肠淋巴再灌注加剧SMAO休克多器官损伤的作用机制

Mechanism of mesenteric lymph reperfusion aggravates multiple organ injury in superior mesenteric artery occlusion shock rats

目的:探讨肠淋巴再灌注(MLR)加剧肠系膜上动脉闭塞性(SMAO)休克大鼠多器官损伤的作用机制。方法:Wistar雄性大鼠均分为4组:sham组,仅麻醉与手术;MLR组,夹闭肠系膜淋巴管(ML)1 h,再灌注2 h;SMAO组,夹闭肠系膜上动脉(SMA)1 h,再灌注2 h;MLR+SMAO:夹闭ML和SMA1 h,再灌注2 h。制备肝、肾、心、肺组织匀浆,检测自由基、一氧化氮(NO)、髓过氧化物酶(MPO)、细胞膜泵活性。结果:SMAO组及MLR+SMAO组多个器官组织匀浆的MDA、NO含量及NOS、MPO活性均显著高于sham组及MLR组,且MLR+SMAO组肝、肾、心、肺组织匀浆的这些指标高于SMAO组;SMAO组及MLR+SMAO组有多个器官组织匀浆SOD和ATPase活性显著低于sham组及MLR组,MLR+SMAO组均低于SMAO组。结论:MLR加剧SMAO休克多器官损伤的作用机制与加剧自由基损伤、NO合成与释放、中性粒细胞扣押、降低细胞膜泵活性有关,肠淋巴途径在SMAO休克的发病学中具有重要作用。

AIM： To explore the mechanism of mesenteric lymph reperfusion （MLR） aggravates multiple organ injury in superior mesenteric artery occlusion （SMAO） shock rats. METHODS： Male Wistar rats were randomly divided into 4 groups： in sham group, only anesthetization and operation were performed; in MLR group, occlusion of mesenteric lymphatics （ML） for 1 h followed by 2 h of reperfusion; in SMAO group, occlusion of superior mesenteric artery （SMA） for 1 h followed by 2 h reperfusion; in MLR ＋ SMAO group, occlusion of SMA and ML for 1 h followed by 2 h of reperfusion. The homogenates of liver, kidney, myocardium and lung were prepared for determining the activities of free radical, nitric oxide, myeloperoxidase （MPO） and cell membrane ATPase. RESULTS： The MDA, NO contents and NOS, MPO activities of multiple organic homogenate in SMAO and MLR ＋ SMAO group were higher than those in sham and MLR group, and these indexes in MLR ＋ SMAO were increased significantly than those in SMAO group. The SOD and ATPase activities of muliple organic homogenate in SMAO and MLR ＋ SMAO group were lower than those in sham and MLR group, and those in MLR ＋ SMAO group was decreased obviously than those in SMAO group. CONCLUSION： The MLR enhances the multiple organ free radical injury, NO synthesis and release, PMN detention and decreases the activity of cell membrane ATPase, aggravating the major organs injury in SMAO shock rats. Intestinal lymphatic pathway plays an important role in the pathogenesis of SMAO shock.