CAJ | 학술논문

目的：观察肢体缺血-再灌注对全身炎症反应与凝血-纤溶系统的影响，观察肢体缺血预处理对全身炎症反应和凝血-纤溶系统的干预作用。方法（40只）SD大鼠随机分为4组：假手术对照组(SC)、单纯缺血组(I)，缺血再灌注(IR)组（夹闭两侧髂外动脉，再以橡皮带扎紧双后肢根部阻断血流,4 h后放开动脉夹、松开橡皮带,恢复血液灌注4 h；IR+IPC组先阻断双后肢血流5 min,然后恢复血流灌注5 min,如此反复3次，其后操作同IR组，缺血再灌注组(IR)和缺血再灌注+缺血预处理组（IR+IPC）。缺血前、缺血4 h及再灌注4 h取外周静脉血，ELISA法测定肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、和组织因子（TF）、组织型纤溶酶原激活物（tPA）及纤溶酶原激活物抑制物-1（PAI-1）活性，比色法测定内毒素（ET），自动血凝仪检测凝血酶原时间(prothrombin time,PT)和活化部分促凝血激酶时间（activated partial thromboplastin time ，APTT）。结果 IR组和IR+IPC组的血浆TNF-α、IL-6、TF、ET含量均显著高于C和I组，但IR+IPC组的IL-6、TF、ET均显著低于IR组，P <0.05或P <0.01；IR组的血浆tPA水平显著低于、PAI显著高于SC组，均 P <0.05，IR+IPC 组的 tPA 高于、PAI 低于 IR 组，均 P <0.05；IR 组的 PT 和 APTT 均明显短于 SC 组、I 组和IR+IPC组。血浆ET、IL-6水平与PAI-1呈正相关，与PT、APTT均呈负相关。结论肢体缺血-再灌注导致全身炎症反应，同时凝血-纤溶系统功能紊乱，肢体缺血预处理干预可以减弱全身炎症反应，调节凝血-纤溶系统功能的平衡。
목적：관찰지체결혈-재관주대전신염증반응여응혈-섬용계통적영향，관찰지체결혈예처리대전신염증반응화응혈-섬용계통적간예작용。방법（40지）SD대서수궤분위4조：가수술대조조(SC)、단순결혈조(I)，결혈재관주(IR)조（협폐량측가외동맥，재이상피대찰긴쌍후지근부조단혈류,4 h후방개동맥협、송개상피대,회복혈액관주4 h；IR+IPC조선조단쌍후지혈류5 min,연후회복혈류관주5 min,여차반복3차，기후조작동IR조，결혈재관주조(IR)화결혈재관주+결혈예처리조（IR+IPC）。결혈전、결혈4 h급재관주4 h취외주정맥혈，ELISA법측정종류배사인자-α（TNF-α）、백개소-6（IL-6）、화조직인자（TF）、조직형섬용매원격활물（tPA）급섬용매원격활물억제물-1（PAI-1）활성，비색법측정내독소（ET），자동혈응의검측응혈매원시간(prothrombin time,PT)화활화부분촉응혈격매시간（activated partial thromboplastin time ，APTT）。결과 IR조화IR+IPC조적혈장TNF-α、IL-6、TF、ET함량균현저고우C화I조，단IR+IPC조적IL-6、TF、ET균현저저우IR조，P <0.05혹P <0.01；IR조적혈장tPA수평현저저우、PAI현저고우SC조，균 P <0.05，IR+IPC 조적 tPA 고우、PAI 저우 IR 조，균 P <0.05；IR 조적 PT 화 APTT 균명현단우 SC 조、I 조화IR+IPC조。혈장ET、IL-6수평여PAI-1정정상관，여PT、APTT균정부상관。결론지체결혈-재관주도치전신염증반응，동시응혈-섬용계통공능문란，지체결혈예처리간예가이감약전신염증반응，조절응혈-섬용계통공능적평형。
Objective To observe the effects of lower limb ischemia-reperfusion on systemic inflammatory response and coagulation-fibrinolysis system, and further explore the role of ischemic preconditioning in systemic inflammatory response and coagulation-fibrinolysis system during lower limb ischemia-reperfusion. Methods 40 SD rats were randomly divided into 4 groups, sham control (SC) group, ischemia (I) group, ischemia reperfusion (IR) group undergoing clamping of bilateral external iliac artery and blood flow occlusion with rubber band of two hind-limbs for 4 hours and then with the blood flow perfusion restored for 4 hours, and ischemic preconditioning (IR+IPC) group undergoing occlusion of blood flow of the 2 hind-limbs for 5 minutes and then restoring blood flow perfusion for 5 min three times. Peripheral venous blood samples were collected before ischemia, 4 hours after ischemia, and 5 min after reperfusion. The concentrations of tumor necrosis factor-e (TNF-α), interleukin-6 (IL-6), plasma tissue factor (TF), tissue plasminogen activator (tPA), and plasminogen activator inhibitor 1 (PAI-1) were assayed by ELISA. The endotoxin (ET) level was measured by using tachypleus amebocyte lysate (TAL) assay. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured by automatic coagulation analyzer. Results The plasma concentrations of TNF-α,IL-6, TF, and ET of the IR and IR+IPC groups were significantly higher than those of the SC and I groups. The IL-6, TF, and ET concentrations of the IR+IPC group were all significantly lower than those of the IR group P <0.05 or P <0.01. The plasma concentration of tPA of the IR group was significantly lower than that of the SC group group, and the PAI-1 of the IR group was significantly higher than that of the SC group (both P<0.05); and the plasma tPA concentration of the IR+IPC group was significantly higher than that of the IR group, and the plasma PAI-1 of the IR+IPC group was significantly lower than that of the IR group (both P<0.05). The PT and APTT of SC, I, and IR+IPC groups were shorter than those of the IR group (P<0.05 or P<0.01). The PT and APTT of the IR group were significantly shorter than those of SC, I, and IR+IPC groups (all P <0.05). The plasma levels of ET and IL-6 were positively related with the PAI-1 concentration, and negatively related with the PT and APTT. Conclusion Lower limb ischemia-reperfusion may induces systemic inflammatory response and coagulation-fibrinolysis system imbalance. Limb ischemic preconditioning is considered being effective in reducing inflammatory response and corrects coagulation-fibrinolysis system imbalance.