慢性血吸虫感染对脓毒症小鼠保护作用的研究

目的 初步探讨慢性血吸虫(SJ)感染对脓毒症小鼠的保护作用及其机制.方法 选择BALB/c雄性小鼠,按随机数字表法分组进行三部分实验.实验1:经腹部皮肤接种SJ尾蚴感染8周建立慢性SJ感染模型,分为正常组和SJ组,每组10只;用酶联免疫吸附法(ELISA)检测血清白细胞介素(IL-4和IL-10)、肿瘤坏死因子-α(TNF-α)、γ-干扰素(IFN-γ)水平,实时荧光定量聚合酶链反应(PCR)检测腹腔巨噬细胞IL-10和TNF-α的mRNA表达,了解慢性SJ感染小鼠免疫状态.实验2:以脂多糖(LPS)腹腔注射诱导小鼠脓毒症模型,分为LPS组和SJ-LPS组,每组15只;用ELISA法动态观察注射LPS后0、24、48和72 h细胞因子的变化,0 h的水平相当于正常小鼠和SJ感染8周水平,观察慢性SJ感染对脓毒症过程的影响.实验3:分别以盲肠结扎穿孔术(CLP)和LPS诱导两种不同的脓毒症模型,评价慢性SJ感染对脓毒症小鼠72 h存活率的影响.结果 实验1:SJ组血清抗炎因子IL-4[(151.35±12.24)ng/L]和IL-10[(133.22±11.09)ng/L]水平较正常组[IL-4(56.32±8.66)ng/L,IL-10(48.17±7.23)ng/L]显著升高(均P＜0.05),并可使巨噬细胞向替代活化性巨噬细胞分化,慢性SJ感染使腹腔巨噬细胞高表达IL-10 mRNA(SJ组4.46±1.82,正常组1.52±0.60),抑制TNF-α mRNA表达(SJ组1.61±0.93,正常组2.32±1.03,均P＜0.05).实验2、3:慢性SJ感染小鼠血清IL-4、IL-10于注射LPS后0 h即显著升高,随后下降,至72 h仍明显高于LPS组[IL-4(ng/L):92.2±7.6比41.5±4.5;IL-10(ng/L):92.1±7.8比35.6±4.0,均P＜0.05];TNF-α、IFN-γ均于24 h达峰值后逐渐下降,至72 h SJ-LPS组仍显著低于LPS组[TNF-α(ng/L):82.9±5.6比91.5±5.2;IFN-γ(ng/L):44.1±4.8比52.6±4.0,均P＜0.05].慢性SJ感染可明显改善CLP或LPS所致脓毒症小鼠的存活率(CLP:80%比20%,LPS:70%比30%,均P＜0.05).结论 慢性SJ感染可使脓毒症小鼠血清抗炎因子升高,存活率上升,从而起到保护作用.

Abstract：

Objective To preliminarily study the protective effect of chronic schistosoma japonica (SJ)infestation against sepsis in mice and its mechanism. Methods BALB/c male mice were used, and the experiment was divided into three parts. Experiment 1: chronic SJ infestation model was reproduced by SJ cercaria inoculation through abdominal skin for 8 weeks. Twenty mice were randomly grouped into normal group (n=10) and SJ group (n=10). The levels of interleukins (IL-4, IL-10), tumor necrosis factor-α(TNF-α) and interferon-γ (IFN-γ) in serum were detected by enzyme linked immunosorbent assay (ELISA).Real-time polymerase chain reaction (PCR) was employed to detect the levels of IL-10 mRNA and TNF-αmRNA in abdominal macrophages. This experiment was meant to evaluate immune state in mice with chronic SJ infestation. Experiment 2: lipopolysaccharide (LPS) was intraperitoneally injected to reproduce sepsis model. Thirty mice were randomly grouped into LPS group (n=15) and SJ-LPS group (n=15). The levels of cytokines were determined by ELISA at 0, 24, 48 and 72 hours after LPS injection. This experiment was meant to detect the effect of chronic SJ infestation in mice during the septic process. Experiment 3 : two types of sepsis model were reproduced by cecal ligation and puncture (CLP) and LPS injection, respectively. The survival rate of mice with chronic SJ infestation in 72 hours in either type of sepsis was evaluated. Results Experiment 1, compared with normal group [IL-4 (56.32±8.66) ng/L, IL-10 (48.17±7.23) ng/L],chronic SJ infestation showed an increase in serum IL-4 [(151. 35 ± 12. 24) ng/L] and IL-10 [(133. 22 ±11. 09) ng/L, both P＜0. 05]. Chronic SJ infestation also resulted in an increase in IL-10 mRNA expression (SJ group 4. 46±1. 82, normal group 1. 52±0. 60) and inhibited TNF-α mRNA expression (SJ group 1. 61±0.93, normal group 2. 32±1.03) in abdominal macrophages (both P＜0. 05), indicating that macrophages could be differentiated into alternative activated macrophages. Experiments 2 and 3 showed that the levels of serum IL-4 and IL-10 were increased at 0 hour after LPS injection, and then gradually decreased in SJ-LPS group, but the levels were still higher than those in LPS group at 72 hours [IL-4 (ng/L): 92. 2±7. 6 vs.41.5±4. 5; IL-10 (ng/L): 92. 1±7. 8 vs. 35. 6±4. 0, both P＜0. 05]; the levels of TNF-α and IFN-γ were increased at 24 hours, and then decreased in SJ-LPS group, and the levels were lower than those in LPSgroup at 72 hours [TNF-α (ng/L): 82. 9±5. 6 vs. 91. 5±5. 2; IFN-γ (ng/L): 44.1±4. 8 vs. 52. 6±4. 0,both P＜0. 05]. Therefore, chronic SJ infestation could improve the survival rate of mice with sepsis induced by CLP or LPS (CLP: 80% vs. 20%, LPS: 70% vs. 30%, both P＜0.05). Conclusion Chronic SJ infestation could elevate anti-inflammatory factors in septic mice, thus ameliorating the survival rate, so it has protective effect on mice with sepsis.     

