脓毒症大鼠血清乳酸、乳酸清除率及转氨酶水平与肝脏损伤关系的探讨

【摘要】目的探讨脓毒症大鼠血清乳酸水平、乳酸清除率及转氨酶水平与肝脏病理变化的关系，并研究乳酸水平、乳酸清除率与转氨酶水平是否存在相关性，评价是否能够作为预测评价脓毒症大鼠肝脏损伤指标。方法将清洁级SD大鼠150只分为正常组50只，假手术组50只，盲肠结扎术（CLP）手术组50只。CLP组于手术成功后的第6、12、24、48及72小时分别取10只处死，并于每个时间点取10只正常组大鼠和10只假手术组大鼠作为相应时间点的对照。在各时间点取肝脏组织进行病理学分析，测定乳酸水平及转氨酶水平，计算乳酸清除率。比较各时间点乳酸水平、转氨酶水平是否存在差异，并分析乳酸、乳酸清除率与转氨酶的相关性。结果CLP组大鼠肝细胞6h组开始出现损伤，12、24和48h损伤逐渐加重，损伤在CLP后48h最重；CLP组12、24h乳酸、谷丙转氨酶（ALT）水平明显增高，与正常组和假手术组相比差异均具有统计学意义（P〈0．05）；CLP组6、12、24、48、72h谷草转氨酶（AST）水平明显高于正常组及假手术组（P〈0．05）。乳酸与ALT水平呈正相关（r：0．766，P〈0．05），乳酸清除率与ALT水平呈负相关（r=-0．712，P〈0．05）。结论在脓毒症中，大鼠乳酸水平与乳酸清除率都同谷丙转氨酶水平存在相关性；三者与肝脏病理损伤时间基本相同；乳酸清除率及乳酸均能反应脓毒症大鼠肝脏损伤。

The levels of serum lactate,lactate clearance rate and transaminase in septic rats and their relation-ship with liver damage

Abstract] Objective To explore the serum lactic acid, transaminase and their relationship with liver pathological damage in sepsis rats, whether a correlation exists between serum lactate clearance rate and transaminase in sepsis rats, and whether they can be used as indicators for the prediction and evaluation of septic rats liver injury. Methods A total of 150 clean Sprague-Dawley （SD） rats was divided into nor- mal group （ n =50） ,sham operated group （ n =50） , and the cecal ligation and puncture （CLP） （ n = 50）. Ten rats were killed after successful surgery at the 6th, 12th, 24th, 48th, and 72nd hour in CLP group, respectively. At each time point, 10 normal rats and 10 sham-operated rats were taken as a control in the corresponding time point. The liver tissue was obtained for pathological analysis. The levels of lactate and liver transaminase were detected and the lactate clearance rate was calculated. The levels of Iaetate and transaminase at each time point were statistically compared. The correlation analysis was performed among serum lactate,transaminase, and liver damage pathological changes. Results The rat hepatoeytes in CLP group begin to appear at the 6th hour, and the damage was gradually enhanced at the 12th, 24th, and 48th, and up to the worst damage at the 48th time point. The levels of lactate and alanine aminotransferase （ALT） in CLP group at the 12th and 24th hour were significantly elevated compared with the normal and sham oper- ation groups （ P 〈0. 05） ; The level of aspartate aminotransferase （AST） in CLP group at the 6th, 12th, 24th, 48th, and 72nd hour was significantly elevated compared with the normal and sham operation groups（ p 〈 0： 05）. A positive correlation was found between the levels of ALT and lactate （ r = 0. 766, P 〈 0. 05）, and a negative correlation was found between lactate clearance rate and ALT （ r = -0. 712, P 〈 0. 05）. Conclusions In septic rats, both lactate and lactate clearance rate were correlated with ALT, and they were correlated with liver pathological damage. The level of lactate, lactate clearance rate, and ALT could be used as the key indicators to predict liver damage in septic rats.