内毒素亲和吸附剂SPV对失血性休克模型大鼠肠壁通透性与细菌移位的影响
|
摘要
目的:观察内毒素亲和吸附剂SPV对失血性休克模型大鼠肠壁通透性与细菌移位的影响。方法:将85只雄性SD大鼠随机分为正常组(5只)、休克组(每时间点各5只,共20只)以及SPV低、中、高剂量组(将蒙脱石散0.3 g、硫酸多黏菌素B 0.5 mg、维生素B_6 5 mg溶于生理盐水中制成总体积为5 mL的SPV溶液,即为低剂量;中、高剂量药物成分是低剂量的2、3倍。各剂量组每时间点各5只,共60只),各给药组大鼠分别灌胃SPV溶液5、10、15 mL,正常组和休克组大鼠灌胃生理盐水5 mL,均给药1次。末次给药30 min后,除正常组外其余各组大鼠均通过股动脉插管放血术复制失血性休克模型。于复苏后1、4、8、16 h分别检测各组大鼠血清中二胺氧化酶(DAO)、内毒素、D-乳酸的活性或含量以及计算肠道细菌移位阳性率。结果:与正常组比较,休克组大鼠各时间点血清DAO活性均显著增强,血清内毒素、D-乳酸的含量以及肠道细菌移位阳性率均显著升高(P<0.05)。与休克组比较,SPV各剂量组大鼠血清DAO活性(1～16 h各时间点)均显著减弱,血清内毒素、D-乳酸的含量(1～16 h各时间点)以及肠道细菌移位阳性率(SPV低剂量组4～16 h各时间点,SPV中、高剂量组1～16 h各时间点)均显著降低(P<0.05),且SPV中、高剂量组上述指标(1～16 h各时间点)均显著低于SPV低剂量组(P<0.05);而SPV中、高剂量组上述指标组间比较差异均无统计学意义(P>0.05)。结论:内毒素亲和吸附剂SPV可剂量依赖性地改善失血性休克模型大鼠的肠壁通透性,并抑制细菌移位。这种作用与其降低血清内毒素、DAO、D-乳酸的活性或含量,下调肠道细菌移位阳性率有关。
OBJECTIVE:To observe the effects of endotoxin affinity adsorbent SPV on intestinal permeability and bacterial translocation in hemorrhagic shock model rats. METHODS:Totally 85 male SD rats were randomly divided into normal group(5 rats),shock group(each 5 rats at each time point,20 rats in total),SPV low-dose,medium-dose and high-dose groups(Montmorillonite powder 0.3 g,Polymyxin B sulfate 0.5 mg,Vitamin B_6 5 mg dissolved in normal saline to obtain SPV solution 5 mL,as low dose;medium and high dose were 2 or 3 times as high as low dose. Each 5 rats of each group at each time point,60 rats in total). Administration groups were given SPV solution intragastrically 5,10,15 mL once,respectively;normal group and shock group were given normal saline 5 mL intragastrically once. Thirty minutes after last medication,other groups received femoral artery catheterization and bleeding to induce hemorrhagic shock model,except for normal group. The activities or contents of diamine oxidase(DAO),endotoxin and D-lactic acid,positive rates of intestinal bacterial translocation were detected in each group at 1,4,8,16 h after recovery. RESULTS:Compared with normal group,the activities of DAO of rats in shock group were enhanced significantly,and the serum contents of endotoxin and D-lactic acid were increased significantly(P<0.05). Compared with shock group,the activities of DAO were decreased significantly in SPV groups(at each time point during 1-16 h);the serum contents of endotoxin and D-lactic acid(at each time point during 1-16 h),positive rates of intestinal bacterial translocation(SPV low-dose group at each time point during 4-16 h,SPV medium-dose and high-dose groups at each time point during 1-16 h)were decreased significantly(P<0.05). Above indexes in SPV medium-dose and high-dose groups(at each time point during 1-16 h)were significantly lower than those of SPV low-dose group(P<0.05). There was no statistical significance in above indexes between SPV medium-dose group and high-dose group(P>0.05). CONCLUSIONS:The endotoxin affinity adsorbent SPV can improve the permeability of the intestinal wall and inhibit bacterial translocation in hemorrhagic shock model rats in dose-dependent manner. The effects of which may be associated with reducing the activities or contents of serum DAO,endotoxin,D-lactic acid,and down-regulating the positive rate of bacterial translocation.
