CAJ | 학술논문

目的：利用盲肠结扎穿孔伴严重腹腔感染造成的脓毒症模型，探讨胰岛素不同目标血糖对脓毒症肝、肺组织形态的影响。方法选取40只SD大鼠随机分为5组，通过盲肠结扎穿孔术（CLP）法制备大鼠脓毒症模型，按分组进行不同处理：假手术组（Sham组），CLP组，目标血糖控制A组、B组和C组，每组8只。CLP术后12 h处死，通过组织形态观察，对肝、肺损伤不同病理积分进行评估。结果肝、肺组织病理总评分在CLP及血糖处理后明显高于Sham组（P＜0．05）。在单项肝、肺的观察指标中，A组与Sham组比较，差异无统计学意义（P＞0．05）；3组血糖组肝、肺损伤程度随着血糖水平升高病变渐进加重，两两比较差异有统计学意义（P＜0．05）。肺损伤主要表现为肺泡壁毛细血管充血、肺小叶及间质水肿、支气管炎，CLP组与血糖控制A、B、C 3组比较，与A、B组差异有统计学意义（P＜0．05），与C组差异无统计学意义（P＞0．05）。肝损伤主要为肝细胞水样变性及脂肪变性，CLP组与血糖控制A、B、C 3组比较，差异有统计学意义（P＜0．05），CLP组出现了明显碎片状坏死。结论脓毒症大鼠的肝、肺损伤程度随着血糖水平升高逐渐加重，控制血糖可使脓毒症模型鼠的肝、肺的损伤减低。
목적：이용맹장결찰천공반엄중복강감염조성적농독증모형，탐토이도소불동목표혈당대농독증간、폐조직형태적영향。방법선취40지SD대서수궤분위5조，통과맹장결찰천공술（CLP）법제비대서농독증모형，안분조진행불동처리：가수술조（Sham조），CLP조，목표혈당공제A조、B조화C조，매조8지。CLP술후12 h처사，통과조직형태관찰，대간、폐손상불동병리적분진행평고。결과간、폐조직병리총평분재CLP급혈당처리후명현고우Sham조（P＜0．05）。재단항간、폐적관찰지표중，A조여Sham조비교，차이무통계학의의（P＞0．05）；3조혈당조간、폐손상정도수착혈당수평승고병변점진가중，량량비교차이유통계학의의（P＜0．05）。폐손상주요표현위폐포벽모세혈관충혈、폐소협급간질수종、지기관염，CLP조여혈당공제A、B、C 3조비교，여A、B조차이유통계학의의（P＜0．05），여C조차이무통계학의의（P＞0．05）。간손상주요위간세포수양변성급지방변성，CLP조여혈당공제A、B、C 3조비교，차이유통계학의의（P＜0．05），CLP조출현료명현쇄편상배사。결론농독증대서적간、폐손상정도수착혈당수평승고축점가중，공제혈당가사농독증모형서적간、폐적손상감저。
Objective To investigate the changes and significance of different target blood glucose on septic liver and lung dam‐age and its morphology .The purpose of this study was to evaluate the pathological injury of liver and lung induced by higher blood glucose .Methods Forty SD rats randomly divided into sham operation group ,sepsis group ,group A (glucose was controlled at 4 .4 to 6 .1 mmol/L) ,group B (glucose was controlled at 6 .1 to 8 .3 mmol/L) and group C (glucose was controlled at 8 .3 to 10 .0 mmol/L) ,with 8 rats in each group .The liver and lung tissue were obtained 12 hours after cecal ligation and puncture .Then evalu‐ate and analyze the morphology change in liver and lung injury from different pathological scores ,including eight observation marker for liver and seven marker for lung .Results The pathological injury of liver and lung was significantly higher than sham treatment group for CLP and group A to C(P<0 .05) .In observation of individual indicators of the injury of liver and lung ,group A had no significant difference with the sham group (P>0 .05) ,but in the three blood glucose groups ,liver and lung injury progressive dis‐ease with the level of blood glucose elevating and the difference was significant(P<0 .05) .The main pathological features of lung injury were alveolar wall capillary congestion ,pulmonary lobules and interstitial edema ,bronchitis ,and CLP group had significant differences with group A and B(P<0 .05) ,and had no significant differences with group C(P>0 .05) .For liver injury the main pathological features were hydropic and fatty degeneration ,and CLP group had significant differences with group A ,B and C(P<0 .05) .While CLP group showed a significant piecemeal necrosis for liver injury .Conclusion The injury of liver and lung injury in septic rats were gradually increased with elevated blood glucose levels ;blood glucose controlled within the normal range of liver rat model of sepsis could reduce the liver and lung injury .