不同目标血糖脓毒症大鼠肝、肺损伤的病理分析  

Study on the impact of different levels intensive glycemic control on the morphology of liver and lung in rats with sepsis

作　　者：何永来[1] 齐妍[2] 张景玉[3] 朱建波[2] 单琦[4] 蒋金芳[2] 梁伟华[2] 李洪安[2] 程青虹[1] 

机构地区：[1]石河子大学医学院第一附属医院ICU,新疆石河子832000 [2]石河子大学医学院病理系/第一附属医院病理科,新疆石河子832002 [3]石河子大学医学院预防医学系,新疆石河子832000 [4]河南科技大学第一附属医院新区ICU,河南洛阳471000

出　　处：《重庆医学》2014年第33期4428-4431,共4页Chongqing medicine

基　　金：国家自然科学基金资助项目(81202120)

摘　　要：目的利用盲肠结扎穿孔伴严重腹腔感染造成的脓毒症模型,探讨胰岛素不同目标血糖对脓毒症肝、肺组织形态的影响。方法选取40只SD大鼠随机分为5组,通过盲肠结扎穿孔术(CLP)法制备大鼠脓毒症模型,按分组进行不同处理:假手术组(Sham组),CLP组,目标血糖控制A组、B组和C组,每组8只。CLP术后12h处死,通过组织形态观察,对肝、肺损伤不同病理积分进行评估。结果肝、肺组织病理总评分在CLP及血糖处理后明显高于Sham组(P<0.05)。在单项肝、肺的观察指标中,A组与Sham组比较,差异无统计学意义(P>0.05);3组血糖组肝、肺损伤程度随着血糖水平升高病变渐进加重,两两比较差异有统计学意义(P<0.05)。肺损伤主要表现为肺泡壁毛细血管充血、肺小叶及间质水肿、支气管炎,CLP组与血糖控制A、B、C3组比较,与A、B组差异有统计学意义(P<0.05),与C组差异无统计学意义(P>0.05)。肝损伤主要为肝细胞水样变性及脂肪变性,CLP组与血糖控制A、B、C 3组比较,差异有统计学意义(P<0.05),CLP组出现了明显碎片状坏死。结论脓毒症大鼠的肝、肺损伤程度随着血糖水平升高逐渐加重,控制血糖可使脓毒症模型鼠的肝、肺的损伤减低。Objective To investigate the changes and significance of different target blood glucose on septic liver and lung dam‐age and its morphology .The purpose of this study was to evaluate the pathological injury of liver and lung induced by higher blood glucose .Methods Forty SD rats randomly divided into sham operation group ,sepsis group ,group A （glucose was controlled at 4 .4 to 6 .1 mmol/L） ,group B （glucose was controlled at 6 .1 to 8 .3 mmol/L） and group C （glucose was controlled at 8 .3 to 10 .0 mmol/L） ,with 8 rats in each group .The liver and lung tissue were obtained 12 hours after cecal ligation and puncture .Then evalu‐ate and analyze the morphology change in liver and lung injury from different pathological scores ,including eight observation marker for liver and seven marker for lung .Results The pathological injury of liver and lung was significantly higher than sham treatment group for CLP and group A to C（P〈0 .05） .In observation of individual indicators of the injury of liver and lung ,group A had no significant difference with the sham group （P〉0 .05） ,but in the three blood glucose groups ,liver and lung injury progressive dis‐ease with the level of blood glucose elevating and the difference was significant（P〈0 .05） .The main pathological features of lung injury were alveolar wall capillary congestion ,pulmonary lobules and interstitial edema ,bronchitis ,and CLP group had significant differences with group A and B（P〈0 .05） ,and had no significant differences with group C（P〉0 .05） .For liver injury the main pathological features were hydropic and fatty degeneration ,and CLP group had significant differences with group A ,B and C（P〈0 .05） .While CLP group showed a significant piecemeal necrosis for liver injury .Conclusion The injury of liver and lung injury in septic rats were gradually increased with elevated blood glucose levels ;blood glucose controlled within the normal range of liver rat model of sepsis could reduce the liver and lung inju

关 键 词：脓毒症 强化血糖控制 肝损伤 肺损伤 

分 类 号：R459.7[医药卫生—急诊医学]