【摘要】 目的探讨肠缺血-再灌注致肠黏膜屏障损害的早期诊断指标。方法Wistar雄性大鼠60只,分为假手术组(SO)、肠缺血15min组、肠缺血45min组、肠缺血45min再灌注2h组、肠缺血45min再灌注6h组,肠缺血45min再灌注12h组,每组均为10只。用无创伤动脉夹夹闭大鼠肠系膜上动脉制作肠缺血-再灌注模型,在相应时间点采集大鼠静脉血。测定各组大鼠血清肌酸激酶(CK)、乳酸脱氢酶(LDH)、D-乳酸和肠脂肪酸结合蛋白(IFABP)。在光镜下观察小肠组织病理学变化。结果与假手术组比较,肠缺血15min时,大鼠血清CK、LDH和D-乳酸无变化,IFABP值显著升高达(374．74±48．85)pg/ml(P＜0．01)；肠缺血45min时,CK达峰值为(1090．40±187．51)U/L,D-乳酸和IFABP均显著增加(P＜0．01)；再灌注2h时,D-乳酸和IFABP达峰值,分别为(2．51±0．19)μg/ml、(1601．42±286．81)pg/ml(P＜0．01)。与缺血45min组比较,再灌注6h时CK值下降明显(P＜0．01),LDH值差异无统计学意义,而D-乳酸和IFABP值仍维持较高水平(P＜0．01)；再灌注12h,D-乳酸和IFABP逐渐下降(P＜0．01)。大鼠小肠黏膜在缺血45min时出现黏膜水肿、点状出血,再灌注6h见部分黏膜层坏死,细胞脱落至肠腔,黏膜下层充血水肿明显。肠黏膜损伤评分值与D-乳酸和IFABP呈显著正相关(P＜0．01)。结论肠脂肪酸结合蛋白联合D-乳酸的监测可作为诊断肠缺血-再灌注致肠黏膜屏障损伤的早期、特异的生化指标。更多还原

【Abstract】 Objective To explore the early diagnostic marker and mechanism of the injury of in- testinal mucosal barrier induced by intestinal ischemia-reperfusion in rats.Methods Sixty male Wistar rats were randomly divided into six groups:the sham operation group(SO),the ischemia 15 minutes group(A),the ischemia 45 minutes group(B),the ischemia 45 minutes plus reperfusion 2 hours group (C),the ischemia 45 minutes plus reperfusion 6 hours group(D),and the ischemia 45 minutes plus reperfusion 12 hours group(E).Using clamping and then releasing superior mesenteric artery the model of intestinal ischemia-reperfusion in rats was made.The sham operation group only underwent laparotomy. At different time points after ischemia and reperfusion the levels of serum CK,LDH,D-lactate and intes- tinal fatty acid binding protein(IFABP)in each group were examined.The morphological changes of in- testinal tissues were observed with light microscopy.Results Compared with group SO,the level of se- rum IFABP in group A was(374.74±48.85)pg/ml,significantly higher(P＜0.01),but the level of CK,LDH and D-lactate had no significant difference(all P＞0.05).In group B,the level of CK was (1090.40±187.51)u/L,peaking at 45 minutes after ischemia,meanwhile,D-lactate and IFABP levels were significantly increased(P＜0.01,respectively).In group C,D-lactate and IFABP were (2.51±0.19)μg/ml and (1601.42±286.81 )pg/ml,respectively,peaking at 2 hours after reperfusion (P＜0.01).At 6 hours after reperfusion,compared with ischemia 45 minutes,CK level was significantly de- creased(P＜0.01),LDH had no significant difference(P＞0.05),but the levels of D-lactate and IF- ABP were(2.03±0.24)μg/ml and(1443.76±174.52)pg/ml,respectively,all sustained a high lev- el(P＜0.01 ).At 12 hours after reperfusion,D-lactate and IFABP levels were gradually decreased(P＜0.01).At 45 minutes after ischemia the morphological changes of intestinal mucosa could be observed. At 6 hours after reperfusion part of the mucous layer appeared necrotic,some intestinal mucosal cells shed to enteric cavity,and submucous layer had hyperemia and edema obviously.Injury scores of intestinal mucosa were significantly correlated to the serum level of D-lactate and IFABP,correlation coefficients were 0.456,0.612(P＜0.01).Conclusion The monitoring of serum IFABP combined with D-lac- tate is a early,sensitive and specific biochemical marker in the diagnosis of intestinal mucosal barrier in- jury after ischemia-reperfusion.更多还原