醋酸钠林格液复苏联合乳酸菌对创伤失血性休克大鼠肠黏膜屏障的保护作用  

Protective effect of sodium acetate Ringer′s solution resuscitation combined with lactic acid bacteria on the intestinal mucosal barrier of rats with traumatic hemorrhagic shock

作　　者：李磊[1] 徐志鹏 夏群[1] 邱兆磊[1] 程峰[1] 窦贺贺[1] 姜海[1] 宋琦[1] 王振杰[1] LI Lei;XU Zhi-peng;XIA Qun;QIU Zhao-lei;CHENG Feng;DOU He-he;JIANG Hai;SONG Qi;WANG Zhen-jie(Department of Emergency Surgery,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院急诊外科,安徽蚌埠233004

出　　处：《蚌埠医学院学报》2021年第6期708-712,共5页Journal of Bengbu Medical College

基　　金：蚌埠医学院自然科学研究重点项目(BYKY2019027ZD)。

摘　　要：目的:探讨醋酸钠林格液复苏基础上应用乳酸菌对创伤失血性休克大鼠肠黏膜屏障的作用。方法:取30只SD大鼠数字法随机分为创伤失血性休克未复苏组(THS组,n=10),醋酸钠林格液复苏组(AR组,n=10),醋酸钠林格液联合乳酸菌复苏组(AL组,n=10),其中AL组大鼠建立休克模型前在正常喂养的基础上加服用乳酸菌素片1周(按照体积面积换算,大鼠每次服用剂量108 mg/kg,每天3次)。THS、AR组及AL组制备成休克模型[平均动脉压维持(35±5)mmHg],AL组及AR组于休克后60 min应用醋酸钠林格液进行30 min液体复苏,复苏后观察4 h取大鼠回肠组织,THS组不予复苏,于休克观察4 h后取回肠组织。利用ELISA检测大鼠外周血肿瘤坏死因子α(TNF-α)、白细胞介素(IL-6)、IL-4、及IL-10含量;应用Western blotting法检测回肠组织ZO-1、Claudin-1、TLR4、p38磷酸化及JNK磷酸化蛋白相对表达水平。结果:与THS组相比,AL组大鼠外周血TNF-α、IL-6含量降低,IL-4、IL-10含量升高,AR组TNF-α含量降低,差异均有统计学意义(P<0.05);与AR组比较,AL组大鼠外周血TNF-α含量降低,差异均有统计学意义(P<0.05),其余各细胞因子水平AR组和AL组比较差异无统计学意义(P>0.05)。回肠组织中,与THS组相比,AR组大鼠外周血TLR4、P-P38、P-JNK含量降低,AL组ZO-1、Claudin-1含量升高,差异均有统计学意义(P<0.05);与AR组相比,AL组ZO-1、Claudin-1含量升高,TLR4、P-JNK含量降低,差异均有统计学意义(P<0.05);回肠组织病理学结果显示AL组回肠组织损伤程度轻于THS组与AR组。结论:在醋酸钠林格液复苏创伤失血性休克基础上,应用乳酸菌可能进一步抑制TLR4-p38MAPK/JNK炎性信号通路的表达,逆转休克造成的促炎因子和抗炎因子的表达失衡,减轻了创伤失血性休克肠道损伤。Objective:To explore the protective effect of sodium acetate Ringer′s solution resuscitation combined with lactic acid bacteria on the intestinal mucosal barrier of rats with traumatic hemorrhagic shock.Methods:Thirty SD rats were randomly divided into traumatic hemorrhagic shock without resuscitation group(THS group,n=10),sodium acetate Ringer′s solution resuscitation group(AR group,n=10)and sodium acetate Ringer′s solution combined with lactic acid bacteria resuscitation group(AL group,n=10).The rats in the AL group were given lactic acid bacteria tablets for 1 week on the basis of normal feeding before the shock model was established(calculated according to the volume area,the rats took 108 mg/kg each time,three times a day).The shock models were established in the THS group,AR group and AL group(average arterial pressure maintained 35±5 mmHg).The AL group and AR group were treated with sodium acetate Ringer′s solution for 30 minutes of fluid resuscitation after 60 minutes of shock,and the rats′ileum were observed for 4 hours after resuscitation tissue.THS group was not resuscitated,and ileum tissue was taken 4 hours after shock observation.ELISA was used to detect peripheral blood tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-4,and IL-10 concentration.Western blotting method was used to detect the expressions of ileum tissue ZO-1,claudin-1,TLR4,p38 phosphorylation and JNK phosphorylation protein.Results:Compared with the THS group,the levels of TNF-αand IL-6 in the peripheral blood in the AL group were decreased,and the levels of IL-4 and IL-10 were increased,and the TNF-αconcentration in the AR group was decreased,and the differences of which were statistically significant(P<0.05).Compared with the AR group,the level of TNF-αin peripheral blood in the AL group was decreased(P<0.05).There was no statistical difference in the levels of other cytokines between AR group and AL group(P>0.05).Compared with the THS group,the levels of TLR4,P-P38,and P-JNK in the peripheral blood of rats in the

关 键 词：创伤失血性休克 醋酸钠林格液 乳酸菌 肠损伤 

分 类 号：R605.971[医药卫生—急诊医学]