中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2010年
1期
43-46
,共4页
阙军%梅勇%徐鑫荣%曹权%张萍
闕軍%梅勇%徐鑫榮%曹權%張萍
궐군%매용%서흠영%조권%장평
蛋白酶抑制剂%激素%内毒素%肺损伤
蛋白酶抑製劑%激素%內毒素%肺損傷
단백매억제제%격소%내독소%폐손상
Protease inhibitor%Hormone%Endotoxin%Lung injury
目的 探讨并比较蛋白酶抑制剂和激素对内毒素性急性肺损伤的保护作用,为临床药物的选择提供依据.方法 新西兰大白兔32只,随机(随机数字法)分为对照组(C组)、内毒素组(L组)、乌司他丁组(U组)和地塞米松组(D组),每组8只.除C组外,其他组均经耳缘静脉给予内毒素(600μg/kg),U、D组在给予内毒素同时分别静脉注射乌司他丁(100000 U/kg)、地塞米松(5 mg/kg).4h后测定血清肿瘤坏死因子α(TNF-α)及一氧化氮(NO)水平,行动脉血气分析,取肺组织观察大体标本形态和光镜下的组织病理形态,测定肺组织湿/干质量比值(W/D)、髓过氧化物酶(MPO)活性、脂质过氧化产物丙二醛(MDA)及超氧化物歧化酶(SOD)活性.数据采用单因素方差分析(SNK-q检验),以P<0.05为差异有统计学意义.结果 光镜下见C组肺组织学正常,L组肺间质弥漫性出血、肺泡腔内可见大量粒细胞聚集、浸润,并可见弥漫性肺泡间隔增厚,而U,D组上述病理表现明显减轻.U,D组与L组相比较兔肺组织湿/干质量比[(5.02±0.11),(4.93 ±0.13)vs.(5.37±0.29)],MPO[(0.51±0.05),(0.54 ±0.07)vs.(0.82±0.09)],MDA[(0.82±0.05),(0.81±0.04)vs.(0.96±0.05)]以及血清NO水平[(296.2±11.7),(291.7±15.8)vs.(351.8±19.6)]和TNF-α[D组(2.021±0.122)vs.L组(4.999±0.139)]明显降低、SOD活性[(120.3±6.1),(122.6±3.5)vs.(105.1±8.5)]明显增强、动脉血气中pH[(7.30 ±0.23),(7.30±0.17)vs.(7.22±0.45)]和PaO_2[(101.9±6.8),(102.5±4.7)vs.(80.3±3.3)]明显升高,差异有统计学意义(P<0.05);而U组与D组上述指标相比较,差异无统计学意义(P>0.05);U,D组与L组相比较PaCO_2[(37.0±3.3),(37.6±3.0)vs.(34.8±2.3)],差异无统计学意义(P>0.05).结论 乌司他丁对内毒素性急性肺损伤的保护作用与地塞米松相当,在临床上可替代地塞米松以减少其副作用.
目的 探討併比較蛋白酶抑製劑和激素對內毒素性急性肺損傷的保護作用,為臨床藥物的選擇提供依據.方法 新西蘭大白兔32隻,隨機(隨機數字法)分為對照組(C組)、內毒素組(L組)、烏司他丁組(U組)和地塞米鬆組(D組),每組8隻.除C組外,其他組均經耳緣靜脈給予內毒素(600μg/kg),U、D組在給予內毒素同時分彆靜脈註射烏司他丁(100000 U/kg)、地塞米鬆(5 mg/kg).4h後測定血清腫瘤壞死因子α(TNF-α)及一氧化氮(NO)水平,行動脈血氣分析,取肺組織觀察大體標本形態和光鏡下的組織病理形態,測定肺組織濕/榦質量比值(W/D)、髓過氧化物酶(MPO)活性、脂質過氧化產物丙二醛(MDA)及超氧化物歧化酶(SOD)活性.數據採用單因素方差分析(SNK-q檢驗),以P<0.05為差異有統計學意義.結果 光鏡下見C組肺組織學正常,L組肺間質瀰漫性齣血、肺泡腔內可見大量粒細胞聚集、浸潤,併可見瀰漫性肺泡間隔增厚,而U,D組上述病理錶現明顯減輕.U,D組與L組相比較兔肺組織濕/榦質量比[(5.02±0.11),(4.93 ±0.13)vs.(5.37±0.29)],MPO[(0.51±0.05),(0.54 ±0.07)vs.(0.82±0.09)],MDA[(0.82±0.05),(0.81±0.04)vs.(0.96±0.05)]以及血清NO水平[(296.2±11.7),(291.7±15.8)vs.(351.8±19.6)]和TNF-α[D組(2.021±0.122)vs.L組(4.999±0.139)]明顯降低、SOD活性[(120.3±6.1),(122.6±3.5)vs.(105.1±8.5)]明顯增彊、動脈血氣中pH[(7.30 ±0.23),(7.30±0.17)vs.(7.22±0.45)]和PaO_2[(101.9±6.8),(102.5±4.7)vs.(80.3±3.3)]明顯升高,差異有統計學意義(P<0.05);而U組與D組上述指標相比較,差異無統計學意義(P>0.05);U,D組與L組相比較PaCO_2[(37.0±3.3),(37.6±3.0)vs.(34.8±2.3)],差異無統計學意義(P>0.05).結論 烏司他丁對內毒素性急性肺損傷的保護作用與地塞米鬆相噹,在臨床上可替代地塞米鬆以減少其副作用.
