舱内爆炸致大鼠腹部闭合性损伤的特点及其对肠黏膜屏障功能的影响
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摘要
战斗舱室是现代战争中的主要作战单元,反装甲攻坚武器可击穿战斗舱室在舱内爆炸,平时恐怖主义活动和意外突发性爆炸事件也主要发生在较狭小空间,因而相对密闭空间爆炸是现代战争和平时爆炸事件的主要特征之一。由于腹部表面积大,腹内脏器多且复杂,冲击波易导致腹腔脏器损伤。在战争中,部分伤员体表没有明显伤痕却存在腹内脏器损伤,这类伤员病情严重,后期可发生脓毒症甚至MODS,危及生命,但因其隐匿性强而未引起广泛重视,常延误诊治。由于没有明确的感染源,而肠道是体内最大的细菌和内毒素库,我们设想伤员发生脓毒症的细菌或内毒素可能来自肠道。机体遭受严重创伤(如冲击伤)后产生应激、缺血-再灌注损伤等因素导致肠黏膜屏障功能受损,肠道通透性增高,肠道细菌或内毒素可逸出肠黏膜,通过循环系统到达远处脏器,诱发MODS。目前国内外军事研究机构对爆炸伤的研究集中在听器、眼、脑、胸部和四肢损伤,对腹部爆炸伤大多着眼于穿透伤、贯通伤、切线伤等体表有明显伤痕的研究,而对相对密闭环境下腹部闭合性损伤的研究甚少。因此,开展爆炸冲击波致腹部闭合性损伤特点及冲击波在肠道黏膜屏障功能障碍中的作用研究,可阐明爆炸性武器对生物致伤特点及其机制,并为伤员制定相应的防护措施提供理论基础。本课题通过建立舱内腹部闭合性爆炸伤大鼠模型,分析了舱内大鼠腹部闭合性爆炸伤的大体形态学和组织病理学特点,明确了腹部爆炸伤严重程度与冲击波物理参数之间的量效关系,开展了大鼠腹部闭合性爆炸伤后肠黏膜屏障功能损害以及细菌移位的研究。
主要研究方法和结果:
1.通过在模拟陆军装甲舱室内爆炸建立致伤大鼠模型,与开阔地相同条件下爆炸致伤进行比较,从整体、器官和组织水平对大鼠腹部闭合性爆炸伤进行观察和伤情分析。结果显示:舱内爆炸时,死亡率21.7%,而舱外为6.7%;舱内爆炸时腹部脏器损伤发生65.0%,而舱外为53.3%;舱内爆炸时肝损伤率36.7%,而舱外为11.7%。舱内组爆炸时腹腔积血发生率20.0%,而舱外为5.0%。腹部脏器损伤病理组织学改变也提示舱内爆炸时腹内脏器受损较严重。
2.在舱内不同距离采用不同剂量的点爆源进行爆炸后分析冲击波物理参数与腹部闭合性爆炸伤严重程度之间的量效关系。结果显示,舱内爆炸冲击波波形复杂,表现为高峰值压力、持续时间长、冲量大、而压力上升时间极短。总体趋势是随起爆药重量的增加、爆心距离缩小,冲击波初始压力峰值、超压峰值升高,比冲量逐渐加大;同时发现大鼠多发伤增加、伤情越来越重,死亡率增高。大鼠半数致死比冲量为73.4KPa·ms;脏器损伤严重程度与比冲量大小呈正比。
3.通过检测舱内腹部爆炸伤大鼠血清及肠道组织氧化应激改变和对大鼠肠道组织细胞凋亡的影响以及血浆DAO、D-Lac水平的动态变化反映肠黏膜损害情况,结果显示:舱内爆炸致大鼠腹部闭合性损伤后氧化应激反应较开阔地爆炸出现早、强度大且持续时间长;舱内腹部闭合性爆炸伤后肠黏膜上皮细胞凋亡发生较早且更严重,Caspase-3表达较开阔地爆炸早且明显上调;肠道细胞凋亡与DAO、D-Lac、IL-6及内毒素正相关。
4.检测大鼠血浆内毒素及IL-6、TNF-α水平,结果表明舱内组的肠源性内毒素血症不仅发生早,而且进展快、持续时间长。舱内爆炸时外周血TNF-α和IL-6水平较高,全身炎症反应较舱外组重,且持续时间长,舱内爆炸时更易发生SIRS。
5.采用普通细菌培养、检测细菌DNA评估爆炸伤后细菌移位,用绿色荧光蛋白标记技术证实细菌移位。结果表明:大鼠腹部爆炸伤后存在肠道细菌移位。细菌培养在舱内3h、舱外8h有细菌生长,总阳性率舱内为35.0%,舱外为15.4%;舱内伤后0.5h、舱外3h外周血检出细菌DNA,总细菌DNA检出率舱内为76.7%,舱外为53.3%。外周血血浆ET、IL-6、DAO、TNF-α水平与细菌移位密切相关。
主要结论:
1.舱内爆炸时,腹部闭合性损伤程度较开阔地爆炸更严重,肝脏损伤率高;
2.复杂冲击波是舱内爆炸伤情严重的主要原因之一;
3.舱内爆炸时氧化应激反应较开阔地爆炸时更严重,血清MDA含量和GSH-Px活性可作为爆炸伤后肠道组织过氧化损伤的诊断指标;
4.舱内爆炸较舱外爆炸时肠黏膜屏障功能受损程度更严重,细菌移位发生早、移位率高;
5.血浆内毒素、IL-6、DAO、TNF-α水平可以间接反映细菌移位情况,对早期诊断细菌移位有一定实用价值。
Battle compartment is major unit for combat in modern war. Antiarmor weapons could punch through the shell of the battle cabin and explode. In peace time, modern terrorism attacks and unexpected emergency event usually occured in the relative closed cabin. So explosion in relative enclosure is one of the key features of explosion events in peace or war time. Explosive blast wave frequently lead to intraabdominal organ damage owing to large surface area of abdominal region and many organs in abdominal cavity. In the battlefield, some wounded soldier suffered intraabdominal organ damage without obvious external injury which could further bring about sepsis, and