【摘要】：目的探討小劑量紅霉素對(duì)氣管損傷后氣管狹窄的抑制作用及可能機(jī)制,探討其用于防治氣管損傷后狹窄的可能。方法42只家兔按隨機(jī)數(shù)字表法分成7個(gè)組,每組家兔各6只,即:NS組為對(duì)照組,PG組為青霉素組,EM組為紅霉素組,EM+PG組為紅霉素+青霉素組,BS組為布地奈德組,EM+BS組為紅霉素+布地奈德組,EM+PG+BS組為紅霉素+青霉素+布地奈德組。各組家兔行氣管切開(kāi)均予以尼龍毛刷(直徑約5mm)反復(fù)刷20次,建立家兔氣管狹窄模型。氣管切開(kāi)術(shù)前1周至術(shù)后第9天,各組家兔均分別給予上述相應(yīng)藥物處理。術(shù)后第10天收集家兔血液標(biāo)本、肺泡灌洗液(BALF)標(biāo)本,酶聯(lián)免疫吸附(ELISA)法檢測(cè)各組家兔血清及BALF液中白細(xì)胞介素(IL)-6、IL-8、轉(zhuǎn)化生長(zhǎng)因子β1(TGF-β1)、血管內(nèi)皮生長(zhǎng)因子(VEGF)的濃度,并且取狹窄段氣管測(cè)量氣管狹窄度。結(jié)果給予小劑量紅霉素的各實(shí)驗(yàn)組(EM、EM+PG、EM+BS、EM+PG+BS組)血清以及BALF中TGF-β1、VEGF、IL-6、IL-8濃度均顯著低于未給予小劑量紅霉素組(NS、PG、BS組)(均P0.05);EM+PG+BS組濃度均顯著低于其他各組(均P0.05);NS、PG、BS組間兩兩比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(均P0.05);EM、EM+PG、EM+BS組間兩兩比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(均P0.05)。42只家兔氣管內(nèi)均有不同程度的肉芽組織增生致氣管狹窄。NS、PG、EM、EM+PG、BS、EM+BS、EM+PG+BS組氣管狹窄度分別為(53.3±4.4)%、(48.2±5.0)%、(24.3±4.4)%、(29.5±3.2)%、(47.8±6.5)%、(27.9±3.1)%、(15.6±2.0)%,EM、EM+PG、EM+BS、EM+PG+BS組狹窄度均顯著輕于NS、PG、BS組,差異均有統(tǒng)計(jì)學(xué)意義,(均P0.05);EM+PG+BS組狹窄度均顯著輕于其他各組,差異均有統(tǒng)計(jì)學(xué)意義,(均P0.05)。結(jié)論小劑量紅霉素能有效抑制氣管損傷后肉芽組織的過(guò)度增生,可減輕氣管損傷后氣管狹窄的程度以及氣管狹窄治療后的再狹窄率,與其他抗菌素及糖皮質(zhì)激素聯(lián)合用藥時(shí)效果更佳,這可能在良性增生性氣管狹窄的防治方面具有潛在的臨床價(jià)值。
[Abstract]:Objective to investigate the inhibitory effect and possible mechanism of low dose erythromycin on tracheal stenosis after tracheal injury. Methods 42 rabbits were randomly divided into 7 groups with 6 rabbits in each group. That is: NS group as control group, PG group as penicillin group, EM group as erythromycin group, EM PG group as erythromycin penicillin group, BS group as budesonide group, EM BS group as erythromycin budesonide group, EM PG BS group as erythromycin penicillin budesonide group. The rabbit model of trachea stenosis was established after tracheotomy with nylon brush (diameter about 5mm) for 20 times. From 1 week before tracheotomy to 9 days after tracheotomy, the rabbits in each group were treated with the above drugs. Blood samples were collected on the 10th day after operation, and (BALF) samples from alveolar lavage fluid were collected. The concentrations of interleukin-6 (IL-8), transforming growth factor 尾 1 (TGF- 尾 1) and vascular endothelial growth factor (VEGF) (VEGF) in serum and BALF fluid of rabbits were detected by enzyme linked immunosorbent assay (ELISA). The trachea was taken to measure the degree of trachea stenosis. Results the concentrations of IL-8 in serum and BALF of each experimental group (EM,EM PG,EM BS,EM PG BS group) treated with low dose erythromycin were significantly lower than those of NS,PG,BS group (P 0.05) and NS,PG,BS group (P 0.05). There was no significant difference between the two groups (P0.05), and there was no significant difference between the two groups in EM,EM PG,EM BS (P0.05). In 42 rabbits, there were different degrees of granulomatous tissue proliferation resulting in tracheal stenosis. The tracheal stenosis was caused by granulation tissue proliferation in 42 rabbits. The degree of stenosis in EM,EM PG,EM BS,EM PG BS group was (53.3 鹵4.4)%, (48.2 鹵5.0)%, (24.3 鹵4.4)%, (29.5 鹵3.2)%, (47.8 鹵6.5)%, (27.9 鹵3.1)%, (15.6 鹵2.0)%, respectively. The difference was statistically significant (P0.05) in); EM PG BS group, the degree of stenosis was significantly lighter than that in other groups, and the difference was statistically significant (P0.05). Conclusion low dose erythromycin can effectively inhibit the excessive proliferation of granulation tissue after tracheal injury, reduce the degree of tracheal stenosis after tracheal injury and the rate of restenosis after tracheal stenosis treatment. Combination with other antibiotics and glucocorticoids may have potential clinical value in the prevention and treatment of benign proliferative tracheal stenosis.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R562.1

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