肠系膜淋巴管引流减轻阳明腑实证大鼠肺损伤的作用机制研究  

A study on alleviation of acute lung injury in rats with bowel repletion pattern by mesenteric lymph drainage and its mechanism

作　　者：卢清龙[1,2] 张淑坤[3] 崔乃强[4] 张艳敏[4] 卓玉珍[3] 

机构地区：[1]天津中医药大学,天津300193 [2]河北省沧州市人民医院ICU,河北沧州061000 [3]天津市中西医结合急腹症研究所,天津300110 [4]天津市南开医院,天津300110

出　　处：《中国中西医结合急救杂志》2015年第5期458-461,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金资助项目（81273951）

摘　　要：目的 观察肠系膜淋巴管引流对阳明腑实证大鼠急性肺损伤（ALI）及p38丝裂素活化蛋白激酶（p38MAPK）信号通路表达的影响.方法 将30只雄性Wistar大鼠按随机数字表法分为假手术组、阳明腑实证模型组和肠系膜淋巴管引流组,每组30只.采用肠系膜上动脉（SMA）缺血1 h、再灌注2 h复制阳明腑实证大鼠模型,引流组于制模结束时进行持续肠系膜淋巴管引流3 h;假手术组大鼠暴露并钝性分离SMA及肠系膜淋巴管后即刻还纳腹腔器官.各组大鼠分别于引流3 h后取肺和回肠组织观察组织病理学改变,用酶联免疫吸附试验（ELISA）检测支气管肺泡灌洗液（BALF）中肿瘤坏死因子-α（TNF-α）和白细胞介素-6 （IL-6）含量,比较肺和回肠组织髓过氧化物酶（MPO）活性变化,并用荧光定量聚合酶链反应（PCR）检测肺组织Toll样受体4（TLR4）和p38MAPK的mRNA表达.结果 光镜下可见模型组大鼠肺毛细血管明显扩张充血,肺间质明显增宽,伴有大量炎性细胞浸润;肠黏膜层变薄,绒毛脱落,伴有大量炎性细胞浸润;模型组BALF中TNF-α和IL-6含量及肺、回肠组织MPO活性、肺组织TLR4和p38MAPK的mRNA表达均较假手术组明显增高.引流组大鼠肺和回肠组织病理学损伤较模型组减轻;BALF中TNF-α和IL-6含量及肺和回肠组织MPO活性、肺组织TLR4和p38 MAPK的mRNA表达均较模型组降低〔BALF中TNF-α（ng/L）：858.55±27.16比1 680.58±105.62;BALF中IL-6（ng/L）：0比484.71±5.43;肺MPO（U/g）：0.95±0.13比1.36±0.11;回肠MPO（U/g）：0.75±0.13 比1.30±0.16;TLR4 mRNA：0.21±0.11比0.69±0.13,p38MAPK mRNA：0.21±0.13比0.47±0.09;均P〈0.05〕.结论 肠系膜淋巴引流能减轻阳明腑实证大鼠的ALI程度,其机制可能与降低肺组织TLR4和p38 MAPK的mRNA表达、减少TNF-α及IL-6释放有关.Objective To observe the effects of mesenteric lymph drainage on acute lung injury and expression of p38 mitogen activated protein kinase （p38MAPK） signal pathway in rats with bowel repletion pattern. Methods Thirty male Wistar rats were randomly divided into three groups according to random number table method, namely sham operation group （sham group）, bowel repletion model group （model group） and mesenteric lymph drainage group （drainage group）, 10 rats in each group. The rat model of bowel repletion was established by ischemia/reperfusion （I/R） method, firstly 1 hour occlusion of superior mesenteric artery （SMA） to induce ischemia followed by reperfusion for 2 hours. In the rats of drainage group, the drainage of mesenteric lymph duct began at the end of model establishment and persisted for 3 hours. In the rats of sham group, the SMA and mesenteric lymph ducts were exposed with blunt dissection, and then they were immediately placed back into the abdominal cavity. After 3 hours of mesenteric lymph drainage, the lung and ileum tissues of rats in each group were harvested for evaluation of pathohistological changes and for the determination and comparison of myeloperoxidase （MPO） activity changes; the levels of tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） in bronchoalveolar lavage fluid （BALF） were detected by enzyme linked immunosorbent assay （ELISA）, and the expressions of Toll-like receptor 4 （TLR4） mRNA and p38MAPK mRNA in the lung tissues were measured by fluorescence quantitative polymerase chain reaction （PCR）.Results Under the light microscope, the pulmonary capillaries markedly dilated and congested, the interstitium width of lung increased with a large amount of inflammatory cells infiltration, the intestinal mucosal layer becoming thinner with detachment of intestinal villi and a large amount of inflammatory cells infiltration were detected in rats of model group. Compared with those in sham group, the levels of TNF-α and IL-6 in BALF

关 键 词：肠系膜淋巴管 阳明腑实证 肺损伤 急性 P38丝裂素活化蛋白激酶 

分 类 号：R-332[医药卫生]