CAJ | 학술논문

目的通过测定单核细胞趋化蛋白1(MCP-1)水平,探讨低分子量肝素(LMWH)和尿激酶对于急性肺血栓栓塞兔模型栓塞早期炎症和肺血管损伤的影响.方法健康雄性日本大耳白兔60只,采用自体血栓回输法建立肺栓塞模型,造模成功后随机分为3组:生理盐水组、LMWH组和尿激酶组,另设假手术组,每组18只,每组于治疗后分别于第2、4、14天处死6只,测量动脉血气分析,采用ELISA法检测栓塞周围肺组织和血清MCP-1浓度,肺血管行Masson染色,观察病理改变.结果造模成功54只,成功率90％ (54/60).生理盐水组MCP-1肺组织浓度第4天时为(48±5)ng/L,第14天时为(41±4) ng/L,LMWH组MCP-1肺组织浓度较低,第4天时为(33±9)ng/L,第14天时为(30±11) ng/L(P ＜0.05);第14天时生理盐水组MCP-1血清浓度为(51±5)ng/L,LMWH组MCP-1血清浓度明显较低[(36±10) ng/L,P＜0.05.尿激酶组第2、4天时MCP-1肺组织浓度[(34±8)、(29 ±7) ng/L]和血清浓度[(44±3)、(44±4) ng/L]均明显低于生理盐水组,P(A-a)O2也明显低于生理盐水组,差异有统计学意义(均P ＜0.05).结论尿激酶溶栓治疗可以迅速改善通气血流比例失调、降低MCP-1浓度,但不能抑制持续的炎症反应.低分子肝素则可以持续减轻栓塞局部和全身的MCP-1浓度和炎症反应,降低后期肺动脉内膜增生.
목적 통과측정단핵세포추화단백1(MCP-1)수평,탐토저분자량간소(LMWH)화뇨격매대우급성폐혈전전새토모형전새조기염증화폐혈관손상적영향.방법 건강웅성일본대이백토60지,채용자체혈전회수법건립폐전새모형,조모성공후수궤분위3조:생리염수조、LMWH조화뇨격매조,령설가수술조,매조18지,매조우치료후분별우제2、4、14천처사6지,측량동맥혈기분석,채용ELISA법검측전새주위폐조직화혈청MCP-1농도,폐혈관행Masson염색,관찰병리개변.결과 조모성공54지,성공솔90％ (54/60).생리염수조MCP-1폐조직농도제4천시위(48±5)ng/L,제14천시위(41±4) ng/L,LMWH조MCP-1폐조직농도교저,제4천시위(33±9)ng/L,제14천시위(30±11) ng/L(P ＜0.05);제14천시생리염수조MCP-1혈청농도위(51±5)ng/L,LMWH조MCP-1혈청농도명현교저[(36±10) ng/L,P＜0.05.뇨격매조제2、4천시MCP-1폐조직농도[(34±8)、(29 ±7) ng/L]화혈청농도[(44±3)、(44±4) ng/L]균명현저우생리염수조,P(A-a)O2야명현저우생리염수조,차이유통계학의의(균P ＜0.05).결론 뇨격매용전치료가이신속개선통기혈류비례실조、강저MCP-1농도,단불능억제지속적염증반응.저분자간소칙가이지속감경전새국부화전신적MCP-1농도화염증반응,강저후기폐동맥내막증생.
Objective To evaluate effect the of thrombolytic (urokinase,UK) and anticoagulant agent (low-molecular-weight heparin,LMWH) on the pulmonary injury of rabbits with acute pulmonary embolism (PE) by assaying monocyte chemoattractant protein-1 (MCP-1).Methods Rabbit models with PE were established by transfusing autologous blood clots on 60 healthy male Japanese white rabbits.Experimental PE rabbits were randomly divided into 3 groups:normal saline(NS) group (n =18),LMWH group (n =18) and UK group (n =18),and other 18 rabbits underwent sham operations as SHAM group (n =18).Each group was divided into 3 subgroups based on 2 days (day2),4 days (day4),and 14 days (day 14) after therapies.Arterial blood gas analysis was measured.MCP-1 levels in lung tissue and blood were assayed with ELISA at various times (day 2,day 4 and day 14).Fixed sections were stained with trichrome for intimal hyperplasia determination.Results The overall rate of success for making PE rabbit models was 90％ (54/60),which was not affected by treatment.Compared with NS group,P(A-a)O2 significantly decreased in UK group.Compared with NS group,MCP-1 levels in lung tissue significantly decreased in LMWH group on day4 [(33 ±9) ng/L vs (48 ±5) ng/L,P ＜0.05] and day 14 [(30 ±11) ng/L vs (41 ± 4) ng/L,P ＜0.05] ; MCP-1 levels in serum on day 14 also significantly decreased in LMWH group [(36 ± 10) ng/L vs (51 ±5) ng/L,P ＜0.05].Compared with NS group,MCP-1 levels in lung tissue significantly decreased in UK group on day 2 and 4 [Day2:(34 ± 8) ng/L vs (50 ±4) ng/L,P ＜0.05 ; Day4:(29 ±7)ng/L vs (48 ±5) ng/L,P ＜0.05] ; MCP-1 levels in serum on day 2 and day 4 also significantly decreased in UK group [Day2:(44 ±3) ng/Lvs (48 ±3) ng/L,P ＜0.05; Day4:(44 ±4) ng/Lvs (53 ± 1)ng/L,P＜0.05].Conclusions UK treatment may rapidly improve V/Q ratio and decrease MCP-1 levels in lung tissue or serum,but it can not inhibit persistent inflammation.LMWH can decrease MCP-1 levels in lung tissue or serum,and inhibit persistent inflammation and late intimal hyperplasia.