乌司他丁对梗阻性黄疸肠粘膜屏障功能影响的实验研究

目的 探讨梗阻性黄疸对肠粘膜屏障功能的影响及乌司他丁(UTI)的保护作用.方法 取雄性SD大鼠72只,随机均分为假手术组(A组)、梗阻性黄疸组(B组)、UTI干预组(C组),每组又分术后3、5、7、10 d4个时相.采用胆总管结扎法建立梗阻性黄疸模型.C组从术后第1天始每天腹腔注射UTI 40 000IU/kg,A组和B组用等量生理盐水作对照.检测各时相肝功能,血浆内毒素,取肠系膜淋巴结、肝、脾组织行细菌培养,光镜观察末端回肠粘膜形态改变,并用病理图像分析系统测量肠绒毛高度及粘膜厚度.结果 各时相肝功能指标、血浆内毒素B组较A组升高(P＜0.01);C组较B组降低(P＜0.01);血浆内毒素C组较A组术后3 d时相差异无统计学意义(P＞0.05).细菌移位率B组较A组升高(P＜0.01);C组较B组降低(P＜0.05);C组与A组相比,差异无统计学意义(P＞0.05).B组术后第3天即见肠粘膜受损改变,随时间推移进行性加重;C组较B组肠粘膜损害明显减轻.B组各时相小肠绒毛高度、粘膜厚度均低于A组(P＜0.01);C组则较B组升高(P＜0.01或P＜0.05);C组较A组术后3 d时相差异无统计学意义(P＞0.05).结论 梗阻性黄疸早期即可导致肠粘膜屏障功能受损,且随时间延长进行性加重;UTI对梗阻性黄疸时受损的肠粘膜屏障功能具有保护作用,对早期病变效果更好.

Effect of ulinastatin on intestinal mucosal barrier function of rats with obstructive jaundice

Objective To investigate the effect of ulinastatin on intestinal mucosal barrier function of rats with obstructive jaundice.Methods Seventy-two male SD rats were randomly divided into sham operation,obstructive jaundice,and ulinastatin treatment groups(groups A,B,and C,respectively).In groups B and C,the common bile duct was ligated to induce obstructive jaundice.The rats in group C were given intraperitoneal injection of ulinastatin at the daily dose of 40 000 IU/kg after the operation,while those in groups A and group B received equal amount of normal saline.At 3,5,7 and 10 days after the operation,the liver function and plasma endotoxin level were evaluated and measured,and bacterial culture of the mesenteric lymph nodes,liver and spleen was performed.The terminal ileum mucosa was observed under light microscope,and the intestinal villi and mucosal thinckness was examined with image analysis system.Results The indices relative to the liver function and plasma endotoxin level were higher at different time points of observation in group B than in group A(P<0.01),and were lower in group C than in group B(P<0.01).Plasma endotoxin level was similar between groups A and C 3 days after the operation(P>0.05).The rate of bacterial translocation was higher in group B than in group A and C(P<0.01,P<0.05),but comparable between groups A and C(P>0.05).Intestinal mucosal injury was observed in group B 3 days after operation,and aggravated with the passage of time.The injury was milder in group C.The intestinal villus length and mucosal thickness were greater in groups A and C than in group B(P<0.01 or P<0.05),but comparable between the former two groups 3 days after operation(P>0.05).Conclusion In early stage of obstructive jaundice,the intestinal mucosal barrier may sustain injuries which aggravate with time;ulinastatin has significant effect in protecting the mucosal barrier function especially against early pathological changes.