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目的:探讨TNF-α在腹部火器伤肠管穿透后肝细胞凋亡中的作用机制。方法:健康长白仔猪42只随机等分为对照组和伤后1、2、4、8、12和24h组。伤后各组建立腹部火器伤肠管穿透模型。用显色基质鲎试剂法检测各组血浆内毒素水平,用免疫组织化学图像分析法测定各组肝内TNF-α含量,采用双抗体夹心ELISA法测定各组血清TNF-α水平,同时测定肝细胞凋亡情况。结果:伤后各组血浆内毒素水平、血清TNF-α水平、肝组织TNF-α的表达及肝细胞凋亡指数均明显高于对照组(P<0.05)。血浆内毒素水平于伤后8h出现高峰,伤后12h仍维持在高峰值水平。血清TNF-α在伤后12h达到高峰(94.36±10.18)ng/L,肝内TNF-α活性和肝细胞凋亡指数均于伤后2h和12h出现2个高峰,与伤后血浆内毒素水平变化基本一致。相关分析表明,伤后肝组织TNF-α含量与血浆内毒素水平及肝细胞凋亡指数均存在正相关(P<0.05)。结论:腹部火器伤肠管穿透后内毒素血症可引起肝内和血液内TNF-α增高,介导肝细胞凋亡的发生。
Objective: To investigate the mechanism of TNF-α in hepatocyte apoptosis after intestine firearm wound. Methods: 42 healthy Changbai pigs were randomly divided into control group and 1, 2, 4, 8, 12 and 24h groups. After the injury, each group established abdominal firearm wound model of intestinal penetration. The levels of plasma endotoxin in each group were measured by chromogenic matrix 鲎 reagent method. The levels of TNF-α in liver of each group were determined by immunohistochemical image analysis. Serum TNF-α levels were measured by double antibody sandwich ELISA. Apoptosis. Results: The level of plasma endotoxin, the level of serum TNF-α, the level of TNF-α in liver tissue and the index of hepatocyte apoptosis in each group were significantly higher than those in control group (P <0.05). Plasma endotoxin levels peaked 8h after injury and remained at a peak level 12h after injury. The level of serum TNF-α reached the peak at 12h after injury (94.36 ± 10.18) ng / L, the activity of TNF-α in liver and the index of apoptosis of hepatocytes were both peaked at 2h and 12h after injury, and the level of plasma endotoxin The changes are basically the same. Correlation analysis showed that there was a positive correlation between TNF-α level in liver tissue and plasma endotoxin level and hepatocyte apoptosis index (P <0.05). Conclusion: Intestinal vascular endotoxemia caused by abdominal firearm wound can induce the increase of TNF-αin liver and blood, and induce the apoptosis of hepatocytes.