multiorgan dysfunction syndrome(MODS), even threat to life, but it was not taken seriously dut to stronger concealment after closed injury. It is plausible to hypothesise that the bacteria or endotoxin could come from gut tract in patients with sepsis after trauma because ther is no definite source of infection and the intestinal tract is the largest bacteria and endotoxin bank in human body. After trauma, many factors can damage intestinal barrier function and enhance the permeabililty of gut mucosa, the bacteria from the gut lumen transfer to distant organs through variable pathway, and induce SIRS and MODS. So, it was reported that intestinal tract is regared as the central organ following surgical stress reaction and initiator of MODS, gut barrier dysfunction and bacterial transloction paly a vital role in pathogenesis and developing of MODS.
In present study, we systemically observed and analyzed morphological and histopathological changes of intraabdominal organs in rats with abdominal closed injury subjected to explosion in relative enclosed space, assessed relationship between degree of abdominal explosive closed injury and physical parameters of blast wave, and then focused on investigating intestinal mucosal lesions and gut bacterial/endotoxin transloction.
Main experimental methods and conclusions are as follows:
1. We established a valid rat model of abdominal closed blast injury exploded at 10 centimeter distal to instantaneous electric detonator contained 600mg diazodinitrophenol in enclosed space to oberve and analyze the traumatic characteristics at levels of whole-body, organ and tissue. The results showed that the traumatic condition of abdominal closed explosive injury of rats in enclosed spaces is much severe than that in the free-field. The major damaged organs in enclosed space were liver and colon with higher hematocelia, and which in the open air were colon and stomach. Kidney, bladder and spleen were not detected obviously injury with naked eye. There is no difference in injury types between two groups which were subcapsular haemorrhagia, hematoma formation in parenchymatous viscera and subserosal or submucosal bleeding in hollow viscera. Pathohistological findings revealed that injury severity of abdominal viscera in enclosure was more obvious than that in free-field. The pathohsitological changes were mainly congestion, hemorrhage, focal necrosis, higher inflammatory cell infiltration in sold viscera and submucosal bleeding, tissue edema, lower inflammatory cell infiltration in gas-containing organs.
