不同剂量氨溴索对实验性肺不张炎症因子及影像学的影响

Inflammatory factor levels and CT images in experimental atelectasis pigs treated with different doses of ambroxol

目的探讨不同剂量氨溴索(ambroxol,AMB)对实验性肺不张炎症因子及影像学的影响。方法将雄性实验用中国小型猪随机分成肺不张组(M组6只)、AMB处理组(T组18只)及对照组(C组6只)。其中T组又随机分成30、60及90mg/Kg剂量的AMB处理的T30、T60及T90组,每组均为6只。M及T组小型猪的右主支气管下端在纤支镜下置入镍钛合金封堵器,T组小型猪在放入封堵器当天即予相对应的AMB剂量静脉注射,每8h注射1次,每3d CT检查肺部确定肺不张的形成,在肺不张形成后的第3天,3组动物均处死,收集右下肺组织行炎症因子TNF-α、IL-1β和IL-10检测。结果 M组和T组呈典型的肺不张CT改变。各组肺组织匀浆中TNF-α、IL-1β和IL-10水平的表达差异均有统计学意义(均P<0.05)。与C组比较,M组和T组TNF-α、IL-1β水平明显升高(均P<0.01);与M组比较,T组TNF-α、IL-1β水平明显下降(均P<0.01);T60组和T90组与T30组比较差异均有统计学意义(均P<0.01),但T60组和T90组间无统计学差异。与C组比较,M组和T组IL-10表达显著下降(均P<0.01);与M组比较,T组IL-10水平明显升高(均P<0.01);但不同治疗剂量3组之间无统计学差异。与C组比较,M组和T组CT值均有显著提高(均P<0.01),但M组和T组间CT值无统计学差异;与M组比较,T组肺不张面积显著减小(均P<0.01),肺不张占单侧肺面积比T90组明显低于T30组(P<0.01),但T30和T60,T60和T90之间并无统计学差异。结论大剂量AMB能抑制实验性肺不张的炎症因子TNF-α、IL-1β的表达,提升IL-10的表达,能减小肺不张面积。

Objective To investigate the effects of different doses of ambroxol on inflammatory factors and CT images in pigs with experimental atelectasis. Methods Thirty male China experimental miniature pigs （CEMP） were randomly divided into control group（C group, n=6）, atelectasis model group（M group, n=6） and ambroxol treatment groups（T groups, n=18）; T groups were further subgrouped to T30, T60 and T90 groups （n=6 in each）. Atelectasis was induced by placement of Ni-Ti alloys occluder in the lower right main bronchus of pigs under bronchofiberscope after anesthesia （groups M and T）. Intravenous injections of ambroxol hydrochloride at doses of 30mg/kg, 60mg/kg or 90mg/Kg were given q8h for 3d in T30, T60 and T90 subgroups, respectively. The development of atelectasis was observed by CT scanning every 3d after occluder was placed. On d3 of atelectasis, all animals were sacrificed. TNF-α, IL-1 β and IL-10 levels were measured using sandwich enzyme-linked immunosorbant assay （ELISA）. Results Typical CT images of atelectasis were observed in group M. Concentration of TNF- α, IL-1 β in M group was significantly higher than those in C group （P〈0.01）, while those in T groups were markedly lower than those in M group. However, there was no significant difference in TNF-α and IL-1 βlevels between group T60 and T90. The expression of IL-10 in M group was significantly decreased, compared with the control group（P〈0.01）. After ambroxol treatment, the expression of IL-10 was increased in all T groups. CT value was significantly higher in M group than that in C group （P〈0.01）, but was not significantly changed in T groups （P 〉0.05） compared to M group. Reduced areas of atelectasis were observed in T groups, but there was no significant difference between groups T30 and T60, and between groups T60 and T90 （P 〉0.05）. Conclusion Ambroxol can inhibit TNF- α, IL-1β levels and decrease IL-10 levels; and reduce the area of atelectasis in experimental atelectasis pigs.