本文選題：膿毒癥　切入點(diǎn)：強(qiáng)化血糖控制　出處：《石河子大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：觀察胰島素不同目標(biāo)血糖下對(duì)膿毒癥大鼠肺血管內(nèi)皮細(xì)胞損傷的影響，探討胰島素目標(biāo)血糖管理對(duì)膿毒癥肺血管內(nèi)皮細(xì)胞損傷的保護(hù)作用及其可能機(jī)制。 方法：隨機(jī)將40只SD雄性大鼠分為5組(每組8只)，通過盲腸結(jié)扎穿孔術(shù)(CLP)法建立大鼠膿毒癥模型，按分組進(jìn)行不同處理：假手術(shù)組（sham組）僅做開關(guān)腹處理，靜脈泵入和其它各組等容量的的生理鹽水；CLP組行盲腸結(jié)扎穿孔術(shù)（cecal ligation and puncture,CLP），靜脈泵入和各血糖控制組等容量的生理鹽水；各血糖控制組行CLP術(shù)，并靜脈泵注胰島素生理鹽水溶液，其中A組目標(biāo)血糖控制在4.4～6.1mmol/L，B組控制在6.2～8.3mmol/L，C組控制在8.4～10.0mmol/L。于造模前后不同時(shí)間點(diǎn)運(yùn)用快速血糖儀檢測(cè)大鼠的血糖水平(BG)，間隔時(shí)間1h，，CLP術(shù)后12h處死大鼠。采用雙抗夾心ELISA法檢測(cè)血清TNF-α、ESM-1的表達(dá)水平；光鏡下觀察肺組織形態(tài)學(xué)變化并行組織病理?yè)p傷評(píng)分分析；采用免疫組織化學(xué)技術(shù)檢測(cè)肺組織中ESM-1的表達(dá)水平。 結(jié)果：CLP組血清TNF-α、ESM-1表達(dá)水平明顯高于sham組及A、B、C組，差異有統(tǒng)計(jì)學(xué)差異（P均0.05），A、B、C三組含量均高于sham組（P0.05）；A組TNF-α、ESM-1表達(dá)水平較B組和C組明顯降低（P均0.05），B組顯著低于C組（P0.05）。CLP組及A、B、C組肺組織損傷病理評(píng)分均顯著高于sham組（P均0.05），而CLP組肺組織病理評(píng)分較A、B、C組三組顯著增高（P均0.05），其中A組明顯小于B組，B組明顯小于C組（P均0.05）；sham組肺組織中ESM-1表達(dá)水平顯著低于CLP組及A、B、C組（P0.05），其中CLP組高表達(dá)例數(shù)最高，C、B、A組依次降低，ESM-1在CLP組的表達(dá)情況與A組比較有顯著性差異（P0.05），而與B、C三組之間比較無(wú)顯著性差異（P0.05）。各組大鼠血清ESM-1水平與血清TNF-1水平、肺組織損傷程度呈顯著正相關(guān)（P0.01），血清ESM-1表達(dá)水平與TNF-α、肺組織損傷程度相關(guān)系數(shù)分別為0.78、0.79；肺組織ESM-1表達(dá)水平與TNF-1、肺組織損傷程度相關(guān)系數(shù)分別為0.48、0.73；同時(shí)血清TNF-α水平與肺組織損傷程度也呈顯著正相關(guān)，r=0.76（P0.01）。 結(jié)論： 1．膿毒癥時(shí)存在肺血管內(nèi)皮損傷，外周血TNF-α、ESM-1及肺組織ESM-1表達(dá)水平升高；隨著肺血管內(nèi)皮損傷程度加重，外周血ESM-1及肺組織ESM-1表達(dá)水平增強(qiáng)； 2．經(jīng)過目標(biāo)血糖控制膿毒癥大鼠肺血管內(nèi)皮細(xì)胞損傷、外周血TNF-α、ESM-1及肺組織ESM-1表達(dá)水平顯著降低，可能目標(biāo)血糖控制對(duì)TNF-α、ESM-1表達(dá)水平有一定的抑制作用，在一定程度對(duì)炎癥的進(jìn)展有削弱作用； 3.與6.2～8.3mmol/L及8.4～10.0mmol/L相比，血糖控制在4.4～6.1mmol/L對(duì)膿毒癥大鼠肺血管內(nèi)皮細(xì)胞損傷的保護(hù)作用最為明顯。
[Abstract]:Aim: to observe the effects of insulin on pulmonary vascular endothelial cell injury in septic rats and to explore the protective effect of insulin target blood glucose management on pulmonary vascular endothelial cell injury in septic rats and its possible mechanism. Methods: forty Sprague-Dawley male rats were randomly divided into 5 groups (8 rats in each group). Sepsis model was established by cecal ligation and perforation in rats. The caecal ligation and puncture group was given cecal ligation and puncture group, and each blood glucose control group received CLP operation, and insulin saline solution was injected intravenously into each blood glucose control group, while the same volume of normal saline was injected into each blood glucose control group, and the same volume of saline was injected into the blood glucose control group, and the same volume of normal saline was injected into the blood glucose control group, and the blood glucose control group was injected with insulin saline solution. The target blood glucose of group A was controlled at 4.4 鹵6.1 mmol 路L ~ (-1) mmol 路L ~ (-1) 路L ~ (-1) 路L ~ (-1) mg 路L ~ (-1) 路L ~ (-1) mg 路L ~ (-1) 路L ~ (-1) mg 路L ~ (-1) 路L ~ (-1) mg 路L ~ (-1) 路L ~ (-1) 路L ~ (-1) 路L ~ (-1) 路L ~ (-1) 路L ~ (-1) 路L ~ (-1) 路L ~ (-1) 路L ~ (-1) mg 路L ~ (-1)? The expression of TNF- 偽 ESM-1 in serum was detected. The morphological changes of lung tissue were observed under light microscope, and the expression of ESM-1 in lung tissue was detected by immunohistochemical