亚低温治疗对猪心肺复苏后肝损伤的保护作用及机制  

Protective effect and mechanism of mild hypothermia on liver injury after cardiopulmonary resuscitation in pigs

作　　者：李亚强[1] 王艳[2] 宋健 解东媛 唐子仁 李春盛[5] 郝建宇[2] 金木兰[6] 胡秀梅[6] 翟佳磊 刘正新[2] Li Yaqiang;Wang Yan;Song Jian;Xie Dongyuan;Tang Ziren;Li Chunsheng;Hao Jianyu;Jing Mulan;Hu Xiumei;Zhai Jialei;Liu Zhengxin(Department of Gastroenterology,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China;Department of Gastroenterology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Gastroenterology and Hepatology,Ningbo Yinzhou People’s Hospital,Ningbo 315000,China;Department of Infection,Shenzhen People’s Hospital,Shenzhen 518101,China;Department of Emergency,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Pathology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京潞河医院消化内科,北京101100 [2]首都医科大学附属北京朝阳医院消化内科,北京100020 [3]宁波市鄞州人民医院消化肝病内科,宁波315000 [4]深圳市人民医院感染病科,深圳518101 [5]首都医科大学附属北京朝阳医院急诊医学科,北京100020 [6]首都医科大学附属北京朝阳医院病理科,北京100020

出　　处：《中华医学杂志》2020年第35期2785-2790,共6页National Medical Journal of China

基　　金：吴阶平医学基金会临床科研专项 (2014-427-2083)。

摘　　要：目的:探讨亚低温治疗对猪心肺复苏后肝脏的影响。方法:选取实验用雄性五指山猪33头,体重(28±2)kg,建立心室纤颤模型,心肺复苏到达基础生命支持后存活30只,随机数字表法分为常规治疗组(C组)与亚低温治疗组(M组)各15头,观察24 h;复苏前、复苏成功后0.5、1、2、4、6、12、24 h抽取静脉血,检测丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平,同时应用ELASA法检测白介素6(IL-6)及肿瘤坏死因子-α(TNF-α)浓度。对组间数据进行比较,方差齐时用LSD检验,不齐时用Tamhane T2检验。结果:复苏成功后24 h时M组存活11头(73.3%)、C组存活8头(53.3%),差异无统计学意义(χ2=1.229,P=0.225)。复苏后两组转氨酶均有升高,M组AST、ALT较C组升高幅度低(均P<0.05)。成功复苏后血液中TFN-α、IL-6的水平升高,4 h时达到高峰,之后下降,M组TNF-α水平在复苏后0.5、2、4、6 h较C组低(t=0.01、0.01、0.87、0.86,均P<0.05),M组IL-6浓度在复苏后0.5、1、2、4 h较C组低(t=0.23、0.78、0.11、0.80,均P<0.05)。结论:复苏成功后,肝脏经历缺血再灌注损伤,可能与TNF-α、IL-6等炎症介质的释放相关,亚低温治疗可抑制TNF-α、IL-6等炎症因子的释放,从而减轻复苏后肝脏的损伤程度,对肝脏有保护作用。Objective To investigate the effect of mild hypothermia therapy on liver after cardiopulmonary resuscitation.Methods Thirty-three inbred Chinese Wuzhishan(WZS)minipigs,weighted(28±2)kg,were used to establish a ventricular fibrillation model.And 30 animals survived after cardiopulmonary resuscitation reached basic life support.The surviving animals were randomly divided into two groups:mild hypothermia group(group M,n=15)and conventional treatment group(group C,n=15).All the animals were observed for 24 hours.Blood samples were extracted at baseline,0.5,1,2,4,6,12 and 24 h after successful resuscitation.The concentrations of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were detected at the time points.The enzyme-linked immunosorbent assay(ELISA)was used to detect the concentrations of interleukin-6(IL-6)and tumour necrosis factor-alpha(TNF-α).The data were compared between the two groups,LSD test was used when the variance was homogeneous,and Tamhane T2 test was used when the variance was uneven.Results Eleven pigs(73.3%)in the group M and 8(53.3%)in the group C survived at 24 h after successful resuscitation,with no statistically significant difference between the two groups(χ2=1.229,P=0.225).After successful resuscitation,the AST,ALT increased in both group but less in M group(all P<0.05).After successful resuscitation,the concentrations of TFN-αand IL-6 in the blood increased in both groups,reached the peak at 4h,and then decreased gradually.The concentrations of TFN-αin group M were lower than those in group C at 0.5,2,4 and 6 h after successful resuscitation(t=0.01,0.01,0.87,0.86,all P<0.05).The concentrations of IL-6 in the group M were lower than those in group C at 0.5,1,2 and 4 h after successful resuscitation(t=0.23,0.78,0.11,0.80,all P<0.05).Conclusions After successful resuscitation,the release of inflammatory mediators,such as TNF-αand IL-6,and cell apoptosis may involve in liver ischemia reperfusion injury.After successful resuscitation,the liver undergoes ischemia-reperfusio

关 键 词：心肺复苏术 亚低温 肝脏 炎症反应 凋亡 

分 类 号：R459.7[医药卫生—急诊医学]