本文關鍵詞：AP時腸黏膜通透性的變化及其機制　出處：《山西醫(yī)科大學》2006年碩士論文　論文類型：學位論文

  更多相關文章： 急性胰腺炎 腸源性內毒素血癥 腸黏膜通透性 細菌移位

【摘要】： 目的:在壞死型胰腺炎基礎上的繼發(fā)感染是AP最主要的死因,這與細菌移位密切相關。ANP時伴有IETM已形成共識。細菌移位與IETM的形成均與腸黏膜通透性增強密切相關。因此,觀察AP時腸黏膜通透性的改變及其機制就顯得十分重要。 材料與方法:健康雌性大鼠體重210g-230g共50只,隨機分為3組。假手術組(sham operation SO):僅開腹輕翻胰腺,不施加處理因素;急性壞死性胰腺炎模型組(acute necrosis pancreatitis ANP):依據經典的手術模型制備;禁食組(fasting diet FD):胃腸外營養(yǎng),禁食72h。于72h處死動物,留取血漿、血清與組織標本待測。偶氮基質法測定血漿內毒素(ET)含量,判定腸源性內毒素血癥情況;放射免疫法測定血清中TNF-α與IL-4,判定機體免疫功能;采用分光光度法測定血漿與腸組織勻漿中的二胺氧化酶DAO,觀察腸組織的損傷情況;碘-淀粉比色法測定血清淀粉酶AMY,判定胰腺炎的嚴重程度;尾靜脈注射Evans藍檢測腸黏膜與血管通透性的變化;采用硫代戊巴比妥鈉法測定血清中丙二醛MDA ;采用熒光光度法檢測血漿與腸組織勻漿中的組胺含量;腸組織甲苯胺藍染色觀察腸組織肥大細胞;HE染色顯示腸與胰腺組織形態(tài)學改變;缺口原位末端標記法判定腸上皮細胞與胰腺腺泡細胞凋亡情況。 結果:各組之間ET、DAO、TNF-α、IL-4及組胺水平均有顯著性差異,其中ANP組各指標水平最高,FD組次之; SO及FD組與ANP組的血清AMY水平有顯著性差異;血漿中ET含量與血漿及腸黏膜組胺、血漿DAO、MDA含量有相關性,血漿及腸黏膜組胺與TNF-α、IL-4含量有相關性。甲苯胺藍染色顯示ANP組肥大細胞處于激活狀態(tài)的數目較多,FD組次之。HE染色與原位細胞凋亡檢測結果相一致,以ANP組腸黏膜與胰腺組織損傷最嚴重、凋亡細胞最多,FD組次之。 結論:禁食與ANP時均使腸黏膜與血管通透性增強,腸上皮細胞出現凋亡,腸黏膜受損,導致IETM形成。IETM又通過直接或間接的作用來加重腸黏膜的損害,而后者的損傷加重又促使IETM的形成,形成一個惡性循環(huán),這也是AP死亡率居高不下的主要原因。
[Abstract]:Objective: Based on secondary necrotizing pancreatitis on AP infection is the leading cause of death, and this is closely related to bacterial translocation of.ANP with IETM has formed a consensus. The formation of bacterial translocation and IETM were closely related with the intestinal mucosal permeability increased. Therefore, to observe the AP changes and mechanism of intestinal mucosal permeability is very important.
Materials and methods: weight 210g-230g healthy female rats 50 rats were randomly divided into 3 groups. Sham operation group (sham operation SO): laparotomy only flip the pancreas, without any treatment; acute necrotizing pancreatitis model group (acute necrosis pancreatitis ANP): the basis of the classic model of surgical preparation; the fasting group (fasting diet FD): parenteral nutrition, fasting 72h. 72h were collected in animal plasma, serum and tissue samples were taken for determination of plasma endotoxin azo matrix method (ET) to determine the content of intestinal endotoxemia; Determination of TNF- alpha and IL-4 in serum by radioimmunoassay, determination of immune function was determined by; two monoamine oxidase DAO in plasma and intestinal homogenate in spectrophotometry, to observe the injury of intestinal tissue; iodine starch colorimetric determination of serum amylase AMY, determining the severity of pancreatitis; tail vein injection of Evans detection of intestinal mucosal and vascular blue The change of permeability; Determination of malondialdehyde MDA in serum by pentobarbital sodium thiosulfate method; histamine content in plasma and intestinal tissue were detected by fluorescence spectrophotometry; observation of intestinal tissue mast cells in intestinal tissue toluidine blue staining; HE staining showed that the morphology of intestinal and pancreatic tissue changes; gap TUNEL determination of intestinal epithelial cells and apoptosis of pancreatic acinar cells.
Results: between the groups ET, DAO, TNF- alpha, IL-4 and histamine levels were significantly different in ANP group, the highest level of each index, SO and FD group; FD group and ANP group, the serum AMY levels were significantly different; the content of ET in serum and plasma and intestinal mucosal histamine, plasma DAO, correlation the content of MDA in plasma and intestinal mucosal histamine and TNF- alpha, there is a correlation between the content of IL-4. Toluidine blue staining of mast cells in ANP group is active number, followed by the FD.HE staining and in situ apoptosis detection results consistent with ANP group intestinal and pancreatic tissue injury is the most serious, most of apoptotic cells in FD group..
Conclusion: fasting and ANP were intestinal mucosal and vascular permeability, intestinal epithelial cell apoptosis, intestinal mucosal damage, leading to IETM formation of.IETM through direct or indirect role to aggravate the damage of intestinal mucosa, and damage aggravated form but also to promote the IETM, forming a vicious spiral, which is the main reason of AP the high mortality rate.

【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2006
【分類號】：R363

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