technique. Results the expression of TNF- 偽 -ESM-1 in the serum of the patients with sham was significantly higher than that of the patients with sham and ANF- 偽 ESM-1. The expression of TNF- 偽 ESM-1 in sham group was significantly lower than that in group B and C group (P < 0.05). The pathological score of lung tissue injury in group A was significantly higher than that in group sham (P < 0.05), but it was significantly lower in group A than that in group B and group C (P < 0.01), but the expression of TNF- 偽 ESM-1 in group A was significantly lower than that in group B and C (P < 0.05). The pathological scores of lung tissue in group A were significantly higher than those in group B and C (P < 0.01). The histopathological score of lung tissue in CLP group was significantly higher than that in group A and B group (P < 0.05). The expression of ESM-1 in lung tissue of group A was significantly lower than that of group B and group C (P < 0.05), and the expression of ESM-1 in group A was significantly lower than that in group A and group C (P 0.05), and the expression of ESM-1 in group A was significantly lower than that in group A and group B (P < 0.05). The expression of ESM-1 in group A was significantly lower than that in group B and group C (P 0.05). The expression of ESM-1 in CLP group was significantly lower than that in group A (P 0.05), but there was no significant difference between group A and group C (P 0.05). The levels of serum ESM-1 and TNF-1 in each group were significantly lower than those in group A. There was a significant positive correlation between the degree of lung injury and the expression of serum ESM-1 and TNF- 偽, and the correlation coefficient between the expression of ESM-1 and the degree of lung injury was 0.788 ~ 0.79, the correlation coefficient between the expression of ESM-1 and TNF-1, the degree of lung injury was 0.48 ~ 0.73, and the level of serum TNF- 偽 was 0.48 ~ 0.73, respectively. There was also a significant positive correlation with the degree of lung injury. Conclusion:. 1. The expression of TNF- 偽 ESM-1 in peripheral blood and ESM-1 in lung tissue increased with the severity of pulmonary vascular endothelial injury, and the expression level of ESM-1 in peripheral blood and lung tissue increased with the severity of pulmonary vascular endothelial injury, and the expression of TNF- 偽 ESM-1 in peripheral blood and lung tissue increased with the severity of pulmonary vascular endothelial injury. 2. The expression of TNF- 偽 ESM-1 in peripheral blood and ESM-1 in lung tissue of septic rats were significantly decreased after target blood glucose control, which may have some inhibitory effect on the expression of TNF- 偽 -ESM-1 in pulmonary vascular endothelial cells of septic rats. To some extent, it weakens the progress of inflammation; 3.Compared with 8.2 mmol / L and 8.4 鹵10.0 mmol / L, the protective effect of blood glucose at 4.4 鹵6.1 mmol / L on pulmonary vascular endothelial cell injury was most obvious in septic rats.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R459.7

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相關(guān)期刊論文 前1條

1 張亮;陳林;黃顯凱;;多發(fā)傷患者血ESM-1的動(dòng)態(tài)變化與膿毒癥的關(guān)系[J];重慶醫(yī)學(xué);2007年22期

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