本文選題：梗阻性黃疸 + 膽汁引流��； 參考：《中國人民解放軍醫(yī)學(xué)院》2014年碩士論文

【摘要】：【研究目的】1、觀察梗阻性黃疸（梗黃）形成與解除大鼠腸黏膜組織形態(tài)、血漿二胺氧化酶（Diamine Oxidase,DAO）的活性變化，探討二者之間的關(guān)系，為臨床建立敏感無創(chuàng)的檢測方法來判斷腸黏膜屏障功能的損傷和修復(fù)狀況提供實驗及理論依據(jù)；2、觀察大鼠防御素-5（Rat Defensin-5,RD-5）mRNA的變化，探討膽汁內(nèi)引流術(shù)優(yōu)于外引流術(shù)的機(jī)制，為臨床治療方式的選擇提供實驗依據(jù)。 【材料與方法】將60只成年雄性SD大鼠隨機(jī)分為四組：梗阻性黃疸組(obstructive jaundice,OJ)、膽汁外引流組(external drainage,ED)、膽汁內(nèi)引流組(internal drainage,ID)及假手術(shù)對照組(shame operation,SH)，各組均15只。建立動物模型：第一次手術(shù)建立SH模型（只分離膽管不結(jié)扎）和OJ模型（分離膽管并結(jié)扎、切斷），，OJ術(shù)后7天行二次手術(shù)，建立ED模型（膽管插管經(jīng)皮引流至體外）和ID模型（膽管與十二指腸間建立引流）。造模成功后，處死大鼠并采集標(biāo)本，下腔靜脈取血ELASA方法檢測各組大鼠血漿DAO的活性;取末段回腸病理切片、HE染色,光鏡下觀察末端回腸組織黏膜形態(tài)學(xué)變化；取末段回腸RT-PCR方法檢測RD-5mRNA的表達(dá)水平。 【結(jié)果】1.膽管梗阻形成后，OJ組大鼠腸黏膜損傷明顯，黏膜變薄、絨毛稀疏、上皮完整性受到破壞并伴有炎性細(xì)胞浸潤，Chiu氏評分為2.158±0.579，ID、ED組大鼠腸黏膜有不同程度的恢復(fù)（Chiu氏評分分別為0.633±0.144，1.329±0.289），ID組更接近SH組（0.315±0.080），四組間兩兩比較P值均0.01；OJ組血漿DAO水平顯著升高，明顯高于SH、ID、ED組（8.183±0.211vs3.570±0.280、3.978±0.269、5.051±0.328U/L，P0.01），引流術(shù)后DAO水平下降，ID組較ED組下降更明顯，二者差異有統(tǒng)計學(xué)意義（P0.01），ID組血漿DAO水平略高于SH組，二者差異無統(tǒng)計學(xué)意義（P0.05）；各大鼠血漿DAO水平與腸粘膜損傷評分的相關(guān)系數(shù)r=0.89(P0.01)，大鼠血漿DAO變化與腸黏膜組織病理學(xué)變化一致，呈正相關(guān)。2.OJ組回腸RD-5mRNA的表達(dá)水平顯著降低，明顯低于SH、ID、ED組(0.0708±0.0061vs0.1895±0.0124、0.1903±0.0143、0.1601±0.0078，P0.01），引流術(shù)后RD-5mRNA的表達(dá)水平升高，ID組較ED組升高更明顯，二者差異有統(tǒng)計學(xué)意義（P0.01），ID組RD-5mRNA表達(dá)水平略高于SH組，二者差異無統(tǒng)計學(xué)意義（P0.05）。 【結(jié)論】梗黃后，機(jī)體高膽紅素血癥及腸道膽汁缺乏致腸黏膜上皮受損，血漿DAO活性升高，膽汁內(nèi)外引流術(shù)可修復(fù)腸黏膜屏障，逆轉(zhuǎn)血漿DAO水平，RD-5mRNA表達(dá)水平增高，且以內(nèi)引流效果更佳。血漿DAO水平變化與腸黏膜形態(tài)學(xué)改變具有一致性，可反映梗黃大鼠腸黏膜屏障損傷及修復(fù)情況；膽汁內(nèi)引流優(yōu)于外引流的機(jī)制之一可能在于腸源性防御素表達(dá)水平更高，抗菌作用更強(qiáng)、更能促進(jìn)腸道黏膜免疫的恢復(fù)。
[Abstract]:[Objective] 1 to observe the formation of obstructive jaundice (stem yellow) and the changes in the tissue morphology of intestinal mucosa and the changes of the activity of plasma two amine oxidase (Diamine Oxidase, DAO) in rats, and explore the relationship between the two, and provide an experimental and theoretical basis for the establishment of a sensitive and noninvasive detection method to judge the damage and repair of the intestinal mucous membrane barrier function. 2, 2, observe the changes of Rat Defensin-5 (RD-5) mRNA of rat, and explore the mechanism of biliary drainage better than external drainage, and provide experimental basis for the choice of clinical treatment.
[materials and methods] 60 adult male SD rats were randomly divided into four groups: the obstructive jaundice group (obstructive jaundice, OJ), the external biliary drainage group (external drainage, ED), the bile drainage group (internal drainage, ID) and the sham operation control group (shame operation,), all of the groups were 15. Type (isolated bile duct without ligation) and OJ model (separating bile duct and ligating and cutting off), two operations were performed 7 days after OJ. The ED model (bile duct intubation percutaneous drainage to external drainage) and ID model (drainage between bile duct and duodenum) were established. After the success of the model, the rats were killed and the specimens were collected, and the blood plasma DAO of the inferior vena cava was taken ELASA method to detect the plasma DAO in each group. The pathological sections of the last ileum, HE staining, and light microscopy were used to observe the morphological changes of the mucosa of the distal ileum tissue, and the expression level of RD-5mRNA was detected by the distal ileum RT-PCR method.
