亚油酸与红细胞急性损伤：人工关节置换后隐性失血的发病机制

Linoleic acid and acute red blood cells injury: mechanism of hidden blood loss after artificial joint replacement

背景:隐性失血常见于人工关节置换后,所造成的术后贫血严重影响患者康复,关于隐性失血的原因说法有很多,但机制尚不明确。目的:研究亚油酸对大鼠血液中红细胞的影响,探讨人工关节置换后隐性失血的发病机制。方法:将50只SD大鼠随机分为5组,对照组(n=10)尾静脉注射乙醇溶液;实验组分为4个组(n=10),分别尾静脉注射15,30,60,90 mmol/L的亚油酸溶液,构建体内高亚油酸水平大鼠模型。分别在给药前及给药后24,48,72 h从眼眶静脉采集血液样本检测红细胞计数、血红蛋白质量浓度、谷胱甘肽过氧化物酶活力、总超氧化物歧化酶活力及过氧化氢浓度变化。结果与结论:实验组在给药浓度为60 mmol/L时大鼠红细胞及血红蛋白明显降低,出现显著的隐性失血。在给药后24 h,实验组与对照组相比血红蛋白质量浓度和红细胞计数都降低,且各实验组比对照组变化更显著(P<0.05);谷胱甘肽过氧化物酶活力、总超氧化物歧化酶活力、过氧化氢浓度均明显降低,实验组与对照组之间变化差异有显著性意义(P<0.05)。给药后48 h,对照组与实验组血液中血红蛋白质量浓度及红细胞计数相对稳定,而谷胱甘肽过氧化物酶活力、总超氧化物歧化酶活力、过氧化氢浓度都明显持续下降,且实验组变化更显著(P<0.05)。说明血液中亚油酸水平的升高可造成血液中红细胞的急性损伤,通过氧化应激反应,导致隐性失血。

BACKGROUND： Hidden blood loss frequently occurs after artificial joint replacement surgery, the resulting anemia may cause serious impact on postoperative rehabilitation. There are many different theories about the hidden blood loss, but the mechanisms are not clear. OBJECTIVE： To study the effect of linoleic acid on red blood cells of rats and explore the pathogenesis of hidden blood loss after artificial joint replacement surgery. METHODS： Fifty Spraque-Dawley rats were randomly divided into five groups. Control group （n=10） was injected with alcohol solution via the tail veins. Four test groups （n=10） were injected with 15 mmol/L, 30 mmol/L, 60 mmol/L, 90 mmol/L linoleic acid via the tail veins, to establish high-level linoleic acid models in vivo. Blood samples collected from the orbital vein were determined before injection and at 24, 48, 72 hours after injection. Changes of hemoglobin, red blood cell count, glutathione peroxidase activity, total superoxide dismutase activity and hydrogen peroxide in the blood samples were observed. RESULTS AND CONCLUSION： Significant hidden blood loss occurred when the concentration was 60 mmol/L in the experimental group, with the hemoglobin and red blood cell count were sharply reduced in blood samples. The hemoglobin and red blood cell count were reduced in all the experimental groups and control group 24 hours after administration, while the experimental groups changed more obviously （P 〈 0.05）; glutathione peroxidase activity, total superoxide dismutase activity and hydrogen peroxide were also significantly reduced in all groups, and the changes showed significant difference among them （P 〈 0.05）. The hemoglobin and red blood cell count were relatively stable in control group and the experimental groups 48 hours after administration, while glutathione peroxidase activity, total superoxide dismutase activity and hydrogen peroxide were significantly decreased, and changes in the experimental groups were more notable （P 〈 0.05）. Experimental findings show that elevated levels of linoleic acid in the blood cause acute oxidative damage of the red blood cells, which eventually lead to acute anemia and hidden blood loss.