肠系膜淋巴管结扎对重症急性胰腺炎大鼠全身炎性反应的保护作用  

The protective effect of mesenteric lymph duct ligation on systemic inflammatory responsein rats with severe acute pancreatitis

作　　者：刘海燕[1] 

机构地区：[1]安徽医科大学第一附属医院重症医学科,安徽省合肥230022

出　　处：《中国基层医药》2015年第15期2260-2263,I0002,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：安徽省高校省级自然科学研究项目（KJ20122174）,安徽医科大学第一附属医院培育基金（2011KJ18）

摘　　要：目的：检测重症急性胰腺炎（SAP）大鼠肠系膜淋巴液中炎性因子表达水平，及肠系膜淋巴管结扎阻断肠淋巴液回流，观察肠淋巴途径在 SAP 致全身炎性反应中的作用。方法24只雄性 SD 大鼠随机分为 A 组（SAP 组）、B 组（SAP ＋肠系膜淋巴管结扎组）和 C 组（假手术对照组），每组8只。A 组和 C 组留取术后24 h 的淋巴液和门静脉血液标本，B 组留取门静脉血，分别测定 TNF-α、IL-1β、IL-6和内毒素水平。三组术后6 h，检测血中 CDl b 表达水平。乳果糖100 mg 和甘露醇50 mg 灌胃，测定24 h 乳果糖／甘露醇（L／M）排泄比值，作为肠黏膜通透性指标。实验结束后无菌条件下留取末端回肠组织，进行病理观察。结果A 组术后24 h 内毒素和细胞因子（TNF-α、IL-1β、IL-6）水平较 C 组均有明显升高（均 P ＜0．01）。淋巴液中同一因子浓度明显高于门静脉血，在 A 组表现尤为明显（P ＜0．05）。B 组大鼠术后24 h 内毒素和细胞因子（TNF-α、IL-1β、IL-6）水平较 A 组均有明显下降（均 P ＜0．05），但仍高于 C 组水平（均 P ＜0．05）。三组大鼠术后6 h 血中 CD11b 表达水平差异有统计学意义，A 组较 B 组和 C 组明显升高（均 P ＜0．01）。A 组术后24 h L／M比值较C 组明显升高（P ＜0．01），而 B 组 L／M比值较 A 组明显下降（P ＜0．05）。结论肠道淋巴途径是 SAP 致全身炎性反应的重要途径，肠系膜淋巴管结扎对 SAP 致全身炎性反应具有保护作用。Objective To observe the role of mesenteric lymphatic pathway in severe acute pancreatitis （SAP）by detection of inflammatory factors levels and mesenteric lymph duct ligation in rats.Methods Twenty-four SD male rats were randomly divided into group A （SAP group）,group B （SAP ＋ mesenteric lymph duct ligation group）and group C（sham operation group）,with eight rats in each group.Samples of portal vein blood and mesenter-ic lymph were collected for measuring the level of tumor necrosis factor α（TNF-α）,interleukin 1β（IL-1β）,interleu-kin 6（IL-6）and endotoxin at twelfth hour.The blood CDl b was tested at sixth hour.24h lactulose /mannitol excretion ratios（L/M）were taken as the intestinal mucosal permeability index by gavage of 100mg lactulose and 50mg mannitol solution.The terminal ileums were collected for pathological examination.Results The blood levels of endotoxin and cytokines（TNF-α,IL-1β,IL-6）were significantly increased in group A compared with group C（all P 〈0.01）.Each factor′s concentration in lymph was much higher than that in portal vein blood,especially in group A.The endotoxin and cytokines（TNF-α,IL-1β,IL-6）levels in portal vein blood of group B were significantly decreased compared with group A（all P 〈0.05）,but still higher than that of group C（all P 〈0.05）.CD11b expression in group A was the highest,followed by group B,group C was the lowest （P 〈0.01）.24h L/M in group A was significantly higher than that in group C （P 〈0.01）,and L/Min group B decreased significantly compared with those in A group（P 〈0.05）. Conclusion Lymphatic pathway is an important pathway of systemic inflammatory response induced by SAP,and ligation of mesenteric lymph duct has a protective effect on the organism.

关 键 词：胰腺炎 细胞因子类 全身炎症反应综合征 

分 类 号：R657.51[医药卫生—外科学]