慢性血吸虫感染对脓毒症小鼠保护作用的研究

Objective To preliminarily study the protective effect of chronic schistosoma japonica (SJ)infestation against sepsis in mice and its mechanism. Methods BALB/c male mice were used, and the experiment was divided into three parts. Experiment 1: chronic SJ infestation model was reproduced by SJ cercaria inoculation through abdominal skin for 8 weeks. Twenty mice were randomly grouped into normal group (n=10) and SJ group (n=10). The levels of interleukins (IL-4, IL-10), tumor necrosis factor-α(TNF-α) and interferon-γ (IFN-γ) in serum were detected by enzyme linked immunosorbent assay (ELISA).Real-time polymerase chain reaction (PCR) was employed to detect the levels of IL-10 mRNA and TNF-αmRNA in abdominal macrophages. This experiment was meant to evaluate immune state in mice with chronic SJ infestation. Experiment 2: lipopolysaccharide (LPS) was intraperitoneally injected to reproduce sepsis model. Thirty mice were randomly grouped into LPS group (n=15) and SJ-LPS group (n=15). The levels of cytokines were determined by ELISA at 0, 24, 48 and 72 hours after LPS injection. This experiment was meant to detect the effect of chronic SJ infestation in mice during the septic process. Experiment 3 : two types of sepsis model were reproduced by cecal ligation and puncture (CLP) and LPS injection, respectively. The survival rate of mice with chronic SJ infestation in 72 hours in either type of sepsis was evaluated. Results Experiment 1, compared with normal group [IL-4 (56.32±8.66) ng/L, IL-10 (48.17±7.23) ng/L],chronic SJ infestation showed an increase in serum IL-4 [(151. 35 ± 12. 24) ng/L] and IL-10 [(133. 22 ±11. 09) ng/L, both P＜0. 05]. Chronic SJ infestation also resulted in an increase in IL-10 mRNA expression (SJ group 4. 46±1. 82, normal group 1. 52±0. 60) and inhibited TNF-α mRNA expression (SJ group 1. 61±0.93, normal group 2. 32±1.03) in abdominal macrophages (both P＜0. 05), indicating that macrophages could be differentiated into alternative activated macrophages. Experiments 2 and 3 showed that the levels of serum IL-4 and IL-10 were increased at 0 hour after LPS injection, and then gradually decreased in SJ-LPS group, but the levels were still higher than those in LPS group at 72 hours [IL-4 (ng/L): 92. 2±7. 6 vs.41.5±4. 5; IL-10 (ng/L): 92. 1±7. 8 vs. 35. 6±4. 0, both P＜0. 05]; the levels of TNF-α and IFN-γ were increased at 24 hours, and then decreased in SJ-LPS group, and the levels were lower than those in LPSgroup at 72 hours [TNF-α (ng/L): 82. 9±5. 6 vs. 91. 5±5. 2; IFN-γ (ng/L): 44.1±4. 8 vs. 52. 6±4. 0,both P＜0. 05]. Therefore, chronic SJ infestation could improve the survival rate of mice with sepsis induced by CLP or LPS (CLP: 80% vs. 20%, LPS: 70% vs. 30%, both P＜0.05). Conclusion Chronic SJ infestation could elevate anti-inflammatory factors in septic mice, thus ameliorating the survival rate, so it has protective effect on mice with sepsis.     

骨髓间充质干细胞对烟雾吸入性损伤兔早期炎症因子分泌的影响

目的 探讨骨髓间充质干细胞(MSCs)对烟雾吸入性损伤早期外周血及肺组织中肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-1β、IL-6、IL-10)分泌的影响.方法 全骨髓培养法体外培养兔MSCs,用流式细胞术鉴定.将56只健康新西兰大耳白兔按随机数字表法分为正常对照组(C组,n=8)、烟雾吸入性损伤组(S组,n=24)、烟雾吸入性损伤+MSCs移植组(M组,n=24),后两组再分为伤后2、4、6 h亚组,每组8只.采用酶联免疫吸附法(ELISA)检测血浆及肺组织匀浆液中促炎因子TNF-α、IL-1β、IL-6及抗炎因子IL-10的含量.结果 与C组比较,S组各时间点血浆促炎、抗炎因子均显著升高;各时间点肺组织促炎因子显著升高,抗炎因子无明显变化.与S组比较,M组各时间点血浆促炎因子显著下降,抗炎因子显著升高[6 h时TNF-α(μg/L):1.7±1.7比4.1±1.6,IL-1β(ng/L):9.9±1.7比21.2±2.6,IL-6(μg/L):1.0±0.3比1.3±0.2,IL-10(ng/L):15.2±4.4比7.9±3.5,均P＜0.05];各时间点肺组织促炎因子显著降低,而抗炎因子仅在4 h、6 h显著升高[6 h时TNF-α(ng/L):503.0±156.4比587.7±171.2,IL-1β(ng/L):0.4±0.2比0.6±0.2,IL-6(ng/L):155.2±13.7比350.2±20.3,IL-10(ng/L):23.3±5.4比11.0±5.6,均P＜0.05].结论 MSCs移植能降低烟雾吸入性损伤早期促炎因子水平,升高抗炎因子水平,改善全身炎症反应,对烟雾吸入性损伤肺组织具有一定的保护作用.

