L-精氨酸预处理对输注库血兔的肺保护作用

Experimental study on the lung protection of L-arginine pretreatment in hemorrhage rabbits receiving banked-blood

目的 探讨L-精氨酸（L-Arg）预处理对输注库血兔肺损伤的影响.方法 60只普通级成年雄性新西兰大白兔,其中20只抽取全血并存于一次性ACD抗凝全血保存袋中作为库血.其余40只随机分为四组：输血组（T组）,L-Arg组（L组）,输血＋L-Arg组（TL组）及空白对照组（C组）.分别记录麻醉及有创操作完成后10 min（T0）、放血结束即刻（T1）、输血结束后即刻（R）、60min（T3）、120 min（T4）的MAP、CVP,检测血浆NO、iNOS活力和TNF-α、IL-6含量,并观察肺组织病理学改变.结果 T3、T4时L和TL组血浆NO含量显著低于T组（P＜0.05）;T2～T4时TL组血浆iNOS活力和TNF-α水平显著低于T组（P＜0.05）;T2、T3时TL组血浆IL-6水平显著低于T组（P＜0.05）.HE染色光镜观察肺组织形态学变化：T组肺泡腔内可见粒细胞明显增多,有的肺泡扩张融合,肺泡壁增厚,肺充血,肺间质水肿,可见大量炎细胞浸润,毛细血管扩张充血.TL组肺泡结构完整,无扩张融合,肺泡壁充血增厚,肺间质充血水肿明显减轻,炎性细胞浸润减少.结论 输注库存血前应用L-Arg预处理可升高NO水平并抑制iNOS的活性;减少炎性细胞因子TNF-α、IL-6的产生并减轻了肺损伤的程度;提示L-Arg对肺保护有一定意义.

Objective To investigate the influence of L-arginine pretreatment on lung injury after banked-blood transfusion.The pharmacologic action and mechanism of L-arginine and its theory accordance in clinical blood transfusion therapy are also explored in this paper.Methods Twenty of 60 New Zealand white rabbits were randomly selected for collection of blood,which will serve as banked-blood.The other 40 rabbits were randomly divided into four groups：,transfusion group （group T,n=10）,L-Arg group （group L,n=10）,transfusion/L-Arg group （group TL,n=10）,control group （group C,n =10）.MAP,CVP,vigor of iNOS,plasma NO,TNF-α and IL-6 concentration were measured before （T0）,after blood loss （T1）,and at the time immediately （T2）,1 h （T3） and 2 h （T1） after banked-blood transfusion.And the pathology changes of lung were investigated.Results NO levels of groups L and TL were significantly lower at T3 and T4 compared with group T （P＜0.05） ; iNOS vigor in group TL were significantly lower at T2-T4 than that of group T （P＜0.05） ; the TNF-α and IL-6 levels of group TL were significantly lower at T2-T4,T2-T5 than those of group T respectively（P＜0.05）.Microscopic studies showed more visible granulocytes in the alveolus in group T,with some alveoli expanding and merging,alveolar wall thickening.The lung in group T was hyperemia and interstitium was hydropsia,generous granulocytes infiltrated and capillaries were expanded and hyperemia.In group TL,the alveoli structure were integrated and no expandation or fusion were observed; alveolar wall thickening and hyperemia,interstitium hyperemia,hydropsia and the granulocytes infiltration were markedly alleviated.Conclusion L-Arg pretreatment in the hemorrhage rabbits receiving banked-blood transfusion may advance the level of NO and inhibit the vigor of iNOS; decrease the level of TNF-a,IL-6 and accordingly ameliorate lung injury,which indicates L-Arg may play a key role in lung protection.