地塞米松对兔急性肺损伤心肌的损伤作用  

Effects of dexamethasone on myocardial injury in rabbits with acute lung injury

作　　者：翁翠莲 刘庆华[3] 

机构地区：[1]福建省立医院呼吸内科,福建福州350000 [2]厦门大学附属第一医院呼吸内科,福建厦门361000 [3]福建省立医院福建医科大学省立临床医学院耳鼻咽喉科重点专科,福建福州350000

出　　处：《中国现代医生》2017年第26期34-36,47,169,共5页China Modern Doctor

基　　金：国家自然科学基金(81301995)

摘　　要：目的探讨地塞米松对内毒素(ET)致急性肺损伤(ALI)兔心肌保护作用的机理。方法日本大白兔24只随机分为生理盐水对照组(A组)、ET组(B组)和ET致伤+地塞米松干预组(C组),每组8只。除了A组以外,B组、C组均从颈静脉给予ET(700μg/kg),C组在给予ET前予地塞米松5 mg/kg。分别于0 h、0.5 h、1 h、2 h、4 h观察动脉血气变化。4 h后处死动物,取肺、心脏组织观察光镜下的组织病理学改变,并检测心脏中心肌型脂肪酸结合蛋白(H-FABP)的变化。结果 B组动物血氧饱和度在0.5 h明显下降(265.4±70.2)mm Hg,肺组织明显渗出,水肿液形成,透明膜形成,肺间质血管内皮细胞肿胀,血管壁见较多的中性粒细胞贴壁。心肌组织细胞肿胀,心肌结构排列紊乱,局灶可见心肌细胞坏死。与A组比较,B组心组织中的H-FABP明显降低[(302.0±89.1)vs(132.6±46.9),P<0.01]。与B组比较,C组的动脉血氧饱和度显著升高,心肌中的H-FABP明显高于ET组,差异有统计学意义[分别为(236.0±88.1)vs(132.6±46.9),P<0.05],心肌损伤较损伤组明显轻。结论 ET所致ALI的心肌损伤作用可能与H-FABP的减少有关,使用地塞米松能增加H-FABP的含量,减轻肺损伤时的心肌受损作用。Objective To investigate the mechanism of protective effect of dexamethasone on myocardium in the rabbits with endotoxin（ET） induced acute lung injury（ALI）. Methods 24 Japanese rabbits were randomly divided into normal saline control group（group A）, ET group（group B） and ET-induced injury＋dexamethasone intervention group（group C）,with 8 rabbits in each group. In addition to group A, group B and group C were given ET（700 μg/kg） via the jugular vein. Group C was given dexamethasone 5 mg/kg before administration of ET. The changes of arterial blood gas were observed at 0 h, 0.5 h, 1 h, 2 h and 4 h respectively. After 4 h, animals were sacrificed, lung and heart tissues were harvested and histopathological changes were observed under light microscope. Changes in the H-FABP were detected in heart. Results The animal oxygen saturation in group B was significantly decreased at 0.5 h（265.4 ±70.2 mm Hg）.Lung tissue was oozing significantly. Edema fluid was formed, and transparent membrane was formed. Pulmonary interstitial vascular endothelial cells were swelling. There were more neutrophils adhering to the wall in vascular wall. Myocardial tissue cells were swelling, and myocardial structure was in disorder. Myocardial cell necrosis could be seen in local focus. Compared with group A, H-FABP in group B was significantly lower than that in group A（302.0±89.1） vs（132.6±46.9,P〈0.01）. Compared with group B, the arterial oxygen saturation in group C was significantly higher. The H-FABP in the myocardium was significantly higher than that in the ET group, and the difference was statistically significant [（236.0±88.1） vs（132.6±46.9, P〈0.05）]. Myocardial injury was significantly milder than that in the injury group.Conclusion The myocardial injury induced by ET may be related to the decrease of H-FABP. The application of dexamethasone can increase the content of H-FABP and reduce the myocardial damage during lung injury.

关 键 词：急性肺损伤 心脏型脂肪酸结合蛋白 地塞米松 

分 类 号：R563[医药卫生—呼吸系统]