不同胆汁引流方式对梗阻性黄疸兔血清内毒素与免疫功能的影响

Influence of different biliary drainage methods on serum endotoxin and immune function in rabbits with obstructive jaundice

目的:探讨不同胆汁引流方式对梗阻性黄疸兔血清内毒素与免疫功能的影响。方法:将36只新西兰白兔随机均分为假手术组、外引流组、内引流组。外引流组与内引流组先建立可逆型梗阻性黄疸模型,7 d后解除梗阻,分别行胆汁外引流与内引流;假手术组按相同时间间隔行2次假手术。各组分别于造模前、造模后7 d、引流术后7 d采血,检测肝功能指标、血清内毒素水平、血中CD4+CD25+调节性T细胞的比例。结果:假手术组各时间点各项指标均无明显变化(均P>0.05);造模后7 d,外引流组与内引流组血清胆红素、转氨酶、内毒素水平均较造模前明显升高,血CD4+CD25+调节性T细胞比例较造模前明显降低(均P<0.05);行引流术7 d后,外引流组与内引流组肝功能指标、内毒素水平、CD4+CD25+调节性T细胞比例均较造模后7 d明显恢复,但内引流组后两项指标的恢复程度均明显优于外引流组(均P<0.05)。结论:胆汁内引流较胆汁外引流更有利于梗阻性黄疸内毒素清除与机体免疫功能快速恢复。

Objective： To investigate the influence of different biliary drainage methods on serum endotoxin level and immune function in rabbits with obstructive jaundice.Methods： Thirty-six New Zealand rabbits were equally randomized into sham operation group, external drainage group and internal drainage group. Rabbits in external drainage group and internal drainage group underwent establishment of reversible obstructive jaundice model, followed by obstruction removal and then internal andexternal biliary drainage respectively at 7 d after model was established, while those in sham operation group were subjected to two sham operations with the same time interval. Blood samples were collected before and 7 d after model establishment, and 7 d after drainage as well, and then the liver function parameters, serum endotoxin level and the ratio of CD4＋CD25＋ regulatory T cells in peripheral blood were determined.Results： No significant change was noted in any of the indexes at any time point in sham operation group（all P〈0.05）. In external drainage group and internal drainage group at 7 d after model establishment, the serum levels of bilirubin, transaminase and endotoxin were all increased, but the ratios of CD4＋CD25＋ regulatory T cells were decreased significantly compared with the levels before model establishment. At 7 d after drainage, the liver function parameters, serum endotoxin level, and ratio of CD4＋CD25＋ regulatory T cells were all significantly recovered in either external drainage group or internal drainage group compared with those at 7 d after model establishment, but the degrees of recovery of the latter two parameters in internal drainage group were greater than those in external drainage group（all P〈0.05）.Conclusion： Internal biliary drainage for obstructive jaundice is more beneficial than external biliary drainage in eliminating endotoxin and accelerating recovery of immune function.