OBJECTIVE:To observe the effects of endotoxin affinity adsorbent SPV on intestinal permeability and bacterial translocation in hemorrhagic shock model rats. METHODS:Totally 85 male SD rats were randomly divided into normal group(5 rats),shock group(each 5 rats at each time point,20 rats in total),SPV low-dose,medium-dose and high-dose groups(Montmorillonite powder 0.3 g,Polymyxin B sulfate 0.5 mg,Vitamin B_6 5 mg dissolved in normal saline to obtain SPV solution 5 mL,as low dose;medium and high dose were 2 or 3 times as high as low dose. Each 5 rats of each group at each time point,60 rats in total). Administration groups were given SPV solution intragastrically 5,10,15 mL once,respectively;normal group and shock group were given normal saline 5 mL intragastrically once. Thirty minutes after last medication,other groups received femoral artery catheterization and bleeding to induce hemorrhagic shock model,except for normal group. The activities or contents of diamine oxidase(DAO),endotoxin and D-lactic acid,positive rates of intestinal bacterial translocation were detected in each group at 1,4,8,16 h after recovery. RESULTS:Compared with normal group,the activities of DAO of rats in shock group were enhanced significantly,and the serum contents of endotoxin and D-lactic acid were increased significantly(P<0.05). Compared with shock group,the activities of DAO were decreased significantly in SPV groups(at each time point during 1-16 h);the serum contents of endotoxin and D-lactic acid(at each time point during 1-16 h),positive rates of intestinal bacterial translocation(SPV low-dose group at each time point during 4-16 h,SPV medium-dose and high-dose groups at each time point during 1-16 h)were decreased significantly(P<0.05). Above indexes in SPV medium-dose and high-dose groups(at each time point during 1-16 h)were significantly lower than those of SPV low-dose group(P<0.05). There was no statistical significance in above indexes between SPV medium-dose group and high-dose group(P>0.05). CONCLUSIONS:The endotoxin affinity adsorbent SPV can improve the permeability of the intestinal wall and inhibit bacterial translocation in hemorrhagic shock model rats in dose-dependent manner. The effects of which may be associated with reducing the activities or contents of serum DAO,endotoxin,D-lactic acid,and down-regulating the positive rate of bacterial translocation.
引文
[1]WILMORE DW,SMITH RJ,O’DWYER ST,et al.The gut:a central organ after surgical stress[J].Surgery,1988,104(5):917-923.
[2]MANN V,MANN S,SZALAY G,et al.Treatment of polytrauma in the intensive care unit[J].Anaesthesist,2010,59(8):739-761.
[3]PETRONI RC,BISELLI PJ,LIMA TM,et al.Impact of time on fluid resuscitation with hypertonic saline(NaCl7.5%)in rats with LPS-induced acute lung injury[J].Shock,2015,44(6):609-615.
[4]JEONG KY,SUH GJ,KWON WY,et al.The therapeutic effect and mechanism of niacin on acute lung injury in a rat model of hemorrhagic shock:down-regulation of the reactive oxygen species-dependent nuclear factorκB pathway[J].J Trauma Acute Care Surg,2015,79(2):247-255.
[5]BERG RD.Bacterial translocation from the gastrointestinal tract[J].Trends Microbiol,1995,3(4):149-150
[6]张波,何建川.血液灌流用内毒素吸附剂的研究进展[J].医学研究杂志,2011,40(5):153-154.
[7]CHANDY T,RAO GH.Evaluation of heparin immobilized chitosan-PEG microbeads for charcoal encapsulation and endotoxin removal[J].Artif Cells Blood Substit Immobil Biotechnol,2000,28(1):65-77.
[8]国家药典委员会.中华人民共和国药典:二部[S].2015年版.北京:中国医药科技出版社,2015:729.
[9]梁红山.国家标准中菌落数检测的有关疑点探讨[J].现代预防医学,2001,28(4):505.
[10]陈华,刘亚千,黄丽洁,等.灵光注射液对失血性休克大鼠胃肠黏膜的保护作用[J].中国实验动物学报,2003,11(2):107-110.
[11]SPAHN DR,BOUILLON B,CERNY V,et al.Management of bleeding and coagulopathy following major trauma:an updated European guideline[J].Crit Care,2013.DOI:10.1186/cc12685.
[12]NUNEZ TC,VOSKRESENSKY IV,DOSSETT LA,et al.Early prediction of massive transfusion in trauma:simple as ABC:assessment of blood consumption?[J].J Trauma,2009,66(2):346-352.
[13]刘劲.蒙脱石散在临床上的应用[J].医药与保健:下旬刊,2009:72-73.
[14]黎源,吴疆.肠道细菌移位的研究进展[J].世界华人消化杂志,2015,23(6):938-943.
[15]RONCO C,KLEIN DJ.Polymyxin B hemoperfusion:a mechanistic perspective[J].Crit Care,2014.DOI:10.1186/cc13912.
[16]AOKI H,KODAMA M,TANI T,et al.Treatment of sepsis by extracorporeal elimination of endotoxin using polymyxin B-immobilized fiber[J].Am J Surg,1994,167(4):412-417.
[17]岳茂兴.偏二甲基肼中毒损伤特点及其临床救治对策研究[J].总装备部医学学报,2001,3(3):155-157.
[18]刘海,赵剑秋,彭晓静,等.内毒素亲和吸附剂对失血性休克大鼠NO、SOD及MDA水平的影响[J].中国老年学杂志,2016,36(7):1563-1565.
[19]WONG J,VILAR E,FARRINGTON K.Endotoxemia in end-stage kidney disease[J].Semin Dial,2015,28(1):59-67.
[20]ALAMILI M,BENDTZEN K,LYKKESFELDT J,et al.Effect of melatonin on human nighttime endotoxaemia:randomized,double-blinded,cross-over study[J].In Vivo,2014,28(6):1057-1063.
