脓毒症与基因多态性相关性研究现状

脓毒症是由感染引起的全身炎症反应（SIRS）,是严重创伤、休克、外科大手术后常见的并发症,可导致脓毒性休克和多脏器功能障碍综合征（multipleorgan dysfunctin syndrome,MODS）,是当今危重病医学领域的研究焦点。脓毒症发生的根源是机体炎症反应失控,炎性递质瀑布样释放,造成组织损伤。     

肾上腺髓质素和内皮屏障功能

研究表明,内皮屏障功能丧失是急性炎症的标志,并且在严重感染中促成器官功能衰竭,但是目前还没有关于内皮屏障功能稳定性治疗方面的研究。内源性肽肾上腺髓质素（Adrenomedullin,AM）血清水平显示其在严重感染包括脓毒症和脓毒性休克时升高,在体内和体外脓毒症模型中用作有效的内皮屏障功能的稳定剂。AM还具有心血管保护作用,包括在炎症状态保护微循环。总之,AM可能作为一个有效的保护因素,通过保护内皮屏障功能防治严重感染中的心血管功能障碍。     

脓毒症血清对大鼠小肠微血管内皮细胞ICAM-1的影响及肾上腺髓质素的干预作用

Objective To observe the levels of intercellar adhesion molecule-1(ICAM-1)of rat intestinal mucosa microvascular endothelial cells in sepsis rat,and to investigate the possible protective effect of adrenomedullin on the expression of intercellar adhesion molecule-1(ICAM-1)of rat intestinal mucosa microvascular endothelial cells,and to confirm whether adrenomedullin can decrease released inflammatory factors to slow down or inhibit the occurrence and development of sepsis.Methods The rat intestinal mucosa microvascular endothelial cells were isolated and cultured in vitro,and it was divided into sham operated(sham operated serum),sepsis serum(with addition of sepsis serum)and ADM serum(with 0.lng/kg adrenomedullin 6h after sepsis treatment)groups.The soluble ICAM-1(sICAM-1)content in RIMMVECs culture supernatant was measured by ELISA at the 24th hour after serum stimulation.Results The ICAM-1 content in the supernatant of sepsis group [(0.33 ±0.04)ng/L] was obviously higher than that in sham operated [(0.15 ± 0.02)ng/L] and ADM [(0.17 ± 0.04)ng/L] group(P ＜ 0.05),but ADM group was no significantly different compared with sham operated group(P ＞ 0.05).Conclusions ADM could decrease the expression of ICAM-I in RIMMVECs,and the low level of ICAM-1 could suppress its downstream inflammation factors and inhibit the occurrence and development of sepsis.     

脓毒症血清对大鼠小肠微血管内皮细胞ICAM-1的影响及肾上腺髓质素的干预作用

目的 观察脓毒症大鼠小肠血管内皮细胞中细胞间黏附分子-1（Intercellar adhesion molecule-1,ICAM-1）的水平,并研究肾上腺髓质素（Adrenomedullin,ADM）是否能通过降低脓毒症大鼠小肠血管内皮细胞中ICAM-1的水平从而抑制炎症因子的释放来减缓和抑制脓毒症的发生发展.方法 大鼠小肠微血管内皮细胞在体外分离培养后,分别用假手术组血清,脓毒症组血清和外源性ADM干预的脓毒症组血清刺激24 h后进行检测.用ELISA法检测血清刺激培养24 h后上清液中可溶性ICAM-1的含量.结果 脓毒症组血清刺激24 h后培养上清液中ICAM-1的含量[（0.33±0.04）ng/L]显著高于假手术血清刺激组[（0.15±0.02）ng/ml,P＜0.05];而ADM干预组[（0.17±0.04）ng/L]与脓毒症组比较,明显降低（P＜0.05）;ADM干预组与假手术组比较,差异无统计学意义（P＞0.05）.结论 肾上腺髓质素可以抑制脓毒症大鼠小肠血管内皮细胞上ICAM-1的表达,从而抑制其介导的炎性细胞释放和迁移,对脓毒症的发生发展有减缓和抑制作用.