平滑肌蛋白22对脓毒症大鼠急性肠损伤早期诊断价值的研究  

The study on the early diagnostic value of smooth muscle protein 22 in acute intestinal injury of septic rats

作　　者：伍万[1] 朱满刚 张政 赵利娟 刘振忠 杨志东 王瑞明[1] Wu Wan

机构地区：[1]杭州市中医院,310000

出　　处：《浙江临床医学》2023年第12期1773-1776,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2023RC241)。

摘　　要：目的探讨平滑肌蛋白22(SM22)对脓毒症大鼠急性肠损伤(AGI)早期诊断的价值意义。方法将48只大鼠随机分为假手术组(Sham)、6 h脓毒症模型组(M6)、12 h脓毒症模型组(M12)、24 h脓毒症模型组(M24),每组各12只。采用盲肠结扎穿孔术(CLP)制备脓毒症模型,假手术组大鼠仅开腹而不行CLP。各组大鼠于造模后经尾静脉推注0.9%NaCl溶液5 mL/100 g液体复苏。6 h、12 h、24 h后取血并处死大鼠,采用酶联免疫吸附试验(ELISA)检测血清和肠组织SM22、肠型脂肪酸结合蛋白(IFABP)、二胺氧化酶(DAO)、白介素-1β(IL-1β)、白介素17(IL-17)、肿瘤坏死因子(TNF-ɑ)。光镜下观察肠黏膜组织病理改变进行chiu’s评分,采用原位末端缺刻标记法(TUNEL)检测肠黏膜上皮细胞凋亡指数(AI)。采用FITC-G检测肠道的通透性。结果与假手术组比较,M6、M12、M24组中血和肠组织SM22、IFABP、DAO、TNF-ɑ、IL-1β、IL-17和FITC-G表达水平逐步增高,差异有统计学意义(P<0.01),且M6、M12、M24各组相互比较差异有统计学意义(P<0.01),而M6血清IFABP、DAO表达水平增高不明显,与假手术组差异无统计学意义。HE染色和肠黏膜上皮细胞凋亡:模型组肠组织病理改变chiu’s评分评分及AI明显增高,与假手术组比较差异有统计学意义(P<0.01),且各模型组之间差异有统计学意义(P<0.01)。相关性分析显示:肠管损伤评分与血清SM22、DAO、IFABP、FITC均呈正相关性(r=0.623,r=0.745,=0.784,r=0.771,P均<0.01)。诊断价值分析:IFABP、DAO、SM22诊断脓毒症AGI的ROC AUC、95%CI、最佳临界值、敏感性、特异性分别是0.843、0.730~0.955、87.60 pg/ml、66.7%、75%、(DAO)0.824、0.707~0.942、1.01 ng/mL、75%、75%、(SM22)0.972、0.934~1.01、0.76 ng/mL、91.7%、91.7%。结论SM22对脓毒症AGI早期诊断的敏感性和特异性及诊断价值高于IFABP和DAO,将成为脓毒症AGI早期诊断的新型生物标志物之一。Objective To discuss the diagnostic meaning of smooth muscle protein of 22 kDa(SM22)as plasma biomarker for the detection of in septic rats acute intestinal injury(AGI).Methods Forty eight Sprague-Dawley(SD)rats were randomly divided into four groups:the sham-operation(sham),the cecal ligation and puncture group for 6 hour(Model6),the cecal ligation and puncture group for 12 hour(Model12),the cecal ligation and puncture group for 24 hour(Model24).Sepsis rat models were established by cecal ligation and puncture method.In sham operation group,only switched abdominal surgery was performed without by cecal ligation and puncture.After the operation,5 mL/100 g of 0.9%NaCl(solution)was injected into the caudal vein in all rats for fluid resuscitation.Six,twelve,twenty-four hours after the operation,the rats were killed.Serum and intestinal tissue levels of intestinal fatty acid binding protein(IFABP),diamine oxidase(DAO),SM22,tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-17(IL-17)were measured by enzyme-linked immunosorbent assay(ELISA).Under microscope,the histopathological changes of ileum mucosal tissues were examined and Chiu scoring was carried out.TdT-mediated dUTP nick end labeling(TUNEL)was applied to detect the ileum mucosal epithelial cell apoptosis index(AI),Fluorescein isothiocyanate(FITC-G)was used to monitor intestinal permeability.Results The level of serum and intestinal tissue SM22,TNF-ɑ,IL-1β,IL-17 and FITC-G were significantly higher in the M6 group than in the sham group(P<0.01).The level of serum and intestinal tissue SM22,IFABP,DAO,TNF-ɑ,IL-1β,IL-17,FITC-G,ileum pathological AI of ileal mucosal epithelial cells were significantly higher in the M12 group than in the M6(P<0.01).The level of serum and intestinal tissue SM22,IFABP,DAO,TNF-ɑ,IL-1β,IL-17,FITC-G ileum pathological,AI of ileal mucosal epithelial cells were significantly higher in the M24 group than in the M12(all P<0.01).Conclusion Serum SM22,IFABP,DAO and FITC-G were positively correlated with ileum pathologi

关 键 词：SM22 脓毒症 急性肠损伤 

分 类 号：R459.7[医药卫生—急诊医学]