[21]SCOTT LJ,FIGGITT DP.Mitoxantrone:a review of its use in multiple sclerosis[J].CNS Drugs,2004,18(6):379-396.
[22]ZHAO L,LUO L,JIA W,et al.Serum diamine oxidase as a hemorrhagic shock biomarker in a rabbit model[J].PLoS One,2014,9(8):e102285.
[23]ZHANG L,FAN X,ZHONG Z,et al.Association of plasma diamine oxidase and intestinal fatty acid-binding protein with severity of disease in patient with heat stroke[J].Am J Emerg Med,2015,33(7):867-871.
[24]LIU W,SHAN LP,DONG XS,et al.Combined early fluid resuscitation and hydrogen inhalation attenuates lung and intestine injury[J].World J Gastroenterol,2013,19(4):492-502.
[2]MANN V,MANN S,SZALAY G,et al.Treatment of polytrauma in the intensive care unit[J].Anaesthesist,2010,59(8):739-761.
[3]PETRONI RC,BISELLI PJ,LIMA TM,et al.Impact of time on fluid resuscitation with hypertonic saline(NaCl7.5%)in rats with LPS-induced acute lung injury[J].Shock,2015,44(6):609-615.
[4]JEONG KY,SUH GJ,KWON WY,et al.The therapeutic effect and mechanism of niacin on acute lung injury in a rat model of hemorrhagic shock:down-regulation of the reactive oxygen species-dependent nuclear factorκB pathway[J].J Trauma Acute Care Surg,2015,79(2):247-255.
[5]BERG RD.Bacterial translocation from the gastrointestinal tract[J].Trends Microbiol,1995,3(4):149-150
[6]张波,何建川.血液灌流用内毒素吸附剂的研究进展[J].医学研究杂志,2011,40(5):153-154.
[7]CHANDY T,RAO GH.Evaluation of heparin immobilized chitosan-PEG microbeads for charcoal encapsulation and endotoxin removal[J].Artif Cells Blood Substit Immobil Biotechnol,2000,28(1):65-77.
[8]国家药典委员会.中华人民共和国药典:二部[S].2015年版.北京:中国医药科技出版社,2015:729.
[9]梁红山.国家标准中菌落数检测的有关疑点探讨[J].现代预防医学,2001,28(4):505.
[10]陈华,刘亚千,黄丽洁,等.灵光注射液对失血性休克大鼠胃肠黏膜的保护作用[J].中国实验动物学报,2003,11(2):107-110.
[11]SPAHN DR,BOUILLON B,CERNY V,et al.Management of bleeding and coagulopathy following major trauma:an updated European guideline[J].Crit Care,2013.DOI:10.1186/cc12685.
[12]NUNEZ TC,VOSKRESENSKY IV,DOSSETT LA,et al.Early prediction of massive transfusion in trauma:simple as ABC:assessment of blood consumption?[J].J Trauma,2009,66(2):346-352.
[13]刘劲.蒙脱石散在临床上的应用[J].医药与保健:下旬刊,2009:72-73.
[14]黎源,吴疆.肠道细菌移位的研究进展[J].世界华人消化杂志,2015,23(6):938-943.
[15]RONCO C,KLEIN DJ.Polymyxin B hemoperfusion:a mechanistic perspective[J].Crit Care,2014.DOI:10.1186/cc13912.
[16]AOKI H,KODAMA M,TANI T,et al.Treatment of sepsis by extracorporeal elimination of endotoxin using polymyxin B-immobilized fiber[J].Am J Surg,1994,167(4):412-417.
[17]岳茂兴.偏二甲基肼中毒损伤特点及其临床救治对策研究[J].总装备部医学学报,2001,3(3):155-157.
[18]刘海,赵剑秋,彭晓静,等.内毒素亲和吸附剂对失血性休克大鼠NO、SOD及MDA水平的影响[J].中国老年学杂志,2016,36(7):1563-1565.
[19]WONG J,VILAR E,FARRINGTON K.Endotoxemia in end-stage kidney disease[J].Semin Dial,2015,28(1):59-67.
[20]ALAMILI M,BENDTZEN K,LYKKESFELDT J,et al.Effect of melatonin on human nighttime endotoxaemia:randomized,double-blinded,cross-over study[J].In Vivo,2014,28(6):1057-1063.
[21]SCOTT LJ,FIGGITT DP.Mitoxantrone:a review of its use in multiple sclerosis[J].CNS Drugs,2004,18(6):379-396.
[22]ZHAO L,LUO L,JIA W,et al.Serum diamine oxidase as a hemorrhagic shock biomarker in a rabbit model[J].PLoS One,2014,9(8):e102285.
[23]ZHANG L,FAN X,ZHONG Z,et al.Association of plasma diamine oxidase and intestinal fatty acid-binding protein with severity of disease in patient with heat stroke[J].Am J Emerg Med,2015,33(7):867-871.
[24]LIU W,SHAN LP,DONG XS,et al.Combined early fluid resuscitation and hydrogen inhalation attenuates lung and intestine injury[J].World J Gastroenterol,2013,19(4):492-502.