清除循环肿瘤坏死因子对急性肺损伤的影响

The protective effect of removing circulatory TNF by immunoa dsorption on endotoxin induced acute lung injury

目的研究亲和免疫吸附清除循环肿瘤坏死因子（ＴＮＦ）对内毒素性急性肺损伤动物的保护作用。方法以６１只新西兰白兔为实验动物，建立内毒素性急性肺损伤模型。随机分为三组：（１）免疫吸附组（２７只），颈静脉注射自制脂多糖（ＬＰＳ）１００×１０８ｃｆｕ·ｋｇ－１后１小时开始血液灌流，通过含重组肿瘤坏死因子α（ｒＨｕＴＮＦα）单克隆抗体的吸附柱，灌流时间２小时；（２）致伤组（２７只），颈静脉注射ＬＰＳ，无吸附柱，仅有相同血量的体外循环；（３）对照组（７只），颈静脉注射生理盐水２ｍｌ，无吸附柱，仅有体外循环。通过亲和免疫吸附清除循环ＴＮＦ，观察了肺系数、肺通透指数、肺泡灌洗液（ＢＡＬＦ）中ＴＮＦ和白细胞介素８（ＩＬ８）水平、白细胞数的变化以及对存活率的影响。结果免疫吸附组能有效清除循环ＴＮＦ、ＢＡＬＦ中ＴＮＦ及ＩＬ８水平较致伤组显著降低（Ｐ＜０．０１），肺毛细血管通透性等指标明显改善（Ｐ＜０．０１），存活率提高（Ｐ＜０．０１）。结论免疫吸附清除循环ＴＮＦ，能有效地保护内毒素所致的急性肺损伤。

Objective To study the protective effect of removing circulatory TNF by immunoadsorption on endotoxin induced acute lung injury in rabbits. Method New Zealand white rabbits injected with lethal dose of endotoxin underwent hemoperfusion with immunoadsorbent. TNF and IL 8 levels in BALF were measured, the nvmber of leukocytes and percentage of PMN in BALF were analyzed and the ratio of wet lung to body weight and pulmonary microvascular permeability index were also studied. In addition, the survival rate was observed. Result Treatment with immunoadsorption markedly attenuated the pulmonary microvascular permeability increased by endotoxin and improved the survival rate. Conclusion Immunoadsorption to remove circulating TNF is an effective way to protect rabbits against endotoxin induced acute lung injury.