经纤支镜行肺减容术机制初步探讨

Mechanisms of lung volume reduction through fibrobronchoscope with tetracycline

目的通过检测转化生长因子β1(TGF-β1)及结缔组织生长因子(CTGF)初步探讨应用四环素经纤支镜行微创肺减容术的机制。方法成年杂种犬5只,麻醉后经口插纤支镜入亚段支气管,放入CRE球囊扩张导管,待球囊充起后注入5%四环素混悬液。进行影像学(CT,术后2、4、8、12周)观察及组织病理学(术后12周)观察,逆转录-聚合酶链反应(RT-PCR)及WB法检测减容后局部肺组织TGF-β1及CTGF表达,对侧正常肺组织为对照组。结果术后12周CT检查示5只杂种犬局部肺组织均呈密度增高致密影,未见炎性病变影像,病理检查肉眼见肺表面瘢痕组织形成,切片示阻塞部位失去正常肺组织结构,形成纤维致密结构,RT-PCR及WB结果示TGF-β1及CTGF表达呈阳性,对照组为阴性。结论应用四环素经纤支镜行微创手术可用于肺减容治疗,TGF-β1和CTGF参与了肺减容过程。

Objective To explore the mechanisms of the lung volume reduction with fibrobronchoscope with tetracycline through the detection of transforming growth factor-beta 1（TGF-β1 ） and connective tissue growth factor（CTGF）. Methods Five dogs were used in this experiment. Fibrobronchoscope was inserted to the subsegmental bronchi by mouth. CRE sacculus dilation catheter was put into local lung inflate sacculus. Suspension of 5% tetracycline was poured in anesthesia animals. Atrophica constitution of local lung was detected by roentgenographic examination and histopathological methods at 2, 4, 8, 12 and 12 week postoperation respectively. RT-PCR and WB were used to detect the expression of TGF-β1 and CTGF. The control group were the normal lung tissue on the other side. Results High density tissue was found at 12week postoperation. Inflammatory pathological changes were not found. Under microscope, scar tissue was seen. The end of the detection of TGF-β1 and CTGF by RT-PCR and WB were positive. They were negative in the control group. Conclusion Operative procedure through fibrobronchoscope with tetracycline is easy, trauma is little, complications are few, and so this method will be used in lung volume reduction. TGF-β1 and CTGF are involved in the procedure of the high density tissue.