腹腔高压氧自由基对肠黏膜细胞凋亡的影响以及对肠道细菌易位的作用

Role of oxygen-free radicals in enterocyte apoptosis and bacterial translocation in abdominal compartment syndrome:

目的:腹腔高压可见于多种外科危重症,可造成机体缺血和再灌注损伤,导致严重炎症反应。以往研究多注意腹腔高压的危害,对再灌注损伤研究较少。文中评估腹腔高压对肠道的影响。方法:120只SD大鼠随机分为4组。腹腔间隙综合征组(ACS):腹内压(IAP)增加至20mmHg。腹腔间隙综合征/减压(ACS/DE)组:IAP增高至20mmHg,再减压至正常。对照1组和对照2组,IAP维持不变。检测肠道丙二醛(MDA),髓过氧化酶(MPO),谷光苷肽(GSH)以及谷胱甘肽过氧化物酶(GSH-Px)水平。同时,光镜检查回肠组织形态和结构以及细胞凋亡情况。取肝、脾、肠系膜淋巴结进行微生物学分析。结果:在腹腔高压状态下,MDA、MPO增加,GSH和GSH-Px减少。微生物分析提示肠道存在细菌易位。形态学检查证实,ACS/DE组Ch iu’s评分和凋亡指数在所有4组中最高。结论:在腹腔间隙综合征状态下,氧化应激在肠道损伤和细菌易位中起着重要作用。并且再灌注阶段的氧自由基对组织的损害要远大于腹腔高压阶段。

Objective： Intra-abdominal hypertension（IAH）,commonly seen in various critical surgical cases,may lead to body ischemia and reperfusion damage and result in serious inflammatory response.Previous studies were concentrated mostly on the risk of IAH,but less on IAH-induced reperfusion damage.The purpose of this study was to investigate the impact of IAH on the intestine.Methods： A total of 120 Sprague-Daley rats were divided into an abdominal compartment syndrome（ACS） group,with intra-abdominal pressure（IAP） increased to 20 mmHg,an ACS/decompression（ACS/DE） group,with increased IAP followed by decompression,and two control groups,with IAP unchanged.Malondialdehyde（MDA）,myeloperoxidase（MPO）,glutathione（GSH） and glutathione peroxidase（GSH-Px） enzyme of the intestine were measured.Additionally,ileal tissues were taken for histopathological examinations and apoptosis detection;the liver,spleen,and mesenteric lymph nodes were obtained for microbiological analysis.Results： In the presence of IAH,MDA and MPO were increased,while GSH and GSH-Px were decreased.Microbiological analysis suggested bacterial translocation across the gut.Morphological examinations indicated that Chiu＇s score and apoptotic index in the ACS/DE group were the highest in the four groups.Conclusion： Oxidative stress plays an important role in the intestinal damage and bacterial translocation in abdominal compartment syndrome.Additionally,the influence of oxygen free radicals occurs mainly during the reperfusion rather than the IAH period.