2. Rats were subjected to explosion at different distance with various dose levels of diazodinitrophenol in cabin model. Physical parameters of blast wave were measured using pressure transducers. Relationship between degree of abdominal explosive closed injury and physical parameters of blast wave was analyzed. The results demonstrated higher peak pressure, shorter duration and larger explosive impulse in relative enclosure. Elevated multiple trauma, more seious condition and higher mortality rate were discovered with increased diazodinitrophenol dose and minified shorter distance. Half lethal dose of specific impulse of rats in cabin was 73.4KPa·ms. There was a significant positive correlation between degree of abdominal explosive closed injury and specific impulse.
3. Malondialdehyde(MDA) content and SOD, GSH-Px activities in serum and intestinal tissue were measured, in addition, apoptosis in gut tissue was detected using TUNEL and plasma D-lactic acid, diamine oxidase levels were assayed. The results indicated that oxidative stress reaction occurred earlier, sustained longer and stronger in rats with abdominal closed explosive injury in enclosed space than that in open space, and serum MDA content, GSH-Px could be one of the diagnostic indicators for oxidative injury of intestinal tissue. Apoptosis and upregulaion of Caspase-3 expression in gut mucosal cell occurred earlier, much severe in rat of compartment than that of open ground. Apoptotic index and positive index of caspase-3 showed a significant positive correlation with the levels of DAO, D-lactic acid, endotoxin, and interleukin-6 which could indirect estimate severity of intestinal mucosa damage and apoptosis. The findings also demonstrated that the degree of intestinal mucosal lesions in rats with abdominal closed blast injury was more severe in enclosed space compared with in free-field. The changes of D-lactic acid and DAO occurred earlier, sustained longer and stronger in rats in enclosed space than that in open space. It was considered that plasma D-lactic acid content could be one of the diagnostic indicators in rats with gut barrier dysfunction.
4. Dynamic changes of plasma endotoxin and IL-6, TNF-αlevels were measured. The results showed that enterogenic endotoxemia occurred ealier, elevated significantly and lasted longer in rats of relative enclosure than that of free-field, which indicated that it was getting easier to develop enterogenic endotoxemia in rats of cabin. Detection of plasma endtoxin could assess intestinal endotoxin transloction. Higher IL-6, TNF-αlevels of plasma were found in abdominal blast injury rats in enclosure, which illustrated that rats in cabin were more severe and could be susceptible to to induce SIRS.
5. Normal bacteria culture, detection of bacterial DNA were performed to evaluate the bacterial traslocation rate. Enhanced green fluorescent protein labeling Escherichia coli DH5αtracking bacterial translocation confirmed that finding. In addition, early diagnostic indicators were screened by receiver operating characteristic curve analysis. It was observed from the findings that bacterial translocation rate was greater in rats of cabin than that of open ground. The sensitivity of PCR method is higher than that of bacteria culture method. The plasma levels of endotoin, IL-6, DAO, TNF-αwere raised if bacteria from gut lumen translocted to circulatory system or distant organs, which could indirect reflect the bacterial transloction and become one of diagnostic or predicting markers of intestinal bacterial transloction after blast injury.
