腹膜淋巴孔途径在腹腔感染早期肺损伤中作用的研究

发布时间：2018-01-20 17:57

  本文关键词： 腹腔感染 淋巴回流途径 腹膜淋巴孔 内毒素 肺损伤　出处：《四川医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨腹膜淋巴回流途径在腹腔感染早期内毒素肺损伤中的作用及调控腹膜淋巴孔对内毒素肺损伤的影响。方法:第一部分:清洁级健康雄性Wister大鼠72只分为3组:对照组(SO组n=24),开腹后翻动盲肠注射生理盐水;实验组(CLP组,n=24),开腹后行盲肠结扎穿孔手术(CLP);干预组(TL组,n=24),开腹后结扎胸导管后行CLP手术。前两组分别于术后3h、6h、12h、24h四个时相点检测大鼠胸导管淋巴浆、门静脉血浆内毒素浓度;同时检测各组肺组织中NF-κB P65浓度,并通过肺组织病理观察、计算肺湿/干重比(W/D)及凋亡细胞检测来评估肺损伤严重程度。第二部分:将54只健康清洁级雄性Wister大鼠随机分为3组:对照组(SO组n=18),开腹后翻动盲肠注射生理盐水;试验组(CLP组,n=18),开腹后行盲肠结扎穿孔手术(CLP);干预组(n=18),CLP手术术前或术后腹腔注射氯沙坦溶液。前两组在时相点1h、2.5h、4h分别与术前干预组(n=6):腹腔注射氯沙坦1h后行CLP手术、术后0.5h干预组(n=6):行CLP手术后0.5h腹腔注射氯沙坦、术后2h干预组(n=6):行CLP手术后2h腹腔注射氯沙坦相对应。分别检测对照组、试验组和干预组大鼠腹膜淋巴孔孔径大小和分布密度、胸导管淋巴浆内毒素浓度,肺组织NF-κB P65免疫组化的蛋白表达、凋亡蛋白酶Caspase3的相对活性。结果:1.1实验组相同时相点胸导管淋巴浆内毒素的浓度远远高于门静脉血浆(p0.01);1.2实验组不同时相点门静脉血浆内毒素的含量差别不大(p0.05);1.3实验组同一时相点,淋巴浆、门静脉血浆中内毒素的浓度均高于对照组(p0.05);1.4实验组肺组织NF-κB P65的含量、病理HE评分、W/D、凋亡指数(AI)均高于相同时相点的对照组(p0.05);1.5同一时相点干预组肺组织NF-κB P65的含量、病理HE评分、W/D、AI均低于实验组(p0.05),但高于对照组(p0.05)。2.1试验组随时间的延长,腹膜淋巴孔的孔径、分布密度以及胸导管淋巴浆内毒素的浓度逐渐增加(p0.05),明显高于对应时相点的干预组(P0.01)和对照组(P0.01)、而干预组又高于对照组(p0.05);术前干预组淋巴孔的指标及胸导管淋巴浆内毒素含量比术后干预组低(P0.05)、而术后2h干预组高于术后0.5h的水平(P0.05);2.2术前干预组肺组织NF-κB P65的平均光密度值及凋亡蛋白酶Caspase3的活性低于术后干预组(p0.05),而术后2h高于术后0.5h的水平(p0.05);干预组均低于对应时相点试验组、但高于对照组的水平(p0.05)。结论:1、腹腔感染早期,内毒素的腹膜淋巴回流途径在肺损伤中占居重要地位,而阻断腹膜淋巴回流途径可以抑制内毒素的淋巴回流,从而减轻其所导致的肺损伤。2.1腹腔感染早期,AngⅡ-R抑制剂氯沙坦可以调控腹膜淋巴孔孔径的大小和密度,减轻内毒素所致的肺损伤;2.2腹腔感染早期,药物的干预时间越早,肺损伤的程度越轻。
[Abstract]:Objective: to investigate the role of peritoneal lymphatic reflux pathway in endotoxin lung injury in early stage of abdominal infection and to regulate the effect of peritoneal lymphatic foramen on endotoxin lung injury. 72 clean grade healthy male Wister rats were divided into 3 groups: control group (. Group so (n = 24). After laparotomy, normal saline was injected into caecum; In the experimental group (CLP group), the operation of cecal ligation and perforation was performed after the operation of cecal ligation and perforation. In the intervention group, CLP operation was performed after ligation of thoracic duct after abdominal ligation. The lymphatic plasma of thoracic duct in the first two groups were detected at 3 h, 6 h, 12 h and 24 h, respectively. Plasma endotoxin concentration in portal vein; At the same time, the concentration of NF- 魏 B p65 in lung tissue of each group was detected, and the pathological changes of lung tissue were observed. Lung wet / dry weight ratio (WR) and apoptotic cell test were calculated to evaluate the severity of lung injury. Part two: 54 healthy clean grade male Wister rats were randomly divided into 3 groups: control group (n = 5). Group so (n = 18). After laparotomy, normal saline was injected into caecum; The experimental group was treated with cecal ligation and perforation after operation. Losartan solution was injected intraperitoneally before or after CLP operation in the intervention group. CLP was performed at 4 h after intraperitoneal injection of losartan, and 0.5 h after operation. Losartan was injected intraperitoneally at 0.5 h after CLP. Losartan was injected intraperitoneally 2 hours after CLP operation in the intervention group 2 hours after operation. The size and distribution density of peritoneal lymphatic pore diameter were measured in control group, experimental group and intervention group. The concentration of endotoxin in lymphatic plasma of thoracic duct and the expression of NF- 魏 B p65 protein in lung tissue. Results the concentration of endotoxin in the lymphatic plasma of thoracic duct was much higher than that in the portal vein plasma at the same time. 1.2 the level of endotoxin in portal vein plasma of experimental group was not different from that of control group at different time points (p0.05). 1.3 the concentration of endotoxin in the plasma of lymphatic plasma and portal vein in the experimental group was higher than that in the control group at the same time point (p 0.05). 1.4 the content of NF- 魏 B p65, pathological HE score and apoptosis index (AI) of lung tissue in experimental group were higher than those in control group at the same time point (P 0.05). 1.5 the content of NF- 魏 B p65 in lung tissue and pathological HE score in the intervention group were lower than those in the experimental group at the same time point (P 0.05). However, the diameter and distribution density of peritoneal lymphatic foramen and the concentration of endotoxin in thoracic duct lymphatic plasma increased gradually with the prolongation of time in the experimental group compared with the control group. It was significantly higher than that of the intervention group (P 0.01) and the control group (P 0.01), and the intervention group was higher than the control group (P 0.05). The indexes of lymphatic foramen and endotoxin content of thoracic duct in preoperative intervention group were lower than those in postoperative intervention group (P 0.05), but the level of P0.05 in intervention group at 2 hours after operation was higher than that in 0.5 h after operation. 2.2 the mean optical density of NF- 魏 B p65 and the activity of apoptotic protease Caspase3 in the preoperative intervention group were lower than those in the postoperative intervention group (P 0.05). The level of P0.05 was higher at 2 h after operation than that at 0.5 h after operation. The intervention group was lower than the control group, but the level was higher than that of the control group (P 0.05). Conclusion: in the early stage of abdominal infection, endotoxin peritoneal lymphatic reflux pathway plays an important role in lung injury. Blocking the peritoneal lymphatic reflux pathway can inhibit the endotoxin lymphatic reflux, which can alleviate the lung injury. 2.1 early abdominal infection. Losartan, an inhibitor of Ang 鈪，

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