Abstract：

Objective To explore the effect of bone marrow mesenchymal stem cells (MSCs) engraftment on secretion of tumor necrosis factor-α (TNF-α), interleukins (IL-1β, IL-6, IL-10) in peripheral blood and lung homogenates in the early stages of smoke inhalation injury. Methods MSCs were proliferated by the method of whole marrow culture and identified by flow cytometry. Fifty-six healthy New Zealand rabbits were randomly divided into control group (C group, n=8), smoke inhalation injury group (S group, n=24)and smoke inhalation injury+MSCs engraftment group (M group, n=24). The latter two groups were subdivided into 2, 4, 6 hours after injury subgroups, with 8 rabbits in each group. The levels of TNF-α,IL-1β, IL-6 and IL-10 in peripheral blood and lung homogenates were measured by enzyme-linked immunosorbent assay (ELISA). Results Compared with C group, concent of pro-inflammatory and anti-inflammatory cytokines in peripheral blood at each time point in S group were increased significantly.The concent of pro-inflammatory cytokines in lung homogenate at each time point in S group was significantly higher than thoae in C group, and that of anti-inflammatory cytokines showed no significant changes.Compared with the S group, concent of pro-inflammatory cytokines in peripheral blood in M group was decreased significantly, and that of anti-inflammatory cytokines was increased significantly [6 hours TNF-α(μg/L):1.7±1.7 vs. 4.1±1.6, IL-1β (ng/L): 9.9±1.7 vs. 21.2±2.6, IL-6 (μg/L): 1.0±0.3 vs.1.3 ± 0. 2, IL-10 (ng/L): 15. 2 ± 4. 4 vs. 7. 9 ± 3.5, all P＜0.05]. Concent of pro-inflammatory cytokines at each time point in M group was decreased significantly when compared with S group in lung homogenate,while only anti-inflammatory cytokine at 4 hours and 6 hours was increased significantly [6 hours TNF-α (ng/L): 503. 0±156. 4 vs. 587.7±171.2, IL-1β (ng/L): 0.4±0.2 vs. 0.6±0.2, IL-6 (ng/L): 155.2±13.7 vs. 350.2±20.3, IL-10 (ng/L): 23.3±5.4 vs. 11.0±5.6, all P＜0.05]. Conclusion MSCs engraftment could decrease pro-inflammatory cytokines and increase anti-inflammatory cytokines in the early stages of smoke inhalation injury, thus amelioratea inflammatory reaponse, which confers protective effect on smoke inhalation injury.     

硫化氢逆转脂多糖诱导大鼠肺动脉低反应性以及与一氧化碳的关系

目的 观察整体水平应用硫化氢(H2S)后脂多糖(LPS)诱导的离体肺动脉对H2S舒张反应的变化及其与一氧化碳(CO)的关系.方法 将48只大鼠按照随机数字表法分为对照组[给予生理盐水(NS)]、LPS组、H2S供体硫氢化钠(NaHS)+LPS组和NaHS+NS组4组,每组12只.采用经大鼠气管内滴注LPS(0.8 ml/kg)染毒;NaHS±+LPS组和NaHS±NS组滴注LPS或NS之前10 min和之后2 h腹腔注射NaHS各0.5 ml(28 μmol/kg).各组取6只大鼠于染毒后12 h制备肺动脉环(PARs),采用离体血管环张力测定技术检测用血红素氧合酶-1(HO-1)抑制剂锌原卟啉Ⅸ(ZnPPⅨ)孵育前后PARs对累积浓度NaHS的舒张反应变化;各组另取6只大鼠于染毒后12 h检测出肺血(EPB)和入肺血(APB)中碳氧血红蛋白(COHb)含量,以其差值反映肺循环CO生成的水平.结果 与对照组相比,滴注LPS后PARs对NaHS的最大舒张反应百分比明显降低[(75.72±7.22)%比(96.40±4.40)%,P＜0.01＝;用ZnPPⅨ孵育PARs后,LPS诱导的PARs对NaHS舒张反应进一步降低[(62.91±8.22)%比(75.72±7.22)%,P＜0.01＝.腹腔注射NaHS可明显逆转LPS诱导的PARs对NaHS的低反应性,PARs对NaHS的最大舒张反应百分比明显升高[(94.65±8.45)%比(75.72±7.22)%,P＜0.01＝;但用ZnPPⅨ孵育PARs后,PARs对NaHS的舒张反应较孵育前显著下降[(83.75±9.76)%比(94.65±8.45)%,P＜0.01＝.NaHS+NS组中PARs对NaHS的舒张反应与对照组相比无明显差异,且在ZnPPⅨ孵育前后也无明显变化.COHb检测结果显示,与对照组相比,滴注LPS后APB和EPB中COHb水平的差值明显增高[(3.12±0.48)%比(2.12±0.32)%,P＜0.05＝;腹腔注射NaHS后,COHb水平的差值[(4.03±0.56)%]较LPS组进一步升高(P＜0.01＝.结论 腹腔注射H2S可以改善LPS诱导的离体肺动脉对H2S的低反应性,其机制可能与增强肺动脉HO-1/CO体系有关.

Abstract：

Objective To explore the effect of hydrogen sulfide (H2S) on abnormal pulmonary artery reactivity induced by lipopolysaccharide (LPS) and its relationship with carbon monoxide (CO). Methods Forty-eight rats were divided into four groups randomly according to table of random number: control group (normal saline, NS), LPS group, a donor of H2S sodium hydrosulfide (NaHS)+LPS group, and NaHS+NS group (n=12 in each group). Rats were given LPS by intratracheal instillation (0. 8 ml/kg). 0. 5 ml of NaHS (28 μmol/kg) was injected intraperitoneally 10 minutes before LPS or NS instillation and 2 hours after LPS or NS instillation in NaHS+LPS and NaHS+NS groups. Twelve hours after instillation of LPS, 6 rats from each group were sacrificed. The pulmonary artery rings (PARs) were prepared and the changes in cumulative relaxation response of PARs to NaHS were detected before and after incubation with an inhibitor of heme oxygenase-1 (HO-1) zinc protoporphyrin Ⅸ (ZnPP Ⅸ ) using isolated vascular ring tension detecting technique. Twelve hours after LPS instillation, the remaining 6 rats in each group were sacrificed, and the contents of carboxyhemoglobin (COHb) in efferent pulmonary blood (EPB) and afferent pulmonary blood (APB) were measured, and the difference between the contents of COHb in EPB and that of APB was calculated to represent content of CO from pulmonary circulation. Results In the present study, compared with control group, after the instillation of LPS the percentage of relaxation response of PARs to NaHS was significantly declined [(75. 72±7. 22)% vs. (96. 40±4. 40)%, P＜0. 01]. After being incubated with ZnPP Ⅸ, the decreased relaxation response of PARs to NaHS induced by LPS was further depressed [(62. 91 ±8. 22) % vs. ( 75. 72 ± 7. 22) %, P ＜ 0. 01]. Administration of NaHS intraperitoneally reversed the hyporesponsiveness of PARs to NaHS, the percentage of relaxation response of PARs to NaHS was significantly increased [(94.65± 8.45)% vs. (75.72 ± 7.22)%, P＜0.01]. However ZnPP Ⅸ also attenuated the effect [(83. 75 ± 9. 76)% vs. (94. 65 ± 8. 45)%, P ＜ 0. 01]. NO significant changes were observed between NaHS+NS group and control group, also between the results before and after ZnPP Ⅸincubation. Compared with control group, the difference between the contents of COHb in EPB and that of APB increased after instillation of LPS [(3. 12±0. 48)% vs. (2. 12±0. 32)%, P＜0. 05], which further increased after intraperitoneal administration of NaHS [(4.03 ± 0. 56) %, P ＜ 0. 01]. Conclusion The results suggested that intraperitoneal administration of H2S could reverse hyporesponsiveness of PARs to H2S induced by LPS, and the result might be related to an intensification of HO-1/CO system in pulmonary artery tissue.     