主要研究方法和结果:
1.通过在模拟陆军装甲舱室内爆炸建立致伤大鼠模型,与开阔地相同条件下爆炸致伤进行比较,从整体、器官和组织水平对大鼠腹部闭合性爆炸伤进行观察和伤情分析。结果显示:舱内爆炸时,死亡率21.7%,而舱外为6.7%;舱内爆炸时腹部脏器损伤发生65.0%,而舱外为53.3%;舱内爆炸时肝损伤率36.7%,而舱外为11.7%。舱内组爆炸时腹腔积血发生率20.0%,而舱外为5.0%。腹部脏器损伤病理组织学改变也提示舱内爆炸时腹内脏器受损较严重。
2.在舱内不同距离采用不同剂量的点爆源进行爆炸后分析冲击波物理参数与腹部闭合性爆炸伤严重程度之间的量效关系。结果显示,舱内爆炸冲击波波形复杂,表现为高峰值压力、持续时间长、冲量大、而压力上升时间极短。总体趋势是随起爆药重量的增加、爆心距离缩小,冲击波初始压力峰值、超压峰值升高,比冲量逐渐加大;同时发现大鼠多发伤增加、伤情越来越重,死亡率增高。大鼠半数致死比冲量为73.4KPa·ms;脏器损伤严重程度与比冲量大小呈正比。
3.通过检测舱内腹部爆炸伤大鼠血清及肠道组织氧化应激改变和对大鼠肠道组织细胞凋亡的影响以及血浆DAO、D-Lac水平的动态变化反映肠黏膜损害情况,结果显示:舱内爆炸致大鼠腹部闭合性损伤后氧化应激反应较开阔地爆炸出现早、强度大且持续时间长;舱内腹部闭合性爆炸伤后肠黏膜上皮细胞凋亡发生较早且更严重,Caspase-3表达较开阔地爆炸早且明显上调;肠道细胞凋亡与DAO、D-Lac、IL-6及内毒素正相关。
4.检测大鼠血浆内毒素及IL-6、TNF-α水平,结果表明舱内组的肠源性内毒素血症不仅发生早,而且进展快、持续时间长。舱内爆炸时外周血TNF-α和IL-6水平较高,全身炎症反应较舱外组重,且持续时间长,舱内爆炸时更易发生SIRS。
5.采用普通细菌培养、检测细菌DNA评估爆炸伤后细菌移位,用绿色荧光蛋白标记技术证实细菌移位。结果表明:大鼠腹部爆炸伤后存在肠道细菌移位。细菌培养在舱内3h、舱外8h有细菌生长,总阳性率舱内为35.0%,舱外为15.4%;舱内伤后0.5h、舱外3h外周血检出细菌DNA,总细菌DNA检出率舱内为76.7%,舱外为53.3%。外周血血浆ET、IL-6、DAO、TNF-α水平与细菌移位密切相关。
主要结论:
1.舱内爆炸时,腹部闭合性损伤程度较开阔地爆炸更严重,肝脏损伤率高;
2.复杂冲击波是舱内爆炸伤情严重的主要原因之一;
3.舱内爆炸时氧化应激反应较开阔地爆炸时更严重,血清MDA含量和GSH-Px活性可作为爆炸伤后肠道组织过氧化损伤的诊断指标;
4.舱内爆炸较舱外爆炸时肠黏膜屏障功能受损程度更严重,细菌移位发生早、移位率高;
5.血浆内毒素、IL-6、DAO、TNF-α水平可以间接反映细菌移位情况,对早期诊断细菌移位有一定实用价值。
Battle compartment is major unit for combat in modern war. Antiarmor weapons could punch through the shell of the battle cabin and explode. In peace time, modern terrorism attacks and unexpected emergency event usually occured in the relative closed cabin. So explosion in relative enclosure is one of the key features of explosion events in peace or war time. Explosive blast wave frequently lead to intraabdominal organ damage owing to large surface area of abdominal region and many organs in abdominal cavity. In the battlefield, some wounded soldier suffered intraabdominal organ damage without obvious external injury which could further bring about sepsis, and multiorgan dysfunction syndrome(MODS), even threat to life, but it was not taken seriously dut to stronger concealment after closed injury. It is plausible to hypothesise that the bacteria or endotoxin could come from gut tract in patients with sepsis after trauma because ther is no definite source of infection and the intestinal tract is the largest bacteria and endotoxin bank in human body. After trauma, many factors can damage intestinal barrier function and enhance the permeabililty of gut mucosa, the bacteria from the gut lumen transfer to distant organs through variable pathway, and induce SIRS and MODS. So, it was reported that intestinal tract is regared as the central organ following surgical stress reaction and initiator of MODS, gut barrier dysfunction and bacterial transloction paly a vital role in pathogenesis and developing of MODS.
In present study, we systemically observed and analyzed morphological and histopathological changes of intraabdominal organs in rats with abdominal closed injury subjected to explosion in relative enclosed space, assessed relationship between degree of abdominal explosive closed injury and physical parameters of blast wave, and then focused on investigating intestinal mucosal lesions and gut bacterial/endotoxin transloction.
