内毒素移位在肠淋巴再灌注加剧SMAO休克大鼠多器官损伤中的作用

目的:探讨肠源性内毒素移位在肠淋巴再灌注(MLR)加剧肠系膜上动脉闭塞性(SMAO)休克多器官损伤中的作用与机制。方法:24只Wistar大鼠随机分为4组(n=6):假手术组(Sham,仅麻醉与手术)、MLR组(夹闭肠系膜淋巴管1 h,再灌注2 h)、SMAO组(夹闭肠系膜上动脉1 h,再灌注2 h)和SMAO+MLR组(同时夹闭肠系膜淋巴管和肠系膜上动脉1 h,再灌注2 h)。再灌注2 h后,腹主动脉取血,制备血浆;留取固定位置的肝、肾、心肌、肺组织,制备组织匀浆。应用鲎试剂动态浊度法检测血浆以及各组织匀浆内毒素(ET)含量;应用酶联免疫方法检测各器官组织匀浆脂多糖结合蛋白(LBP)、脂多糖受体(CD14)和肿瘤坏死因子(TNF-α)水平。结果:Sham组和MLR组各指标均无统计学差异;SMAO组及SMAO+MLR组的血浆、肝、肾、心肌、肺组织匀浆的ET含量均显著高于Sham组和MLR组,且SMAO+MLR组血浆及各组织匀浆的ET水平均显著高于SMAO组;SMAO组及SMAO+MLR组肝、肾、心肌、肺组织匀浆CD14、LBP和TNF-α水平显著高于Sham组及MLR组,且SMAO+MLR组各指标均高于SMAO组。结论:MLR加剧SMAO休克多器官损伤的作用机制与ET经过肠淋巴途径移位、激活内毒素增敏系统LBP/CD14、促进炎症反应有关。

Role of endotoxin translocasion on mesenteric lymph reperfusion aggravating multiple organ injury in SMAO shock rats

Objective: To investigate the role of mesenteric lymph reperfusion(MLR) aggravates multiple organs injury in superior mesenteric artery occlusion(SMAO) shock and its mechanism.Methods: Twenty four Wistar rats were randomly divided into 4 groups(n=6): Sham group(only anesthetized and operated),MLR group rats performed 1 h occlusion of mesenteric lymph duct(MLD),then followed by 2 h of reperfusion,SMAO group(rats performed 1 h occlusion of superior mesenteric artery(SMA) and then followed by 2 h of reperfusion),SMAO+MLR group(rats performed 1 h occlusion of SMA and MLD and then followed by 2 h of reperfusion).The blood sample was taken out from abdominal aortic for plasma and the liver,kidney,myocardium,lung tissues in fixed position were prepared for making homogenate after reperfusion of 2 h respectively.And the levels of endotonxin(ET) in plasma and homogenates were determined with kinetic turbidimetric technique of tachypleus amebocyte lysate,the contents of lipopolysaccharide-binding protein(LBP),lipopolysaccharide receptor(CD14) and tumor necrosis factor-α(TNF-α) in homogenates were determined with enzyme-linked immunosorbent assay method.Results: The indices have no statistics difference between sham group and MLR group.The ET levels of the plasma and hepatic,renal,myocardial,pulmonary homogenates in SMAO and SMAO+MLR groups were significant higher than that of sham and MLR groups,and these indices in SMAO+MLR were increased significantly than those in SMAO group.The CD14,LBP and TNF-α contents of the hepatic,renal,myocardial and pulmonary homogenates in SMAO and SMAO+MLR groups were significant higher than those in sham and MLR groups,and these indices in SMAO+MLR were higher than SMAO group significantly.Conclusion: The mechanism of MLR aggravates multiple organs injury in SMAO shock may be associated with enterogenous ET through intestinal lymphatic pathway to translocate,activate the LBP/CD14 as endotoxin sensitizing system and promote inflammatory response.