中药复方通腑颗粒及其组分对脓毒症大鼠肠黏膜机械屏障的影响

目的 探讨中药复方通腑颗粒及其组分对脓毒症大鼠肠黏膜机械屏障的保护作用.方法 按随机数字表法将大鼠分为模型组、大黄组、厚朴组、通腑颗粒组,以正常大鼠作为正常对照组.腹腔注射大肠杆菌脂多糖(LPS)6 mg/kg制备大鼠脓毒症模型,制模成功后通腑颗粒组灌胃通腑颗粒28 g·kg-1·d-1,大黄组、厚朴组分别灌胃大黄、厚朴5 g·kg-1·d-1,模型组灌胃等量生理盐水,各组均每日1次.分别于术后24、48及72 h心脏取血,采用酶联免疫吸附法(ELISA)测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)水平;72 h时取小肠组织,观察小肠黏膜病理改变并进行病理评分.结果 模型组各时间点血清TNF-α、IL-8均较正常对照组明显升高;各治疗组治疗后血清TNF-α、IL-8均明显低于模型组;通腑颗粒组各时间点TNF-α(ng/L)明显低于大黄、厚朴组(24 h:44.64±1.48比47.18±1.83和46.96±2.23,48 h:51.38±1.36比57.17±2.23和59.41±2.01,72 h:55.54±2.58比64.34±1.02和65.96±3.45,均P<0.05);72 h时IL-8(ng/L)明显低于厚朴组(65.53±4.52比69.14±2.82,P<0.05).正常对照组小肠黏膜病理评分为0;大黄、厚朴、通腑颗粒组小肠黏膜病理评分(分)均明显低于模型组(3.15±0.28、 3.18±0.08、 2.95±0.15比3.90±0.17,均P<0.01),且以通腑颗粒组下降程度明显.电镜下观察正常对照组小肠黏膜紧密连接完整,微绒毛及线粒体形态正常;模型组小肠黏膜微绒毛缺失、崩解,紧密连接破坏;大黄组与厚朴组小肠黏膜细胞间紧密连接局部模糊;通腑颗粒组小肠黏膜细胞间紧密连接保存相对完整.结论 脓毒症大鼠存在肠黏膜屏障损伤;中药通腑颗粒及其组分大黄、厚朴均可降低脓毒症大鼠血清TNF-α和IL-8水平,减轻肠黏膜损伤,从而起到保护肠道屏障的作用,以通腹颗粒作用明显.

Abstract：

Objective To investigate the effects of Tongfu granules (通腑颗粒) and its constituents on barrier function of small intestine in rats with sepsis. Methods The male rats were divided into model group, Tongfu granules group, Rhubarb (大黄) group and Magnoliae cortex (厚朴) group by random digits table, normal rats as control group. Intraperitoneal injection of lipopolysaccharide (LPS, 6 mg/kg) was used to reproduce sepsis model. After establishment of model, rats in Tongfu granules group were given Tongfu granules 28 g·kg-1·d-1 by gavage, and Rhubarb group and Magnoliae cortex group rats were given Rhubarb or Magnoliae cortex 5 g·kg-1·d-1 by gavage, while the model group was given normal saline in same quantity, once a day. Blood samples of rats were collected at 24, 48, 72 hours for measuring tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) with enzyme linked immunosorbent assay (ELISA). The pathological changes in intestinal mucosa were observed, and the pathological scores was estimated at 72 hours. Results The levels of TNF-α and IL-8 were significantly higher in model group than those in control group at different time points. The serum levels of TNF-α and IL-8 were significantly lower in treatment groups than those in model group, and the level of TNF-α (ng/L) in Tongfu granules group was significantly lower than that in Rhubarb and Magnoliae cortex groups at different time points (24 hours: 44.64±1.48 vs. 47.18±1.83 and 46.96±2.23, 48 hours: 51.38±1.36 vs. 57.17±2.23 and 59.41±2.01, 72 hours: 55.54±2.58 vs. 64.34±1.02 and 65.96±3.45, all P<0.05), and IL-8 (ng/L) level at 72 hours was significantly lower than that in Magnoliae cortex group (65.53±4.52 vs. 69.14±2.82, P<0.05). The scores of the lesions were significantly higher in model group than that in control group (3.90±0.17 vs. 0). The scores of Rhubarb group, Magnoliae cortex group and Tongfu granules group were 3.15±0.28, 3.18±0.08, and 2.95±0.15, respectively, which were lower than those of the model group (all P<0.01), and the Tongfu granules group descended obviously than other groups. In control group, the intercellular tight junctions were normal, and the morphology of microvilli and mitochondria was also normal. In model group, the microvilli of intestinal mucosa of the small intestine were absent or disintegrated. The intercellular tight junctions were seen to be blurred in Rhubarb and Magnoliae cortex groups, and they were close to normal state in Tongfu granules group. Their integrity was better preserved compared with that of the model group. Conclusion Injury of barrier function of the small intestine was found in septic rat. It was found that traditional Chinese medicine Tongfu granules, Rhubarb and Magnoliae cortex could protect the barrier function of the small intestine by decreasing the TNF-α and IL-8 levels in septic rats. Above-mentioned effects of Tongfu granules were better than Rhubarb and Magnoliae cortex.     