목적 탐토병비교단백매억제제화격소대내독소성급성폐손상적보호작용,위림상약물적선택제공의거.방법 신서란대백토32지,수궤(수궤수자법)분위대조조(C조)、내독소조(L조)、오사타정조(U조)화지새미송조(D조),매조8지.제C조외,기타조균경이연정맥급여내독소(600μg/kg),U、D조재급여내독소동시분별정맥주사오사타정(100000 U/kg)、지새미송(5 mg/kg).4h후측정혈청종류배사인자α(TNF-α)급일양화담(NO)수평,행동맥혈기분석,취폐조직관찰대체표본형태화광경하적조직병리형태,측정폐조직습/간질량비치(W/D)、수과양화물매(MPO)활성、지질과양화산물병이철(MDA)급초양화물기화매(SOD)활성.수거채용단인소방차분석(SNK-q검험),이P<0.05위차이유통계학의의.결과 광경하견C조폐조직학정상,L조폐간질미만성출혈、폐포강내가견대량립세포취집、침윤,병가견미만성폐포간격증후,이U,D조상술병리표현명현감경.U,D조여L조상비교토폐조직습/간질량비[(5.02±0.11),(4.93 ±0.13)vs.(5.37±0.29)],MPO[(0.51±0.05),(0.54 ±0.07)vs.(0.82±0.09)],MDA[(0.82±0.05),(0.81±0.04)vs.(0.96±0.05)]이급혈청NO수평[(296.2±11.7),(291.7±15.8)vs.(351.8±19.6)]화TNF-α[D조(2.021±0.122)vs.L조(4.999±0.139)]명현강저、SOD활성[(120.3±6.1),(122.6±3.5)vs.(105.1±8.5)]명현증강、동맥혈기중pH[(7.30 ±0.23),(7.30±0.17)vs.(7.22±0.45)]화PaO_2[(101.9±6.8),(102.5±4.7)vs.(80.3±3.3)]명현승고,차이유통계학의의(P<0.05);이U조여D조상술지표상비교,차이무통계학의의(P>0.05);U,D조여L조상비교PaCO_2[(37.0±3.3),(37.6±3.0)vs.(34.8±2.3)],차이무통계학의의(P>0.05).결론 오사타정대내독소성급성폐손상적보호작용여지새미송상당,재림상상가체대지새미송이감소기부작용.
Objective To study and compare the protective effects of pmtease inhibitor and corticosteroid on endotoxin-indueed acute lung injury in order to guide the choice of appropriate drugs. Method Thirty-two New Zealand rabbits were randomly divided(random number) into four groups with 8 rabbits in each, namely normal controls(C) ; lipopolysaecharide(LPS) group(L) ; ulinastatin(UTI) group(U) and dexamcthasone(DEX) group (D) .Except group C, all rabbits were injected with a dose of LPS 600 μg/kg iv. Meanwhile the rabbits in group U,group D received UTI(100 000 μ/kg), DEX(5 mg/kg), respectively. The specimens were collected 4 hours later for detecting the levels of TNF-α and NO in serum, and blood gas analysis, histological manifestations, the lung wet/dry weight ratio, lung tissue MPO and SOD activity, lung tissue MDA. Data were analyzed by ANOVA (SNK- q test), and P < 0.05 was considered as significantly different. Results Compared with group C, the lungs of the rabbits in group L had inflammatory granulocyte infdtration, diffused alveolar septum thickening and hemorrhagic spots were observed in pathological examinations. The histological changes of group U and group D were much lessened than those in group L. As groups U and D were compared with group L, there were significant differences inmany biomarkers including lung wet/dry weight ratio[(5.02±0.11),(4.93±0.13) vs.(5.37 ±0.29)],lung tissue MPO activity[(0.51 ± 0.05),(0.54±0.07) vs.(0.82 ± 0.09)] and MDA[(0.82 ±0.05),(0.81 ±0.04) vs.(0.96±0.05)], NO[(296.2± 11.7),(291.7 ± 15.8) vs.(351.8±19.6)] and TNF-α[group D(2.021 ± 0.122) vs. group L(4.999 ± 0.139)],lung tissue SOD activity[(120.3 ± 6.1),(122.6±3.5) vs.(105.1 ± 8.5)] and blood gas analysis[pH(7.30±0.23),(7.30±0.17) vs.(7.22±0.45) and PaO_2( 101.9 ± 6.8).( 102.5 ± 4.7) vs.(80.3 ± 3.3)] ; but there were no differences of above mentioned biomarkers between group U and D( P > 0.05). And there were no significant differences in PaCO_2 betweeu group U and D and group L[(37.0 ± 3.3),(37.6 ± 3.0) vs.(34.8 ± 2.3)]( P > 0.05). Conclusions The protective effects of ulinastatin on endotoxin-induced acute lung injury is comparable to those of dexamethasone, thus the former may be a clinical substitute for the latter with less side effects.
