高氧液联合缺血后处理对家兔肠缺血再灌注致肝损伤的保护作用

目的探讨高氧液联合缺血后处理对家兔肠缺血再灌注所致肝损伤的保护作用。方法将家兔48只随机分为假手术组(SO组)、缺血再灌注组(IR组)、高氧液组(HO组)和高氧液缺血后处理组(HI组),每组12只。SO组家兔仅手术显露肠系膜上动脉(SMA);IR组家兔阻断SMA 60 min,再灌注120 min;HO组家兔在阻断SMA 60 min和再灌注120 min过程中静脉输入高氧液;HI组家兔于阻断SMA 60 min后,再灌注开始时静脉输入高氧液,同时进行3个循环的30 s再灌注/30 s阻断的缺血后处理。再灌注120 min后采集各组家兔动脉血、静脉血及部分小肠、肝组织,检测肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-10、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)及内毒素水平,测定血清及小肠、肝组织内丙二醛(MDA)含量及髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)活性,Chiu 6级评分法观察肠黏膜损伤情况,细菌培养观察细菌移位率,免疫组织化学观察肝组织中核因子κB(NF-κB)p65的表达。结果 IR组家兔血清中TNF-α、IL-10、内毒素水平显著高于SO组(P<0.01);HO组和HI组家兔血清中TNF-α、内毒素水平显著低于IR组(P<0.05);HI组家兔血清中TNF-α、内毒素水平显著低于HO组(P<0.05,P<0.01)。HO组和HI组家兔血清中IL-10水平显著高于IR组(P<0.01),HO组和HI组家兔血清中IL-10水平比较差异无统计学意义(P>0.05)。IR组家兔血清中MPO活性和MDA水平显著高于SO组(P<0.01),HO组和HI组家兔血清中MPO活性和MDA水平显著低于IR组(P<0.01);HI组家兔血清中MPO活性和MDA水平显著低于HO组(P<0.05,P<0.01)。IR组家兔血清中SOD活性显著低于SO组(P<0.01),HO组和HI组家兔血清中SOD活性显著高于IR组(P<0.01),且HI组家兔血清中SOD活性显著高于HO组(P<0.01)。IR组、HO组和HI组家兔肠黏膜损伤评分显著高于SO组(P<0.01),HO组和HI组家兔肠黏膜损伤评分显著低于IR组(P<0.01),HI组家兔肠黏膜损伤评分显著低于HO组(P<0.05)。IR组家兔小肠黏膜组织中MPO活性和MDA水平显著高于SO组(P<0.01);HO组和HI组家兔小肠黏膜组织中MPO活性和MDA水平显著低于IR组(P<0.01);HI组家兔小肠黏膜组织中MPO活性和MDA水平显著低于HO组(P<0.05)。IR组家兔小肠黏膜组织中SOD活性显著低于SO组(P<0.01);HO组、HI组血清SOD活性仍显著高于IR组(P<0.01);HI组家兔小肠黏膜组织中SOD活性显著高于HO组(P<0.05)。SO组家兔肝组织均无细菌移位,IR组家兔肝脏细菌移位率100.0%,HO和HI组家兔肝脏细菌移位率均为83.3%,HO和HI组家兔肝脏细菌移位率与IR组比较差异均无统计学意义(P>0.05)。IR组、HO组、HI组家兔肝组织内NF-κB p65阳性表达显著高于SO组(P<0.01),HO组和HI组家兔肝组织内NF-κB p65阳性表达显著低于IR组(P<0.01),HI组家兔肝组织内NF-κB p65阳性表达显著低于HO组(P<0.05)。IR组家兔肝组织中MPO活性及MDA、ALT、AST水平显著高于SO组(P<0.01);HO组和HI组家兔肝组织中MPO活性及MDA、ALT、AST水平仍显著低于IR组(P<0.01);HI组家兔肝组织中MPO活性及MDA、ALT、AST水平显著低于HO组(P<0.05)。IR组家兔肝组织中SOD活性显著低于SO组(P<0.01),HO组和HI组家兔肝组织中SOD活性显著高于IR组(P<0.01);HI组家兔肝组织中SOD活性显著高于HO组(P<0.05)。结论高氧液联合缺血后处理可以减轻肠缺血再灌注引起的肝损伤。

Protective effect of hyperoxic solution combined with ischemic postconditioning on hepatic injury induced by intestinal ischemia reperfusion in rabbits

Objective To observe the protective effect of hyperoxic solution combined with ischemic postconditioning（ IP） on hepatic injury induced by intestinal ischemia reperfusion in rabbits. Methods A total of 48 rabbits were randomly divided into sham operation group（ SO group）,ischemia reperfusion group（ IR group）,hyperoxic solution group（ HO group） and HO ＋ IP group（ HI group）,with 12 rabbits in each group. The rabbits in SO group were treated with exposing superior mesenteric artery（ SMA）. The rabbits in IR group were treated with SMA interruption and 120 minutes reperfusion. The rabbits in HO group were treated with hyperoxic solution by intervenous drop infusion in the course of 60 minutes SMA interruption and 120minutes reperfusion. The rabbits in HI group were treated with hyperoxic solution by intervenous drop infusion before reperfusion,at the same time,three cyclical reperfusion（ 30 seconds） and interruption（ 30 seconds） were performed. The arterial blood,venous blood,enteric and hepatic tissue were collected at the time of 120 minutes after reperfusion. The levels of tumor necrosis factor-α（ TNF-α）,interleukin-10（ IL-10）,alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST） and endotoxin were detected. The level of malonaldehyde（ MDA）,the activity of myeloperoxidase（ MPO） and superoxide dismutase（ SOD） in enteric and hepatic tissue were detected. The intestinal mucosae injury was evaluated by Chiu-6 standard scoring. The bacterial metachoresis rat was observed by germiculture. The expression of nuclear factor-κB（ NF-κB） in hepatic tissue was detected by immunohistochemistry. Results The levels of serum TNF-α,IL-10 and endotoxin in IR group were significantly higher than those in SO group（ P〈0. 01）. The levels of serum TNF-α and endotoxin in HO group and HI group were significantly lower than those in IR group（ P〈0. 05）. The levels of serum TNF-α and endotoxin in HI group were significantly lower than those in HO gro