糖皮质激素及其受体在大鼠严重创伤后早期肝脏损害中的变化

目的 探讨严重创伤后血浆糖皮质激素（Glucocorticoid,GC）、肝组织糖皮质激素受体（Glucocorticoid receptor,GR）的变化，及其在肝脏继发性损害中的作用。方法 成年雄性Wistar大鼠176只，随机分成正常对照组、严重创伤组、阻断GR50%伴严重创伤组、阻断GR80%伴严重创伤组。采用严重胸部撞击伤伴单侧股骨骨折模型。动态观察创伤后大鼠血浆皮质醇浓度、肝组织RG、肝脏病理、血清肝功能生化指标等变化。结果 创伤后血浆皮质醇浓度迅速增加，伤后4h达到峰值，24h仍维持在高水平；肝组织GR的结合容量伤后即开始下降，12h降至最低，24h有所回升，但肝脏病理、血清ALT及白蛋白的改变无显著差异。当使用GR阻断剂后，血浆皮质醇浓度较严重创伤组明显增加；肝脏明显淤血，肝窦内有较多炎性细胞浸润，且与GR阻断程度有关；血清ALT在伤早期即有明显升高，白蛋白明显下降。结论 GR不足可导致创伤后肝功能损害的发生；GR可作为反映早期肝功能损害的重要指标。

The study on glucocorticoid and its rece ptor with liver impairment in early stag e after severe trauma

Objective To study changes of plasma cortisol and glucocorticoid receptor(GR) in hepatic tissue in rats in early stage after severe trauma,as well as the role of GC and GR in secondary liver injury.Methods 176 adult male Wistar rats were randomly divided into control,severe trauma,severe trauma with 50% GR blocked,severe trauma with 80% GR blocked groups.Rat model was produced by adopting severe thoracic impact injury associated with unilateral femoral fracture.The changes of rat plasma cortisol,hepatic tissue GR,pathogical changes of liver and hepatic function markers in serum after severe trauma.Results Were measured cortisol in serum rapidly increased,peaking at 4h after trauma,and remained high at 24h after trauma.Binding and protein content of GR gradually decreased in hepatic tissue after severe trauma,reaching the lowest level at 12h,and gradually recovered at 24h after trauma.But of the hepatic pathology,serum ALT and albumin did not show obvious changes after trauma.After usage of GR blocked agent,serum cortisol was more increased.Hepatic congestion was obvious,with many inflammatory cells infiltrating the hepatic sinusoids.These pathologic changes were closely related to the degree of GR blockade.Serum ALT increase as well as albumin was obvious in the early stage after trauma.Conclusion GR insufficiency may cause secondary hepatic injury after severe trauma,GR might be considered as an important marker reflecting early hepatic function impairment. [