衡炎方对严重脓毒症免疫调控的前瞻性研究

目的 观察衡炎方对严重脓毒症患者免疫调控机制的影响.方法 将入选的严重脓毒症患者按随机数字表法分为两组,最终衡炎方组22例,对照组23例.衡炎方组在对照组西医综合治疗措施基础上,每日口服(或胃管内注入)衡炎方[组成:僵蚕10 g,蝉蜕10 g,姜黄10 g,大黄(后下)3 g,黄芪10 g,麦冬10 g,红参10 g,牡丹皮10 g,桃仁10 g,红花10 g等]50 ml,每日3次,连服7 d.于治疗前及治疗后1、3、7 d记录两组患者排便次数及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,检测CD3+、CD4+、CD8+ T淋巴细胞及白细胞介素(IL-6、IL-10)、肿瘤坏死因子-α(TNF-α).结果 与对照组同期比较,衡炎方组治疗后7 d,排便次数明显增多,APACHEⅡ评分及IL-6、IL-10、IL-6/IL-10比值和TNF-α均明显下降,而CD3+、CD4+、CD8+T淋巴细胞均明显增高,差异均有统计学意义[排便次数(次):2.1±0.7比0.6±0.6;APACHEⅡ评分(分):13.8±5.6比16.8±5.6;IL-6(ng/L):45(32,89)比80(41,116);IL-10(ng/L):4.2(3.6,9.8)比6.6(3.5,10.6);IL-6/IL-10比值:10.6(7.2,24.8)比12.8(7.6,28.8);TNF-α(ng/L):4.2±2.6比5.6±2.7;CD3+:6.59±2.80比5.65±2.92,CD4+:3.65±2.17比3.25±2.46,CD8+:2.73±1.29比2.26±1.48,P<0.05或P<0.01].结论 衡炎方具有双向调节脓毒症免疫紊乱,减轻脓毒症患者全身炎症反应,改善脓毒症患者免疫抑制的作用.

Abstract：

Objective To observe the role of Hengyan medicinal recipe (衡炎方) on the regulation of immunity in patients with severe sepsis. Methods Patients with severe sepsis included in the study were randomly divided into two groups. Hengyan medicinal recipe group (n=22), in which patients were treated with Hengyan medicinal recipe 50 ml, 3 times daily, for 7 days.The recipe was composed of Bombyx batryticatus (僵蚕) 10 g, Cicada slough (蝉蜕) 10 g, Curcuma (姜黄) 10 g, Rhubarb (大黄) 3 g, Radix astragalus (黄芪) 10 g, Radix ophiopogonis (麦冬) 10 g, Red ginseng (红参) 10 g, Paeony (牡丹皮) 10 g, Walnut kernel (桃仁) 10 g, Safflower (红花) 10 g, combined with western medicine treatment.The patients in control group (n=23) were treated with western medicine same as above. In all patients the number of bowel movement and the scores of acute physiology and chronic health evaluationⅡ (APACHEⅡ) were recorded. Blood was taken for the determination of the levels of interleukins (IL-6, IL-10), tumor necrosis factor-α (TNF-α), CD3+, CD4+, CD8+ T cell before and 1, 3, 7 days after the treatment. Results Compared with the control group, the number of bowel movement, scores of APACHEⅡ and IL-6, IL-10, IL-6/IL-10, TNF-α in Hengyan medicinal recipe group were decreased significantly at 7 days, while the levels of CD3+, CD4+, CD8+ T cell were increased significantly [the number of bowel movement (times): 2.1±0.7 vs. 0.6±0.6, APACHEⅡ score: 13.8±5.6 vs. 16.8±5.6, IL-6 (ng/L): 45 (32, 89) vs. 80 (41, 116), IL-10 (ng/L): 4.2 (3.6, 9.8) vs. 6.6 (3.5, 10.6), IL-6/IL-10: 10.6 (7.2, 24.8) vs. 12.8 (7.6, 28.8), TNF-α (ng/L): 4.2±2.6 vs. 5.6±2.7, CD3+: 6.59±2.80 vs. 5.65±2.92, CD4+: 3.65±2.17 vs. 3.25±2.46, CD8+: 2.73±1.29 vs. 2.26±1.48, P<0.05 or P<0.01]. Conclusion Hengyan medicinal recipe could not only reduce the systemic inflammation, but also plays a role in bidirectional regulation of the immune disturbance to ameliorate immune suppression of sepsis patients.     

血红素加氧酶-1表达对大鼠呼吸机相关性肺损伤的作用及机制研究

目的 观察呼吸机相关性肺损伤(VILI)模型大鼠肺组织中血红素加氧酶-1(HO-1)表达的变化,探讨HO-1诱导剂血晶素拮抗VILI的作用机制.方法 56只雄性SD大鼠按照随机数字表法分成对照组(C组),VILI模型组(M组),诱导剂血晶素1、2、3、4组(H1、 H2、H3、H4组,制模前24 h分别腹腔注射血晶素40、80、120、160 μmol/kg)和抑制剂Z组[制模前24 h腹腔注射锌原卟啉(ZnPP)10 μmol/kg].除C组外各组机械通气4 h后处死大鼠,收集支气管肺泡灌洗液(BALF),测定总蛋白、肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL-10)含量;取肺组织,测定肺湿/干重(W/D)比值、乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)和丙二醛(MDA)水平及HO-1蛋白表达;光镜下行肺组织病理观察.结果 与C组相比,M组大鼠肺病理损伤严重,BALF中总蛋白、TNF-α、IL-10,肺组织W/D比值、MDA、LDH及HO-1蛋白表达均明显增加, VILI模型复制成功.与M组比较,随着血晶素剂量的增加,H1、H2、H3组总蛋白(g/L)显著下降(0.74±0.06、0.73±0.07、0.70±0.07比0.84±0.08,均P<0.01);W/D比值下降(4.93±0.27、4.91±0.24、4.87±0.23比5.53±0.48,均P<0.01);SOD活性(U/mg)显著升高(85±9、82±15、93±11比55±12,均P<0.01);MDA含量(nmol/mg)显著降低(15±3、15±3、13±2比18±4,P<0.05或P<0.01);IL-10含量(pg/L)逐渐升高(0.42±0.06、0.46±0.06、0.47±0.05比0.36±0.07),TNF-α含量(pg/L)逐渐降低(0.18±0.07、0.14±0.03、0.10±0.07比0.23±0.06),但只有H2、H3组差异有统计学意义(均P<0.01);LDH活性(U/g)降低(11 353±1 317、11 516±1 613、9 631±1 520比12 361±1 841),但仅H3组差异有统计学意义(P<0.01);HO-1蛋白表达[吸光度(A)值]逐渐增强(0.164±0.010、0.190±0.149、0.205±0.018比0.122±0.016,均P<0.01);肺病理损伤逐渐减轻.而随着剂量进一步增加,H4组肺组织损伤较H1、H2、H3组加重.给予HO-1抑制剂ZnPP后HO-1的保护作用消失.结论 血晶素诱导HO-1适度表达可以减轻VILI,其适度表达的最佳剂量为120 μmol/kg,其机制可能通过抗炎和抗氧化应激发挥对肺组织的保护作用.     

