肠道缺血再灌注损伤对肺的影响  

Lung injury caused by intestinal ischemia/reperfusion

作　　者：何桂珍[1] 陈雪峰[1] 崔晓雨[1] 董良广[1] 王玉康[1] 周开国[1] 王洁[1] 朱乾坤[1] He Guizhen Chen Xuefeng Cui Xiaoyu Dong Liangguang Wang Yukang Zhou Kaiguo Wang Jie Zhu Qiankun(Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医院肠外肠内营养科,100730

出　　处：《中华普通外科杂志》2016年第12期1022-1026,共5页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（30940069）;北京自然科学基金资助项目（7102127）

摘　　要：目的评价肠道缺血再灌注损伤对肺的影响。方法sD大鼠30只，随机分为3组：对照组（blank组）、假手术组（sham组）、肠道缺血再灌注组（I／R组，缺血60min／再灌注120nlin），每组10只，取血、肠道和肺组织进行分析。结果blank组和sham组空肠绒毛结构完整，I／R组空肠和回肠黏膜肿胀、萎缩。Blank组和sham组细菌培养均为阴性，I／R组细菌移位率为40％。I／R组血清高迁移率族蛋白1、内毒素、D-乳酸及二胺氧化酶浓度均高于blank组及sham组（均P〈0．05）；I／R组血清IL-6、IL-1B、可溶性细胞黏附分子-1和TNF-α水平均高于blank组和shanl组（均P〈0．05）；I／R组的血浆游离氨基酸和谷氨酰胺浓度比blank组降低（P〈0．05）。I／R组肺支气管壁增厚，淋巴细胞浸润，肺泡上皮破坏，可见肺水肿及出血。blank组、sham组和I／R组平均Ⅱ型肺泡上皮细胞凋亡数分别为（14±15）、（19±15）、（134±104）个／视野，I／R组高于前两组（P〈0．05）；I／R组肺组织的髓过氧化物酶水平与blank组比较差异有统计学意义（P〈0．05）；I／R组的NO、NOS及iNOS含量均高于blank组和sham组（均P〈0．05）。结论肠道缺血再灌注损伤时，肠道细菌移位增加，血中内毒素和炎性因子水平升高，继而引起肺泡结构破坏，肺上皮细胞凋亡。Objective To investigate lung injury caused by intestinal ischemia/reperfusion （I/R） in rats. Methods Thirty SD rats were divided into three groups （ n = 10 each） ： Blank group, sham group and L/R group. At the end of the experiment, blood, intestinal tissues and lung tissues were obtained for analysis. Results The intestinal villi structures were normal in blank and sham group. In I/R group, the mucosa were swelling, atrophied. Bacteria translocation rate in the I/R group was 40%. HMGB1, endotoxin, D-lactate, and DAO in the serum were significantly higher in I/R group （ P 〈 0. 05 ）. Serum IL-6, IL-1β, sICAM-1 and TNF-α, were significantly elevated in the I/R group （P 〈0. 05 ）. Plasma individually free amino acids and glutamine decreased in I/R group （ P 〈 0.05 ）. In I/R group bronchial walls thickened with lymphocytes infiltration, alveolar epithelium damage, pneumonedema and hemorrhage. The average cell apoptosis of type Ⅱ alveolar epithelium were （ 14 ± 15 ） , （ 19 ± 15 ） and （ 134 ± 104 ） in the blank, sham and I/R group （ P 〈 0. 05 ）. MPO levels in lung tissue in I/R group increased （ P 〈 0. 05 ）. NO, NOS and iNOS level in I/R group were higher than that in the blank and sham group （P 〈 0.05）. Conclusions In intestinal ischemia/reperfusion, bacteria translocation increased. Serum level of endotoxin, inflammatory factors elevated causing lung injury demonstrated by the alveolar structure changes, apoptosis of lung epithelium cells.

关 键 词：再灌注损伤 肺损伤 细菌移位 炎症趋化因子类 细胞凋亡 

分 类 号：R574[医药卫生—消化系统] R563[医药卫生—内科学]