腹腔开放疗法对腹腔间隙综合征合并脓毒症大鼠肝功能损害的治疗作用

Open abdomen management treatment of liver injury in rats with abdominal compartment syndromeand sepsis

目的评价腹腔开放疗法对大鼠腹腔间隙综合征合并脓毒症时肝脏损害的治疗作用。方法将制作腹腔感染合并腹腔间隙综合征模型成功的SD大鼠（72只）随机分为2组：常规关腹组（对照组）和腹腔开放组（开放组）。每组分别于术后1、6h、1、3、5、7d分别各处死6只动物，取血检测肝功能。肝脏一部分行病理学评分，另一部分使用RT．PCR检测肝脏中的Toll样受体4（TLR4）、肿瘤坏死因子（TNF）－OL、白介素（IL）-6、信号转导与转录活化子3（STAT3）和细胞因子信号因子3（SOCS3）水平。结果发现在手术后的早期阶段，开放组大鼠肝脏组织中的TNF－α、IL-6、STAT3表达明显高于对照组（P〈0．05），同时TLR4和SOCS3的表达减弱（P〈0．05）。开放组丙氨酸氨基转移酶、天冬氨酸氨基转移酶水平也明显低于对照组（P〈0．05）。结论腹腔开放疗法可在术后的早期阶段促进肝脏再生，同时腹腔开放疗法在术后早期阶段可明显降低TLR4表达，从而达到减少局部炎症损害的作用。

Objective To evaluate the open and closed management treatment of liver injury in rats with sepsis and abdominal compartment syndrome （ACS）. Methods The sepsis and ACS rats （ n = 72 ） were randomized divided into two groups. One group used closed management （n = 36） , the other accepted the open abdomen management （n =36）. The rats were killed at l, 6 h, 1, 3, 5,7 d after operation. Blood was collected for liver function tests. Liver sections assessed pathologically and the expressions of Toll-like receptor 4 （ TLR4 ） , tumor necrosis factor （ TNF ） -α, interleukin （IL） -6, signal transducers actwators of transcription（ STAT3 ） and suppressor of cytokine signaling 3 （SOCS3） of rat livers were examined by RT- PCR. Results The early stage after operation, TNF-α and IL-6 concentrations, STAT3 expressions in rat liver were higher in open abdomen rats than the closed management ones （ P 〈 0. 05 ）. TLR4 and SOCS3 expressions were lower in open abdomen rats than the closed management ones （ P 〈 0. 05 ） . Aspartate aminotransferase, alanine aminotransferase levels also was lower in open abdomen ones （P 〈 0. 05 ）. Conclusions The randomized study demonstrates that open abdomen management could improve liver regeneration in the early stage after operation. Also open abdomen could reduce inflammatory response by reducing TLR4 expressions.