益赛普对脂多糖引起大鼠急性肝损伤的保护作用

目的 探讨注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(益赛普,rhu TNFR:Fc)对脂多糖(lipopolysaccharide,LPS)致大鼠急性肝损伤的保护作用及作用机制.方法健康成年SD大鼠48只,随机分为4组:对照组,益赛普组,LPS模型组(急性肝损伤组)和益赛普+LPS组(益赛普治疗组),每组12只.大鼠禁食12 h后麻醉并行颈动脉插管,颈动脉插管后连接到ALC-MPA多道牛物信号分析系统监测血压,对照组注射等体积生理盐水;益赛普组24 h前皮下注射益赛普0.4mg/kg,插管稳定后舌下静脉注射等体积生理盐水;LPS模型组舌下静脉注射LPS 10mg/kg;益赛普+LPS组24 h前皮下注射益赛普0.4 mg/kg,然后舌下静脉注射LPS 10 mg/kg,此过程每组6只采用多道生物信号分析系统监测各组大鼠血压变化和大鼠死亡情况,并计算各组存活率,平均血压低于10 mmHg时记为大鼠死亡并即刻取肝,右叶同一部位肝组织10%中性福尔马林固定,部分保存于-80℃.观察6 h仍未死亡即处死.每组的另外6只大鼠在LPS或生理盐水注射后0.5 h采血2 mL,离心后取其上清液,保存于-80℃,用于测定TNF-α含量和活性,3 h再采血用于测定ALT、AST的含量.采用酶联免疫吸附法(ELISA)测定血清中肿瘤坏死因子α(TNF-α)含量和用流式细胞术测其活性;生化法测定血清中丙氨酸转氨酶(ALT)、门冬氨酸转氨酶(AST)含量;同时测定肝组织超氧化物歧化酶(SOD)、髓过氧化物酶(MPO)活性和丙二醛(MDA)含量及观察肝脏的形态学变化.应用单因素方差分析TNF-α含量及其活性、ALT、ASY含量以及MPO和MDA含量,X~2检验分析大鼠存活率.结果 对照组和益赛普组大鼠在观察期间(6 h)全部存活;益赛普+LPS组较LPS组:大鼠存活率提高(67%vs.17%,P<0.05),TNF-α活性低[(7.3±2.8)%vs.(51.3±6.4)%,P<0.05],肝组织的SOD活性增高[(188.4±20.2)U/mg prot vs.(142.5±18.3)U/mg prot,P<0.05];肝组织MPO活性降低[(0.38±0.04)U/g vs.(0.54±0.02)U/g,P<0.05]肝组织MDA含量降低[(1.40±0.10)nmol/mg prot vs.(2.81±0.11)nmol/mgprot,P<0.05],同时益赛普可降低血清AST、ALT,减轻肝组织的病理损伤.结论益赛普对LPS所致急性肝损伤有保护作用,其机制主要是与抑制TNF-α活性和抗氧化作用有关.     

缺氧诱导因子-1α对大鼠心肌缺血/再灌注损伤的保护作用及其信号转导

目的 观察缺氧诱导因子-1α(HIF-1α)对大鼠心肌缺血/再灌注损伤(IRI)的保护作用及蛋白激酶C(PKC)信号转导作用.方法 采用结扎冠状动脉左前降支30 min、再灌注180 min的方法建立IRI动物模型.将32只雄性Wistar大鼠按随机数字表法分为假手术组、IRI组、缺血预处理(IPC)组、IPC加PKC抑制剂组(IPC+Ⅰ组,IPC前静脉注射PKC抑制剂白屈菜季铵碱5 mg/kg),每组8只.再灌注180 min后取出心脏,测定HIF-1α、血红素氧合酶1(HO-1)的mRNA和蛋白以及天冬氨酸特异性半胱氨酸蛋白酶3(caspase-3)蛋白的表达;心内取血测定白细胞介素-8(IL-8)和髓过氧化物酶(MPO)水平.结果 与假手术组比较,IRI组心肌HIF-1α、HO-1的mRNA和蛋白及caspase-3蛋白表达均明显增多(HIF-1α mRNA:0.849±0.032比0.356±0.022,HIF-1α蛋白:0.762±0.042比0.324±0.016,HO-1 mRNA:0.862±0.045比0.332±0.012,HO-1蛋白:0.792±0.044比0.335±0.031,caspase-3蛋白:0.371±0.015比0.061±0.012,均P＜0.01),血IL-8、MPO显著升高[IL-8:(812±26)ng/L比(72±13)ng/L,MPO:(78.7±2.9)kU/L比(13.3±1.5)kU/L,均P＜0.01].与IRI组比较,IPC组HIF-1α、HO-1的mRNA和蛋白表达(HIF-1α mRNA,1.412±0.039,HIF-1α蛋白:1.362±0.045,HO-1 mRNA:1.523±0.038,HO-1蛋白:1.420±0.041)明显增多,caspase-3蛋白表达(0.129±0.019)明显降低(均P＜0.01),血IL-8[(432±59)ng/L]和MPO水平[(43.2±5.9)kU/L)明显降低(均P＜0.01).IPC+Ⅰ组各指标与IRI组无明显差异.结论 HIF-1α对心肌IRI具有重要保护作用,HIF-1α的表达是依赖PKC激活的,PKC是HIF-1α表达的重要信号转导通路.     

