Objective To investigate the effects of internal and external biliary drainages on tumor necrosis factor-a (TNF-a) and neutrophilic elastase ( NE) levels of lung in rats with obstructive jaundice. Methods Sixty-four male a-dult Sprague-Dawley rats were randomly divided into four groups: obstructive jaundice ( OJ) , internal biliary drainage (ID) , external drainage (ED) and sham operation (SH). Rat models were established by twice operations. On the 14th day after the second operation, the rats were succumbed and the homogenate specimens of lung were taken and diluted into 10%. The concentration of TNF-a in lung homogenate was measured by enzyme linked immuno sorbent assay (ELISA) and NE level was detected by biochemistry test. Results Rats models were successfully established. After bile duct ligation in rats, the levels of TNF-a and NE in lung were higher in rats with OJ than those in SH rats (100.893 pg/mL±21.271 pg/mL vs 64.091 pg/mL± 13.034 pg/mL,P <0. 01 ;50. 396 μg/mL ± 17. 388 μg/mL vs 39.718 μg/mL ±9.625 μg/mL, P<0.05). After relief of obstructive jaundice by internal drainage, the level of TNF-α decreased (75.141 pg/mL ± 15. 849 pg/mL, P <0. 01) ; while the TNF-α of ED group still remained higher compared with OJ group (112. 129 pg/mL ± 36. 886 pg/mL, P > 0. 05). The level of NE decreased in both ID and ED groups (39. 390 αg/mL±12.410 αg/mL, 44.790 αg/mL± 16.681 αg/mL). There was significant difference between ID gvoup and OJ group (P < 0. 05). However, the difference between OJ and ED group was not significant (P > 0.05). Moreover, after internal drainage, the NE level almost reversed to the normal condition and there was no difference compared with SH group ( P > 0.05 ). Conclusion After common bile duct ligation, the level of inflammatory cy tokines in lung was significantly elevated in obstructive jaundice. Internal biliary drainage could obviously improve the lung inflammatory cytokines in rats with obstructive jaundice, whereas external biliary drainage had less effect and even deteriorated it. Internal biliary drainage could be more efficient than external biliary drainage in relief lung injury induced by obstructive jaundice.%目的 研究胆汁内外引流方法对梗阻性黄疸大鼠肺肿瘤坏死因子α(TNF-α)、中性粒细胞弹性蛋白酶(NE)水平的影响.方法 将64只成年SD雄性大鼠随机分为4组,分别建立梗阻性黄疽(OJ)、胆汁内引流术(ID)、胆汁外引流术(ED)及假手术(SH)4组模型.于2次术后第14天留取肺组织匀浆液标本.采用双抗体夹心酶联免疫吸附法(ELISA)检测10％肺匀浆液TNF-α水平,生化法检测10％肺匀浆液NE水平.结果 成功建立了大鼠梗阻性黄疸及内外引流术模型.梗阻性黄疸时大鼠肺TNF-α、NE水平较假手术对照组明显升高(100.893 pg/mL±21.271 pg/mL vs 64.091 pg/mL±13.034 pg/mL,P ＜0.01；50.396 μg/mL±17.388μg/mL vs 39.718μg/mL±9.625 μg/mL,P＜0.05).通过胆汁内引流术解除黄疸后,大鼠肺TNF-α浓度(75.141 pg/mL±15.849 pg/mL)与梗阻性黄疸组相比下降明显(P＜0.01)；而通过胆汁外引流术解除黄疸后,大鼠肺TNF-α浓度仍较高(112.129 pg/mL±36.886 pg/mL),与梗阻性黄疸组相比无差异(P＞0.05).行胆汁内、外引流术后,大鼠肺NE水平均降低(39.390 μg/mL±12.410μg/mL、44.790 μg/mL±16.681μg/mL),但与梗阻性黄疸组相比内引流明显(P＜0.05)、外引流无差异(P＞0.05),且内引流恢复至正常水平,与假手术对照组相比无差异(P＞0.05).结论 梗阻性黄疸可导致肺组织炎症细胞因子升高,胆汁内引流术可明显改善梗阻性黄疸时肺组织炎症细胞因子水平、甚至接近正常,而胆汁外引流术没有改善肺炎症细胞因子水平,提示术前利用胆汁内引流术解除梗阻性黄疸缓解肺部炎症反应优于外引流术.
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