白芨胶、明胶海绵、MPH在肾穿刺通道中止血作用及IL-10、TNF-α表达的对比研究

发布时间：2018-07-02 21:24

本文选题：白芨胶 + 明胶海绵　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:建立新西兰实验兔肾脏穿刺造瘘模型;白芨胶(Bletilla glue)、明胶海绵、微孔多聚糖止血粉(Microporous polysaccharide hemispheres,MPH)三种止血材料应用于肾脏穿刺通道,记录术中穿刺通道止血时间、术后尿液中晶体含量、穿刺通道中TNF-α、IL-10表达及其相关性变化。比较三种材料在肾穿刺通道中的止血时间、术后尿液结晶含量以及肾脏穿刺通道愈合时间。以寻找一种较为合适的无管化经皮肾镜术(Tubeless Percutaneous Nephrolithotomy,TPCNL)肾穿刺通道止血栓塞剂,利于减少出血及尿外渗等无管化经皮肾镜术并发症的发生。方法:选用新西兰实验兔126只(雌雄不限,体重2.0-2.5kg),随机分成三组,即白芨胶组、明胶海绵组、微孔多聚糖(MPH)组,每组42只;将三组实验兔均建立单侧肾穿刺造瘘模型,并于肾脏穿刺通道内分别注入白芨多糖胶、明胶海绵、微孔多聚糖止血粉,术中观察并记录各组实验兔术中穿刺止血时间。三组分别于术后3 d、1w、2w、3 w、4 w、6 w和8w七个时间点处死。膀胱穿刺取尿液行尿沉渣中晶体数量定量检查,对比各组实验兔尿液中晶体含量。取肾脏穿刺通道组织行HE染色,观察通道处肾脏组织不同时间点的病理改变;免疫组织化学法(immunohistochemistry,IHC)检测各组肾穿刺通道中TNF-α、IL-10两种蛋白不同时间点的变化。结果:1.三组实验兔术中肾穿刺通道止血时间为明胶海绵组(82.40±18.40 S)白芨胶组(92.69±22.63S)MPH组(120.33±26.23S),两两比较差异有统计学意义(P0.05),三组间方差分析结果显示差异具有统计学意义(F=31.504,P0.001)。2.HE观察结果各组肾穿刺通道病理变化。白芨胶组:3d时处死动物,观察肾穿刺通道见大量肉芽组织及新生血管形成,伴炎性细胞浸润。2周后见少量瘢痕组织形成,3周时肾脏穿刺通道已愈合。明胶海绵组:建模3天后观察通道内可见大量炎性细胞浸润,无明显肉芽组织以及新生血管形成,通道内可见陈旧性红细胞;建模后3周通道内可见较多成熟的血管腔,伴有少量瘢痕组织增生以及炎性细胞浸润,表明仍处于通道修复中;约于建模后6周时通道已基本愈合。MPH组:建模3天后观察通道内可见大量炎性细胞浸润,无明显肉芽组织以及新生血管形成,通道内可见陈旧性红细胞;建模后3周通道内可见较多成熟的血管腔,伴有少量瘢痕组织增生以及炎性细胞浸润,表明仍处于通道修复中;约于建模后6周时通道已基本愈合。上述结果显示,三组实验模型建模3天时通道中白芨胶组炎症反应最轻,瘢痕愈合最早。3.三组实验兔各时间点尿液晶体数比较显示:与明胶海绵及MPH相比,白芨胶组3d和1w时尿液晶体数与其余两组差异无统计学意义(P0.05);但在2w、3w、4w、6w、8w时白芨胶组晶体数显著低(P0.05)。4.免疫组化结果显示,IL-10及TNF-α的表达主要在肾小管及肾小球胞浆中,显微镜下观察阳性染色呈棕黄色颗粒。且各组积分光密度(IOD)结果显示,3d、1w、2w、3w、4w、6w、8w白芨胶组IL-10表达显著高于其余两组(P0.05),而TNF-α的表达显著低于其余两组(P0.05)。结论:1.三种止血材料在术中止血时间依次为明胶海绵组白芨胶MPH。2.与明胶海绵及MPH相比,白芨胶在肾组织中较快吸收,术后晶体产生较少,术后形成结石风险小于后两种材料。3.白芨胶用于肾穿刺通道止血所产生的IL-10高于明胶海绵及MPH,TNF-α低于明胶海绵及MPH,更利于穿刺通道组织的愈合。
[Abstract]:Objective: to establish a New Zealand experimental rabbit kidney puncture stomatostomy model, Bletilla glue, gelatin sponge and Microporous polysaccharide hemispheres (MPH), three kinds of hemostatic materials used in the renal puncture channel, to record the time of blood stop in the puncture channel, the content of the crystal in the urine after the operation, and the TNF- a, IL-1 in the puncture channel. The 0 expression and its correlation change. Compare the time of hemostasis of the three materials in the renal puncture channel, the content of urine crystallization and the healing time of the renal puncture channel, in order to find a more suitable Tubeless Percutaneous Nephrolithotomy, TPCNL for the hemostasis of the renal puncture channel, which is beneficial to reduce the bleeding and urine. Methods: 126 New Zealand experimental rabbits (male and male and body weight 2.0-2.5kg) were randomly divided into three groups, namely, Bletilla glue group, gelatin sponge group, and microporous polysaccharide (MPH) group, with 42 rats in each group. The three experimental rabbits were set up a unilateral renal puncture stoma model and were injected into the renal puncture channel respectively. In the three groups, the three groups were killed at 3 D, 1W, 2W, 3 W, 4 W, 6 W and 8W at seven time points, respectively. The pathological changes of renal tissue at different time points at the channel were observed by HE staining, and the changes of TNF- alpha and IL-10 two proteins at different time points were detected by immunohistochemistry (IHC). Results: the time of hemostasis of the renal puncture channel in the 1. three