选择性肠道去污染对创伤性截瘫家兔内毒素及炎症因子的影响

Effect of selective decontamination of the digestive tract on plasma endotoxinand and inflammatory crtokine in rabbits with complete paraplegia

目的探讨选择性肠道去污染(SDD)对截瘫家兔血中内毒素(ET)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和降钙素原(PCT)的影响,明确外周血炎症因子水平与肠黏膜屏障功能障碍的关系。方法建立截瘫家兔模型,采用PTA方案进行SDD处理4天。采集小肠标本进行HE染色观察小肠黏膜变化,并检测外周血ET和IL-6、TNF-α及PCT水平。结果 SDD处理后血浆ET浓度明显降低(P<0.001),血中感染指标IL-6、TNF-α、PCT水平也较对照组明显降低(P<0.05)。相关分析表明,外周血内毒素水平与血浆IL-6、TNF-α、PCT呈显著正相关(P<0.05),小肠Chiu病理评分与IL-6、TNF-α、PCT、ET水平呈显著正相关(P<0.01)。结论 SDD处理截瘫家兔后可减轻全身炎症反应,保护肠黏膜,减少肠道内毒素移位,从而预防肠源性感染。

Objective To investigate changes of plasma endotoxin, interleukine-6 （IL-6）, tumor necrosis factor-al- pha （TNF-α） and procalcitonin （PCT） levels in paraplegic rabbits treated with selective digestive decontamination （SDD）. Methods Animals were subjected to a complete paraplegia following spinal cord injury, and divided into SDD- treated and control groups. The treatment group received SDD using PTA protocol by gavage three times daily for 4 days after injury. The control group was given the same amount of normal saline. Plasma were collected to detect ET, IL-6, TNF-α and PCT concentrations, and samples from the small intestine were collected to assess morphological changes, u- sing Hematoxylin and eosin staining. The correlation between ET, IL-6, TNF-α and PCT levels and the degree of intesti- nal mucosal damage were analyzed. Results Plasma ET concentration in SDD group was significantly lower than that in control group [（0.15（0.05） EU/ml vs （0.57（0.11） EU/ml, t=15. 341, P〈0. 001）. In addition, plasma IL-6, TNF-α, and PCT levels in SDD group were also obviously lower that in control group. Correlation analysis showed ET, IL-6, TNF-α and PCT levels were positively correlated with the degree of intestinal mucosal injury （P〈0.05）. Conclusion SDD alleviates systematic inflammatory reaction and decreases endotoxin translocation from the intestinal tract in rabbits with complete paraplegia.