骶神经电刺激对脊髓损伤后肠-肝轴的作用  

Effect of electrical stimulus on sacral nerve on the gut-liver axis in rabbit after acute spinal cord injury

作　　者：白春宏[1] 李双英[2] 刘浩[1] 安洪[3] 王莎莉[4] 

机构地区：[1]中国人民武装警察部队后勤学院附属医院脊柱一科,天津300162 [2]中国人民武装警察部队后勤学院附属医院脑科中心,天津300162 [3]重庆医科大学附属第一医院骨科,重庆400016 [4]重庆医科大学神经科学研究中心,重庆400016

出　　处：《第三军医大学学报》2014年第17期1775-1779,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金青年项目(81101441)~~

摘　　要：目的探讨骶3神经根电刺激对兔急性完全性脊髓损伤后肠-肝轴的作用。方法 1采用Fehlings脊髓损伤模型。2电生理研究:分别采用3个强度参数(6、8、10 V)和3个波宽(200、400、600μs)进行刺激,记录、分析和寻找最适合参数。3肠-肝轴体系研究:新西兰成年白兔42只分为正常组(6只)、对照组(18只)和实验组(18只)。对照组和实验组又在截瘫后24、48、72 h无菌条件下取小肠、肝脏、肝门静脉血作为检验标本。肝脏进行细菌培养,门静脉血定量测定血清内毒素及ALT、AST和GGT;取小肠组织进行光镜、电镜观察并进行ZO-1免疫组化染色;HE染色观察肝脏形态。结果 1脊髓损伤后胃肠道生理均有变化,主要生理改变以单袋结肠和远端结肠的运动功能障碍较明显;骶神经电刺激能较好地恢复失神经肠道蠕动,促进排便。2经电刺激后,肠黏膜结构改善明显,肝脏细菌培养阳性率降低(12/18 vs 3/18,P<0.01);72 h肝门静脉血内毒素水平明显降低[(1.14±0.70)EU/L vs(0.07±0.05)EU/L,P<0.05];光镜观察肝脏结构改变明显减轻。24、48、72 h血液中ALT、AST和GGT数值均有统计学差异。经电刺激后,实验组各时间段ALT、AST和GGT数值虽然较正常组数值高,但较对照组明显降低(P<0.05)。结论骶3神经根电刺激能较好地恢复失神经肠道蠕动(主要单袋结肠、远端结肠),通过改善肠黏膜屏障功能减少细菌移位和内毒素血症,减轻肝脏损害,从而阻碍肠-肝轴恶性循环。Objectives To determine the effect of sacral nerve stimulation （SNS） on the gut-liver axis after spinal cord injury （SCI）. Methods Intestinal dysfunction model was established in rabbits after SCI by Fehlings method. The strength of stimulus （6, 8 and 10 V） and frequency of （200,400 and 600 μs） were applied respectively, then the response was recorded and analyzed. The experimental group （EG group, n = 18） included paraplegic rabbits that received electrical stimulation of the S3 nerve root. The paraplegic control group （CG group, n = 18） and the normal control group （NG group, n = 6） did not receive electrical stimulation. Under aseptic conditions, tissue samples of the small intestine, portal vein blood, and liver were collected at 24, 48 and 72 h after SCI. The liver tissue was analyzed with bacterial cultures, blood sample was analyzed to measure endotoxin, and serum levels of ALT, AST, and GGT were detected. HE staining was used to study the morphology of liver tissue. Morphology, ultrastructure, and ZO-1 immunohistochemical assay of the small intestine was analyzed. Results After SCI, the main change specifically demonstrated on dyskinesia of single haustrum and distal colon. SNS preferably recovered the movement of denervation intestine and promoted the defecation. After stimulation, the pathologic changes of intestinal barrier was alleviated, and the positive rates of the all cases in the liver were remarkably different from those in the CG group （ 12/18 vs 3/18, P 〈 0. 01 ）. Endotoxin levels in the EG at 72 h were significantly lower than the levels in the CG group （ 1.14 ±0. 70 vs 0. 07 ± 0.05 EU/L, P 〈 0.01 ） at the same sampling time. The injury of liver was correspondingly alleviated. The serum levels of ALT, AST, and GGT at 24, 48 and 72 h were significantly higher in the CGand EG groups than in the NG group, but their levels at the 3 time points were reduced apparently in EG group than in the CG group （P 〈 0.05 ）. Conclusion Electrical stimulus to sa

关 键 词：骶神经刺激 脊髓损伤 肠道屏障功能 肠-肝轴 兔 

分 类 号：R454.1[医药卫生—治疗学] R574.4[医药卫生—临床医学]