大鼠烧伤休克期手术对炎症反应和T细胞免疫的影响

Wound excision in hypovolemic phase alters the inflammatory response and T cell immunity in burn rats

目的探讨烧伤休克期手术后炎症反应和T细胞免疫的变化。方法 将大鼠随机分为未烧伤组、烧伤手术组和烧伤未手术组,在其背部制成30％,TBSA的三度烧伤模型。手术组于烧伤后4 h行创面切痂和辐照猪皮覆盖术。各组动物于伤后3、6、10 d分别测定TNF-α、IL-2、IL-6和CD4+细胞、CD8+细胞。结果 烧伤后3 d,未手术组CD4+细胞、CD8+细胞和IL-2、IL-6、TNF-α显著增高(P<0.05);手术组CD4+细胞、CD8+细胞显著下降,IL-2水平下降,IL-6和TNF—o明显上升,但TNF-α较未手术组显著降低(P<0.05)。伤后6 d,未手术组CD8+细胞显著增加,同时IL-2、IL-6开始下降(P<0.05);手术组CD4+细胞、cD8+细胞显著增高,而IL-2、TNF—α显著降低(P<0.05)。烧伤后10 d,未手术组CD4+细胞和CD8+细胞都显著下降(P<0.05);手术组CD4+细胞增高,CD8+细胞显著下降,IL-2和IL-6显著下降,而TNF-α继续增高(P<0.05)。结论 大鼠烧伤休克期切除创面,虽然不能阻止烧伤后全身炎症反应的发生,但能减轻炎症反应,使病情趋于稳定。手术降低了血清中炎性介质,减轻全身的炎症反应,上调T细胞的免疫力。

Objective To sudy the dynamic change of T-cell immunity and inflammatory response after wound excision in hypovolemic phase in thermal injured rats. Methods Forty-two male Spraque-Dawley rats were randomly separated into three groups; sham thermal injured rats, non-operation thermal injured rats, operation thermal injured rats. Thermal injury was produced by submerging the dorsal area of the rats into water at 95 ℃ for 10 s. This resulted in full-thickness burn wound with a mean size of 30% TBSA. We estimated the TNF-α, IL-2, IL-6, CD4 + cell and CD8 + cell at d3 , d6, d10 post-burn. Results At 3 d after burn the serum TNF-α, IL-2 and IL-6 level and CD4 + cell, CD8 + cell of rats were significantly higher in non-operation group(P <0.05). The IL-2 and CD4+ cell, CD8+ cell were significantly lower in the operation group, the TNF-α was also elevated, but it was significantly lower than that in non-operation group(P <0.05). At 6 d the decreased TNF-α and IL-2 level were observed in the operation group , but the CD4 + cell and CD8 + cell were significantly higher( P < 0. 05 ) . In the non-operation group, CD8 + cell was significantly higher, but IL-2, IL-6 were decreased (P <0.05). At 10 d, the CD4+cell and CD8 + cell were significantly lower, but the serum TNF-α level was elevated in the non-operation group (P <0.05). In the operation group, high CD4+ cell, low CD8+ cell and lower IL-2, IL-6 and higher TNF-α were observed ( P <0.05). Conclusion Wound excision in the hypovolemic phase for thermal injured rats can not cut-off systemic inflammatory response after burn trauma, but it could attenuate the inflammatory response. And the condition of the patient becomes stable with further treatment. Wound excision attenuates the systemic inflammatory response by decreasing the proinflammatory mediators and it up-regulates the T-cell immunity after burn.