[results] after the formation of 1. bile duct obstruction, the intestinal mucosa of OJ rats was significantly damaged, the mucosa thinned, the villus was sparse, the epithelial integrity was damaged and inflammatory cell infiltration, the Chiu score was 2.158 + 0.579, ID, the intestinal mucosa of the group ED rats had different degrees of recovery (Chiu's score was 0.633 + 0.144,1.329 + 0.289 respectively), and the ID group was closer to the SH group (0.3 15 + 0.080), 22 of the four groups, the P value was 0.01, and the level of plasma DAO in group OJ was significantly higher than that in SH, ID, ED group (8.183 + 0.211vs3.570 + 0.280,3.978 + 0.269,5.051 + 0.328U/L, P0.01). The decrease of DAO level after drainage was more obvious than that in the group of two. The level of two groups was slightly higher than that of the group, two There was no statistical significance (P0.05). The correlation coefficient of plasma DAO level and intestinal mucosal injury score of rats was r=0.89 (P0.01), and the changes of DAO in plasma of rats were in accordance with the pathological changes of intestinal mucosa, and the expression level of the ileum RD-5mRNA in the positive correlation group was significantly lower than that of the SH, ID, ED group (0.0708 + 0.0061vs0.1895 + 0.0124,0.1903). 0.0143,0.1601 + 0.0078, P0.01), the expression level of RD-5mRNA increased after drainage, and the increase in ID group was more obvious than that in ED group. The difference between the two groups was statistically significant (P0.01), and the level of RD-5mRNA in the ID group was slightly higher than that in the SH group, and the difference between the two groups was not statistically significant (P0.05).
[Conclusion] the intestinal mucosal epithelium was damaged by hyperbilirubinemia and intestinal bile deficiency, the activity of plasma DAO increased, the internal and external drainage of bile can repair the intestinal mucosal barrier, reverse the plasma DAO level, increase the level of RD-5mRNA expression, and the effect of internal drainage is better. The change of plasma DAO level is consistent with the morphological changes of intestinal mucosa. It can reflect the damage and repair of intestinal mucosal barrier in the stem yellow rats. One of the mechanisms of bile drainage is better than the external drainage mechanism, which may lie in the higher expression level of enteric defensin, stronger antibacterial effect, and can promote the recovery of intestinal mucosal immunity.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 郎宇璜;李文綱;周超;;不同程度創(chuàng)傷性腦損傷后腸黏膜屏障功能的變化[J];創(chuàng)傷外科雜志;2011年06期

2 王思珍;王新波;;梗阻性黃疸對腸粘膜屏障破環(huán)的研究進(jìn)展[J];肝膽外科雜志;2011年04期

本文編號：2073374