选择性肠道去污染对创伤性截瘫家兔内毒素及炎症因子的影响

摘要

Objective To investigate changes of plasma endotoxin,interleukine-6 (IL-6),tumor necrosis factor-alpha (TNF-α) and procalcitonin (PCT) levels in paraplegic rabbits treated with selective digestive decontamination (SDD).Methods Animals were subjected to a complete paraplegia following spinal cord injury,and divided into SDDtreated and control groups.The treatment group received SDD using PTA protocol by gavage three times daily for 4 days after injury.The control group was given the same amount of normal saline.Plasma were collected to detect ET,IL-6,TNF-α and PCT concentrations,and samples from the small intestine were collected to assess morphological changes,using Hematoxylin and eosin staining.The correlation between ET,IL-6,TNF-α and PCT levels and the degree of intestinal mucosal damage were analyzed.Results Plasma ET concentration in SDD group was significantly lower than that in control group [(0.15(0.05) EU/ml vs (0.57(0.11) EU/ml,t=15.341,P＜0.001).In addition,plasma IL-6,TNF-α,and PCT levels in SDD group were also obviously lower that in control group.Correlation analysis showed ET,IL-6,TNF-α and PCT levels were positively correlated with the degree of intestinal mucosal injury (P＜0.05).Conclusion SDD alleviates systematic inflammatory reaction and decreases endotoxin translocation from the intestinal tract in rabbits with complete paraplegia.%目的 探讨选择性肠道去污染(SDD)对截瘫家兔血中内毒素(ET)、白介素-6(IL-6)、肿瘤坏死因子-a(TNF-α)和降钙素原(PCT)的影响,明确外周血炎症因子水平与肠黏膜屏障功能障碍的关系.方法 建立截瘫家兔模型,采用PTA方案进行SDD处理4天.采集小肠标本进行HE染色观察小肠黏膜变化,并检测外周血ET和IL-6、TNF-α及PCT水平.结果 SDD处理后血浆ET浓度明显降低(P＜0.001),血中感染指标IL-6、TNF-α、PCT水平也较对照组明显降低(P＜0.05).相关分析表明,外周血内毒素水平与血浆IL-6、TNF-α、PCT呈显著正相关(P＜0.05),小肠Chiu病理评分与IL-6、TNF-α、PCT、ET水平呈显著正相关(P＜0.01).结论 SDD处理截瘫家兔后可减轻全身炎症反应,保护肠黏膜,减少肠道内毒素移位,从而预防肠源性感染.