Main experimental methods and conclusions are as follows:
1. We established a valid rat model of abdominal closed blast injury exploded at 10 centimeter distal to instantaneous electric detonator contained 600mg diazodinitrophenol in enclosed space to oberve and analyze the traumatic characteristics at levels of whole-body, organ and tissue. The results showed that the traumatic condition of abdominal closed explosive injury of rats in enclosed spaces is much severe than that in the free-field. The major damaged organs in enclosed space were liver and colon with higher hematocelia, and which in the open air were colon and stomach. Kidney, bladder and spleen were not detected obviously injury with naked eye. There is no difference in injury types between two groups which were subcapsular haemorrhagia, hematoma formation in parenchymatous viscera and subserosal or submucosal bleeding in hollow viscera. Pathohistological findings revealed that injury severity of abdominal viscera in enclosure was more obvious than that in free-field. The pathohsitological changes were mainly congestion, hemorrhage, focal necrosis, higher inflammatory cell infiltration in sold viscera and submucosal bleeding, tissue edema, lower inflammatory cell infiltration in gas-containing organs.
2. Rats were subjected to explosion at different distance with various dose levels of diazodinitrophenol in cabin model. Physical parameters of blast wave were measured using pressure transducers. Relationship between degree of abdominal explosive closed injury and physical parameters of blast wave was analyzed. The results demonstrated higher peak pressure, shorter duration and larger explosive impulse in relative enclosure. Elevated multiple trauma, more seious condition and higher mortality rate were discovered with increased diazodinitrophenol dose and minified shorter distance. Half lethal dose of specific impulse of rats in cabin was 73.4KPa·ms. There was a significant positive correlation between degree of abdominal explosive closed injury and specific impulse.
3. Malondialdehyde(MDA) content and SOD, GSH-Px activities in serum and intestinal tissue were measured, in addition, apoptosis in gut tissue was detected using TUNEL and plasma D-lactic acid, diamine oxidase levels were assayed. The results indicated that oxidative stress reaction occurred earlier, sustained longer and stronger in rats with abdominal closed explosive injury in enclosed space than that in open space, and serum MDA content, GSH-Px could be one of the diagnostic indicators for oxidative injury of intestinal tissue. Apoptosis and upregulaion of Caspase-3 expression in gut mucosal cell occurred earlier, much severe in rat of compartment than that of open ground. Apoptotic index and positive index of caspase-3 showed a significant positive correlation with the levels of DAO, D-lactic acid, endotoxin, and interleukin-6 which could indirect estimate severity of intestinal mucosa damage and apoptosis. The findings also demonstrated that the degree of intestinal mucosal lesions in rats with abdominal closed blast injury was more severe in enclosed space compared with in free-field. The changes of D-lactic acid and DAO occurred earlier, sustained longer and stronger in rats in enclosed space than that in open space. It was considered that plasma D-lactic acid content could be one of the diagnostic indicators in rats with gut barrier dysfunction.
4. Dynamic changes of plasma endotoxin and IL-6, TNF-αlevels were measured. The results showed that enterogenic endotoxemia occurred ealier, elevated significantly and lasted longer in rats of relative enclosure than that of free-field, which indicated that it was getting easier to develop enterogenic endotoxemia in rats of cabin. Detection of plasma endtoxin could assess intestinal endotoxin transloction. Higher IL-6, TNF-αlevels of plasma were found in abdominal blast injury rats in enclosure, which illustrated that rats in cabin were more severe and could be susceptible to to induce SIRS.
5. Normal bacteria culture, detection of bacterial DNA were performed to evaluate the bacterial traslocation rate. Enhanced green fluorescent protein labeling Escherichia coli DH5αtracking bacterial translocation confirmed that finding. In addition, early diagnostic indicators were screened by receiver operating characteristic curve analysis. It was observed from the findings that bacterial translocation rate was greater in rats of cabin than that of open ground. The sensitivity of PCR method is higher than that of bacteria culture method. The plasma levels of endotoin, IL-6, DAO, TNF-αwere raised if bacteria from gut lumen translocted to circulatory system or distant organs, which could indirect reflect the bacterial transloction and become one of diagnostic or predicting markers of intestinal bacterial transloction after blast injury.
引文
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