烟碱对心肌缺血/再灌注损伤大鼠炎症细胞因子的影响

目的 探讨烟碱对心肌缺血/再灌注(I/R)损伤大鼠炎症细胞因子的影响.方法 50只健康雄性SD大鼠按随机数字表法分为假手术组、I/R组、烟碱高剂量(400μg/kg)组、烟碱低剂量(40μg/kg)组及α-银环蛇毒素(α-BGT,1μg/kg)组5组,每组10只.采用结扎心脏左冠状动脉前降支30 min、再灌注90 min制作大鼠心肌I/R损伤模型;假手术组仅穿线不结扎.制模前30 min各药物组颈静脉注射相应剂量药物干预,假手术组和I/R组给予等量生理盐水.于再灌注末取右颈动脉血,测定肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、IL-10浓度和肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)活性;然后处死动物,取缺血区心肌组织测定髓过氧化物酶(MPO)活性;采用免疫组化和逆转录-聚合酶链反应检测心肌组织细胞间黏附分子-1(ICAM-1)蛋白及mRNA表达,并观察心肌超微结构.结果 与假手术组比较,I/R组血浆TNF-α、IL-8、IL-10、CK-MB、cTnI、心肌MPO活性及ICAM-1蛋白和mRNA表达均显著升高[TNF-α(ng/L):158.7±32.7比31.5±5.8,IL-8(ng/L):0.71±0.06比0.30±0.04,IL-10(ng/L):69.0±7.8比41.4±4.3,CK-MB(U/L):2 540±169比1 120±102,cTnI(μg/L):26.2±4.6比0.9±0.2,MPO(U/g):4.2±0.6比1.6±0.4,ICAM-1蛋白:0.210±0.025比0.100±0.018,ICAM-1 mRNA:1.82±0.23比1.18±0.20,P＜0.05或P＜0.01],病理学显示心肌组织损伤较重.与I/R组比较,烟碱高剂量组血浆TNF-α、IL-8降低[TNF-α(67.3±9.8)ng/L,IL-8(0.47±0.04)ng/L],IL-10升高[(147.5±12.5)ng/L],CK-MB、cTnI及心肌MPO活性、ICAM-1蛋白和mRNA均降低[CK-MB(1 282±145)U/L,cTnI(4.7±1.4)μg/L,MPO(2.5±0.4)U/g,ICAM-1蛋白0.140±0.026,ICAM-1 mRNA 1.31±0.25,P＜0.05或P＜0.01],心肌组织损伤减轻;而烟碱低剂量组和α-BGT组上述指标与I/R组比较差异无统计学意义.结论 烟碱可阻断内皮细胞表达黏附分子,阻断中性粒细胞黏附、游出,改善抗炎/促炎反应平衡,从而拮抗大鼠心肌I/R损伤时的过度炎症反应.     

肠淋巴途径在失血-脂多糖二次打击大鼠心肌损伤中的作用

目的 探讨肠系膜淋巴管结扎干预失血-脂多糖(LPS)致大鼠心肌损伤的作用机制.方法 将雄性Wistar大鼠按随机数字表法分为假手术组、未结扎组、结扎组;以失血-LPS复制二次打击动物模型,结扎组于失血后行肠系膜淋巴管结扎术以阻断肠淋巴液回流.创伤后24 h处死各组大鼠制备心肌组织匀浆,检测髓过氧化物酶(MPO)、ATP酶活性以及肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)含量;制备心肌病理切片,用原位末端缺刻标记法(TUNEL)检测细胞凋亡率,免疫组化法检测bcl-2和bax蛋白表达.结果 未结扎组大鼠心肌MPO[(0.23±0.08)U/g]、TNF-α[(9.99士2.74)pg/g]、IL-6((31.57士12.71)pg/g;～均显著高于假手术组[MPO:(0.12士0.03)U/g、TNF-α:(4.17±1.35)μ/g、IL-6:(17.86±5.17)μg/g,均P＜0.01],ATP酶活性显著低于假手术组;结扎组大鼠心肌MPO[(0.13±0.03)U/g]、TNF-α[(5.57±1.65)μg/g]、IL-6[(23.24±5.95)μg/g]均显著低于未结扎组(P＜0.05或P＜0.01),ATP酶活性显著高于未结扎组.未结扎组心肌细胞凋亡率[(22.7±6.9)%)、心肌细胞bax蛋白表达(104.5±11.4)显著高于假手术组[凋亡率:(3.8±1.2)%,bax蛋白:142.1±10.9]和结扎组[调亡率:(8.4±2.8)%,bax蛋白;128.4±9.6],bcl-2蛋白表达(196.4±19.3)显著低于假手术组(132.2±12.3)和结扎组(165.1±11.6,均P＜0.01).结论 肠系膜淋巴管结扎通过降低炎症介质TNF-α、IL-6水平,提高bcl-2蛋白表达和心肌细胞膜ATP酶活性,从而干预失血-LPS致大鼠心肌损伤.     

血管紧张素Ⅱ对急性肺损伤大鼠肺水通道蛋白1表达的影响

目的 观察血管紧张素Ⅱ(AngⅡ)对急性肺损伤(ALI)大鼠肺水通道蛋白1(AQP1)表达的影响及在肺水肿形成中的作用.方法 按随机数字表法将40只SD大鼠分为假手术组、模型组、AngⅡ受体阻滞剂预处理组及治疗组,每组10只.采用失血性休克-内毒素二次打击建立大鼠ALI模型.预处理组静脉注射脂多糖(LPS)前30 min注射AngⅡ受体阻滞剂30 μg/kg,注射LPS后30 min注射30 μg/kg生理盐水;治疗组注射LPS前30 min注射30 μg/kg生理盐水,注射LPS后30 min再注射AngⅡ受体阻滞剂30 μg/kg;模型组注射LPS前、后均给予30 μg/kg生理盐水.制模后6 h处死大鼠,取下腔静脉血,用放射免疫法测定血清肿瘤坏死因子-α(TNF-α)水平;取肺组织,计算湿/干重(W/D)比值,用放射免疫法测定肺组织AngⅡ表达,用逆转录-聚合酶链反应测定AQP1 mRNA表达.结果 与假手术组相比,ALI大鼠血清TNF-α水平及肺组织W/D比值、AngⅡ表达明显增加,AQP1 mRNA表达明显减少.预处理组及治疗组血清TNF-α水平(μg/L)较模型组明显减少(4.79±0.24、5.55±0.36比6.34±0.31,均P<0.05),肺组织W/D比值减小(4.34±0.23、4.85±0.20比5.41±0.26,均P<0.05),AQP1 mRNA表达明显增加(0.854±0.067、0.727±0.081比0.358±0.071,均P<0.05);而AngⅡ表达(ng/g)有所降低(172.19±15.82、202.82±20.47比245.88±26.31),但差异无统计学意义(均P>0.05).AQP1 mRNA表达与AngⅡ表达和肺组织W/D比值均呈负相关(r1=-0.782,r2=-0.726,均P<0.05).结论 ALI时AngⅡ可能直接或通过炎症介质下调肺脏AQP1 mRNA表达,为肺水肿形成的机制之一.     