groups of experimental rabbits was 82.40 (82.40). The group (92.69 + 22.63S) MPH (120.33 + 26.23S) of Bletilla striata glue group (120.33 + 26.23S), 22 difference was statistically significant (P0.05). The variance analysis between the three groups showed that the difference was statistically significant (F=31.504, P0.001).2.HE observation results of the pathological changes of the renal puncture channel. The Bletilla glue group was killed at 3D and observed a large number of granulation in the renal puncture channel. Tissue and neovascularization, with inflammatory cell infiltration.2 weeks after the formation of a small number of scar tissue, 3 weeks after the healing of the renal puncture channel. Gelatin sponge group: after 3 days of modeling, a large number of inflammatory cells in the observation channel, no obvious granulation tissue and neovascularization, the passage of old red blood cells in the passageway, after modeling in the 3 week channel More mature vascular cavities were seen, with a small amount of scar tissue proliferation and inflammatory cell infiltration, indicating that the channel was still in the channel repair. About 6 weeks after modeling, the channel had basically healed in the.MPH group. A large number of inflammatory cells were found in the observation channel for 3 days after modeling, and there was no obvious granulation and neovascularization, and the passage was obsolete. Red blood cells were more mature in 3 weeks after modeling, with a small amount of scar tissue proliferation and inflammatory cell infiltration, which showed that the channel was still in the channel repair. The channel was basically healed at 6 weeks after modeling. The results showed that the inflammatory reaction in the Bletilla colloid group was the lightest in the three groups of experimental models at 3 days, and the scar healing was the most. Compared with gelatin sponge and MPH, there was no significant difference in urine crystal number between 3D and 1W of Bletilla colloid group and the other two groups compared with gelatin sponge and MPH (P0.05), but in 2W, 3W, 4W, 6W and 8W, the number of crystal number was significantly lower (P0.05) in 2W, 3W, 4W, 6W and 8W, but the expression of.3. was mainly in the kidneys. In the tube and the glomerular cytoplasm, the positive staining was brown and yellow granules under microscope, and the results of the integral light density (IOD) showed that the IL-10 expression of 3D, 1W, 2W, 3W, 4W, 6W and 8W Bletilla colloid group was significantly higher than the other two groups (P0.05), while the expression of TNF- alpha was significantly lower than the other two groups (P0.05). Conclusion: the time of hemostasis in the 1. three kinds of hemostat is in turn in the order of the hemostasis. Compared with gelatin sponge and gelatin sponge and gelatin sponge and MPH, Bletilla colloid MPH.2. absorbs quickly in the kidney tissue and has less crystal production after operation. The risk of formation of stone after operation is less than that of after two materials, the IL-10 is higher than gelatin sponge and MPH, TNF- A is lower than gelatin sponge and MPH, and it is better for puncture passage. The healing of the tissue.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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