实利用高渗盐水进行液体复苏可保护缺血-再灌注过程中的肠道黏膜屏障功能,并减轻该过程中机体系统性炎症反应综合征(SIRS),从而为临床大出血、严重感染、大面积烧伤后肠功能障碍患者液体复苏方案的选择提供新的策略方法和理论依据.方法①选用清洁级雄性Sprague-Dawley(SD)大鼠,体重250g-300g,通过肠系膜上动脉夹闭法建立大鼠小肠缺血-再灌注损伤模型。②选用清洁级雄性Sprague-Dawley(SD)大鼠,随机分为假手术组(Sham组),缺血-再灌注损伤组(IR组)和高渗盐水复苏组(HS组)。IR组夹闭肠系膜上动脉1h后开放并经尾静脉输入0.9%氯化钠溶液;HS组夹闭肠系膜上动脉1h后开放并经尾静脉输入7.5%氯化钠溶液;Sham组操作方法同IR组,但不进行肠系膜上动脉夹闭。再灌注6h后取标本。③免疫组化检测小肠粘膜内淋巴细胞(intraepithelial lymphocyte,IEL)和固有层淋巴细胞(lamina propria lymphocytes,LPL)中T细胞亚群改变;流式细胞术检测大鼠外周血T细胞亚群及NK细胞。结果①肠黏膜上皮细胞层中的上皮内淋巴细胞(IEL)和位于疏松结缔组织中的固有层淋巴细胞(LPL)中CD4+T细胞数量和CD8+细胞数量,IR组和HS组显著高于Sham组,HS组显著高于IR组。②外周血T细胞亚群及NK分析:HS组CD3+CD8+T细胞显著低于IR组和Sham组(P<0.05),HS组NK细胞比例显著低于IR组和NS组(P<0.05),余未见显著性差异。结论利用高渗盐水复苏缺血小肠,可有效保护小肠免疫屏障,抑制全身炎性反应综合征。Objective This study will confirm that hypertonic saline can protect small intestinal mucosal immune barrier and suppression system inflammatory response syndrome in the small intestine ischemia-reperfusion injury, which will provided new the methods and ideas in the clinical treatment of intestinal ischemia-reperfusion iniury. Meth- ods 1. Intestinal ischemia-reperfusion injury model were established through the clipping of superior mesenteric artery in Sprague-Dawley（SD）rats （weight 250 g-300 g）. 2. Sprague-Dawley（SD）rats were randomly divided into 3 groups： Sham group,IR group and HS group. In IR group,the superior mesenteric artery was clipped for lh and then resusci- tate with 0.9% Nail; In Hs group the superior mesenteric artery was clipped for lh and then resuscitate with 7.5% Nail% In the Sham group the operation is same to the IR group but without superior mesenteric artery clipping. 3. T cell subsets change of small intestinal lymphocytes （IEL） and lamina propria lymphocytes （LPL）,T cell subsets and NK cells in peripheral blood were observed. Results 1. CD4＋ T-cell and CD8＋ cells in cell numbers of IEL and LPL in IR group and HS group was significantly higher than that in the Sham group（P〈0.01） ,and that in HS group was signifi- cantly higher than that in IR group（P〈0.01）. 2 peripheral blood T cell subsets and NK：In HS group,CD3＋ CD8＋ T cells was significantly lower than that in the IR group and NS group （P〈0.05）. NK cells in HS group was significantly lower than that in the IR group and NS group （P〈0.05）. No significant difference was seen in other groups. Conclu- sion Hypertonic saline can protect small intestinal mucosal immune barrier and suppression system inflammatory re- sponse syndrome in the small intestine ischemia-reperfusion injury.

关 键 词：缺血-再灌注损伤 高渗盐水 液体复苏 肠粘膜免疫屏障 系统炎性反应综合征 

分 类 号：R363[医药卫生—病理学]