卡巴胆碱对大鼠烫伤休克期肠内补液时肠道的影响

目的 研究拟胆碱药卡巴胆碱对大鼠烫伤休克期肠内补液时肠道局部炎症反应和肠组织损伤的影响,为烧伤休克胃肠道补液研究提供依据.方法 38只雄性Wistar大鼠,采用沸水法(100℃,10 s)造成背部35%TBSAⅢ度烫伤.随机分为不复苏组(单烫组,n=8)、葡萄糖-电解质溶液(glucose electrolyte solution)复苏组(GES组,n=10)、卡巴胆碱治疗组(CAR组,n=10)和GES+卡巴胆碱复苏组(GES/CAR组,n=10).两液体复苏组大鼠在烫伤后30 min将GES经十二指肠造口匀速泵入,按Parkland公式设定补液速率,即烫伤后第一个24 h补液总量4 ml·1%TBSA-1·kg-1,前8 h匀速补一半.CAR组和GES/CAR组大鼠在伤后30 min将CAR以60μg·kg-1溶于0.5 ml生理盐水中一次注入十二指肠.所有大鼠在烫伤后4 h处死,取空肠组织测定一氧化氮合酶(N0s)、一氧化氮(NO)、肿瘤坏死因子-α(TNF-α)含量和髓过氧化物酶(MPO)活性,同时测定血浆二胺氧化酶(DAO)活性,采用组间方差分析统计比较各组上述指标的差别.结果 GES组的肠组织NOS、NO、TNF-α、MPO和血浆DAO水平与单烫组差异无统计学意义;GES/CAR组各指标较GES组均明显降低[NOS(1.276±0.39I vs.(1.818±0.436),P＜0.01;NO(0.925±0.402)vs.(1.561±0.379),P＜0.01;TNF-α(0.87±0.13)vs.(1.94±0.47),P＜0.01;MPO(0.465±0.092)vs.(0.832±0.214),P＜0.01;DAO(0.732±0.192)vs.(1.381±0.564),P＜0.01],CAR组各指标也较单烫组和GES组明显降低(P＜0.05或P＜0.01).结论 卡巴胆碱能减轻烫伤休克大鼠肠内液体复苏时的肠道局部炎症反应和组织损伤,其作用机制可能与其兴奋胆碱能神经N受体,抑制促炎因子释放的作用有关.     

内毒素性急性肺损伤大鼠肺HO-1的表达及其意义

目的观察内毒素(LPS)性急性肺损伤(ALI)大鼠肺组织血红素氧合酶-1(HO-1)的表达,探讨其意义。方法18只SD大鼠随机均分为ALI、锌原卟啉(ZnPP)预处理和正常对照3组,尾静脉注射给药。ALI组注入LPS 5 mg/kg,对照组注入生理盐水,ZnPP预处理组注入ZnPP 10μmol/kg 10 min后再注入LPS 5 mg/kg,各组注入液体总量相同。3 h后腹主动脉放血处死大鼠,生理盐水肺灌洗,取左肺制作组织匀浆,TRIZOL法提取总RNA后,用半定量逆转录聚合酶链反应(SqRT-PCR)测定HO-1 mRNA;另取右下肺制作病理切片,光镜观察并盲法评分比较肺组织学变化。结果静脉注入LPS后大鼠肺组织HO-1 mRNA的表达明显上调(P<0.05),肺损伤严重,评分显著增加;ZnPP预处理组ALI大鼠肺组织HO-1 mRNA的表达明显受抑,肺损伤更严重,评分更高(P<0.05);直线相关分析显示,HO-1 mRNA的受抑程度与损伤评分呈显著负相关(P<0.05)。结论内毒素性ALI肺组织表达上调的HO-1对肺损伤有一定的保护作用。     

高浓度氧对未成年大鼠肺部炎症反应的影响

目的 探讨高浓度氧对未成年大鼠肺部炎症反应的影响.方法 将40只出生21 d的SD大鼠按随机数字表法分为空气对照组及高氧暴露12、24、48、72 h组,每组8只,分别将大鼠置于空气和常压高氧箱(氧含量达92%～94%)中.于相应时间点采用放血法处死大鼠后取肺组织,并行支气管肺泡灌洗.采用硫代巴比妥酸法和比色法分别测定肺组织丙二醛(MDA)含量及髓过氧化物酶(MPO)活性;采用酶联免疫吸附法(ELISA)检测支气管肺泡灌洗液(BALF)中肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和IL-10含量;观察肺组织病理改变,并进行肺损伤评分.结果 与空气对照组比较,高氧暴露12 h肺组织MDA含量(mmol/g)即显著升高(2.24±0.43比1.57±0.31),MPO活性(U/g)于高氧暴露24 h显著升高(1.24±0.25比0.69±0.22),并均随高氧暴露时间延长逐渐增加(P<0.05或P<0.01).BALF中TNF-α、IL-6和IL-10含量于高氧暴露24 h时较空气对照组显著增加[TNF-α(ng/L):135.2±44.0比94.5±22.3,IL-6(ng/L):73.1±14.2比55.7±17.3,IL-10(ng/L):67.9±21.7比48.2±7.6,P<0.05或P<0.01];但高氧暴露48 h时较24 h时显著降低(48 h时BALF中TNF-α、IL-6、IL-10分别为105.4±17.0,54.3±17.4,50.9±6.9,均P<0.05).高氧暴露12 h时肺损伤评分(分)即较空气对照组显著升高(4.5±1.4比1.3±0.5),并随高氧暴露时间延长进一步升高(P<0.05或P<0.01).结论 高浓度氧可引起未成年大鼠肺部炎症损伤;炎症细胞因子的出现高峰均在高氧暴露24 h.