TNF-α在腹部火器伤肠管穿透后肝损伤机制中的作用

目的：探讨TNF-α在腹部火器伤肠管穿透后肝损伤中的作用。方法：健康长白仔猪42头随机等分为对照组和伤后1、2、4、8、12和24h组，实验组建立腹部火器伤肠管穿透模型后，用免疫组化及图像分析法检测各组肝内TNF-α的表达，同时应用TUNEL法测定肝细胞凋亡和血清中ALT水平变化情况，在光镜下观察各组肝脏组织学变化。结果：伤后各组肝内TNF-α表达均明显高于对照组，并于伤后2h和12h出现2个高峰（P〈0．05）。伤后各组出现逐渐加重的肝细胞水肿、变性、坏死，肝细胞凋亡指数和血清ALT水平也在伤后明显升高，并于伤后2h和12h出现2个高峰（P〈0．05）。结论：腹部火器伤肠管穿透后肝内TNF-α表达增多，与肝细胞凋亡、肝脏结构和功能损伤基本一致，TNF-α可能诱导了腹部火器伤肠穿孔后继发性肝损伤的发生。

Role of TNF-α in liver injury after intestinal perforation due to abdominal firearm wound

Objective： To study the role of TNF -α in the liver injury after intestinal perforation due to abdominal firearm wound. Methods： A total of 42 Chang - Bai piglets were randomly divided into 7 groups ： control group and wounded 1 h , 2 h , 4 h , 8 h , 12 h , and 24 h group. The model of intestinal perforation due to abdominal firearm wound was established in wounded groups. Hepatic TNF - α expression was measured with immunohistochemical staining and image analysis in all groups. Hepatocyte apoptosis index and serum ALT level were also determined at the same time. The pathological change of hepatic tissue was observed under light microscope. Results：Hepatic TNF -α content in wounded groups was gradually elevated compared with control group （P 〈 0.05 ）. Hepatocyte edema, metamorphosis and necrosis were gradually aggravated from 1 h group to 24 h group. Hepatocyte apoptosis index and serum ALT level were markedly increased, and two peaks were found in 2 h group and 12 h group （P 〈 0.05 ）. Conclusion：After intestinal perforation due to abdominal firearm wound, hepatic TNF-α content increases and it is positively correlated with hepatocyte apoptosis, hepatic morphological and functional injury. TNF -α can induce subsequent liver injury after the wound.