输注库血前吸入NO对糖尿病兔肺动脉压的影响

The impact of NO inhalation on pulmonary artery pressure in diabetic rabbits during blood transfusion

目的探讨输注库血前吸入NO（一氧化氮）对糖尿病兔肺动脉压的影响及其机制。方法 60只健康清洁的成年雄性新西兰大白兔,其中30只经颈内静脉抽取全血,按血站标准采集处理并存于一次性ACD抗凝全血保存袋中作为库血于4℃保存。剩余30只建立2型糖尿病模型,随机分为3组（n=10）,分别是DS组：输库血（保存2周）组; DF组：输新鲜血（保存24 h）组; DN组：输库血（保存2周）前预先吸入NO。检测输血前（T0）、输血第5 min（T1）、输血第10 min（T2）、输血结束即刻（T_3）、输血结束后1 h（T4）的平均肺动脉压,同时检测血浆NO活力和IL-6、TNF-α含量以及eNOS蛋白表达情况。结果 DS组与DF组比较,T1、T3时MPAP分别为29. 27±2. 34 vs 27. 02±2. 29（P〈0. 05）和32. 25±2. 47vs 28. 93±2. 58（P〈0. 05）; DS组与DN组比较,T1-T_4时MPAP分别为29. 27±2. 34 vs 25. 59±2. 81（P〈0. 05）、30. 19±2. 66 vs 23. 09±3. 71（P〈0. 05）、32. 25±2. 47 vs 21. 29±2. 84（P〈0. 05）和29. 51±2. 62 vs 17. 53±3. 69（P〈0. 05）; DF组与DN组比较,T_2~T_4时MPAP分别为30. 19±2. 66 vs 23. 09±3. 71（P〈0. 05）、32. 25±2. 47 vs21. 29±2. 84（P〈0. 05）、29. 51±2. 62 vs 17. 53±3. 69（P〈0. 05）。DS组与DF组比较,T_3、T_4时IL-6和TNF-α表达水平分别为211. 3±32. 7 vs 179. 6±33. 4（P〈0. 05）、234. 2±42. 5 vs 167. 1±30. 2（P〈0. 05）和23. 5±1. 3 vs 19. 2±1. 5（P〈0. 05）、28. 4±1. 6 vs 21. 6±2. 1（P〈0. 05）; DS组与DN组比较,T_2-T_4时IL-6和TNF-α表达水平分别为179. 2±34. 0 vs148. 6±30. 5（P〈0. 05）、211. 3±32. 7 vs 162. 1±36. 5（P 〈0. 05）、234. 2±42. 5 vs134. 2±36. 6（P 〈0. 05）和19. 7±1. 8 vs11. 4±1. 2（P〈0. 05）、23. 5±1. 3 vs 12. 3±1. 6（P〈0. 05）、28. 4±1. 6 vs 9. 3±1. 5（P〈0. 05）; DF组与DN组比较,T_4时IL-6和TNF-α表达水平分别为167. 1±30. 2 vs 134. 2±36. 6（P〈0. 05）和21. 6±2. 1 vs 9. 3±1. 5（P〈0. 05）。DS组与DF组比较,T_3、T_4时NO含量分别为74. 1±12. 6 vs 104. 8±15. 0（P〈0. 05）和66. 4±17. 1 vs 87. 3±15. 9（P〈0. 05）; DS组与DN组比较,T_2-T_4时NO含量分别为81. 3±15. 4 vs 107. 7±24. 6（P〈0. 05）、74. 1±12. 6 vs 120. 6±16. 3（P〈0. 05）、66. 4±17. 1 vs 104. 0±14. 7（P〈0. 05）; DF组与DN组比较,T_3、T_4时NO分别为104. 8±15. 0 vs 120. 6±16. 3（P〈0. 05）和87. 3±15. 9 vs 104. 0±14. 7（P〈0. 05）。与DS组比较,DF、DN组eNOS蛋白含量明显升高（P〈0. 05）;与DF组比较,DN组eNOS蛋白含量明显升高（P〈0. 05）。结论输注库血前吸入NO可降低肺动脉压,其机制可能与减少炎性因子IL-6和TNF-α的释放有关。

Objective To investigate the influence of NO（ nitric oxide） on the pulmonary artery pressure in diabetic rabbits and its mechanism during and after blood transfusion under the general blood bank regulations. Methods A total of60 New Zealand white rabbits were enrolled in this test. Thirty of the 60 were sent for blood collection from the internal jugular vein and the blood was stored in disposable ACD anticoagulant whole blood storage bags,serving as the blood source. The other 30 of the 60 New Zealand white rabbits were processed with a type II diabetes model and randomly divided into three groups（ n = 10） ： The DS group： transfusion of blood（ preserved 2 w） group; The DF group： transfusion of fresh blood（ preservation 24 h） group; The DN group： Pre-inhalation of NO prior to storage of blood（ 2 w）. The mean pulmonary arterial pressure was measured before and after blood transfusion（ T_0）,5 min（ T_1）,10 min（ T_2）,upon（ T_3） and 1 h（ T_4） after transfusion. IL-6、TNF-α and the expression of eNOS protein were also measured. Results The MPAP values of the DF and DN group at T_1,T_3 and T_1—T_4 were significantly lower than that of the DS group.（ P 0. 05）. IL-6 and TNF-α values were significantly increased in group DF at T_2—T_4（ P 0. 05）,compared with the DS group. The levels of IL-6 and TNF in the DN group were significantly lower than those of the DF group（ P〈0. 05） at T_4; Compared with the DS group,the DF and DN group showed significantly higher eNOS protein expression（ P〈0. 05）. Conclusion The Inhalation of nitric oxide can decrease the pulmonary artery pressure,which may be related to the decreased expression of inflammatory cytokines IL-6 and TNF-α.