腹部火器伤肠管穿透后内毒素血症在肝细胞凋亡中的作用

The role of endotoxemia in the mechanism of hepatocyte apoptosis induced by intestinal perforations due to abdominal firearm wound

目的探讨血浆内毒素在腹部火器伤肠管穿透后肝细胞凋亡中的作用。方法健康长白仔猪42头随机等分为对照组和伤后1 h、2 h、4 h、8 h、12 h和24 h组,实验组建立腹部火器伤肠管穿透模型后,用显色基质鲎试剂法检测各组血浆内毒素水平,用免疫组化图像分析法测定各组肝内NF-κB、TNF-α含量,同时测定肝细胞凋亡情况。结果伤后各组血浆内毒素水平、肝组织TNF-α的表达及肝细胞凋亡指数均明显高于对照组(P<0.05)。血浆内毒素水平于伤后8 h出现高峰,伤后12 h仍维持在高峰值水平;伤后各组肝内NF-κB活性明显高于对照组,并于伤后1 h和8 h出现2个高峰(P<0.05);肝组织TNF-α含量、肝细胞凋亡指数均于伤后2 h和12 h出现2个高峰。相关分析表明,伤后肝组织NF-κB、TNF-α含量与血浆内毒素水平及肝细胞凋亡指数均存在正相关(P<0.05)。结论腹部火器伤肠穿孔后内毒素血症可引起肝内NF-κB、TNF-α含量增高来介导肝细胞凋亡的发生。

Objective To study the role of plasma endotoxin in the mechanism of hepatocyte apoptosis induced by intestinal perforations due to abdominal firearm wound. Methods A total of 42 Chang - Bai piglets were randomized into 7 groups：control group and wounded lhour group, 2 hour group, 4 hour group, 8 hour group, 12 hour group, 24 hour group. The model of intestinal perforations due to abdominal firearm wound was established in wounded groups. Levels of plasma endotoxin was measured by using ehromogenic limulus amehoeyte lysate test. Hepatic NF - KB ,TNF-α content was measured with immunohistochemical staining and image analysis in all groups. Hepatocyte apoptosis inde- xes were also determined at the same time. Results Levels of plasma endotoxin, hepatic TNF -α content and hepato- cyte apoptosis indexes in wounded groups were all significantly elevated compared to control group（ P 〈 O. 05 ）. Plasma endotoxin reached the peak in 8 h group,and it was still at the peak level in 12 h group. Levels of hepatic NF - KB ac- tivity in wounded groups were significantly elevated compared to control group, and they appeared two peaks in 1 h group and 8 h group （ P 〈 O. 5 ）. Hepatic TNF -α content, hepatocyte apoptosis indexes appeared two peaks in 2 h group and 12 h group. Meanwhile, hepatic NF -KB,TNF -or activity were positive correlation with both plasma endo- toxin level and hepatocyte apoptosis indexes （ P 〈 O. 05 ）. Conclusions After intestinal firearm wound, endotoxemia provokes hepatic NF - KB ,TNF -α activity increase and they can mediate hepatocyte apeptosis.