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目的观察胰岛素(INS)和丙酮酸乙脂(EP)拮抗严重烫伤后多器官功能不全综合征(MODS)大鼠炎症反应和氧化应激的效果。方法将80只SD清洁级30%体表面积Ⅲ度烫伤MODS大鼠随机分为INS治疗组(INS组,n=20)、EP治疗组(EP组,n=20)、INS和EP联合治疗组(INS+EP组,n=20)及治疗对照组(对照组,n=20)。INS组、EP组、INS+EP组及对照组分别腹腔注射INS[2.0 U/(kg·d)]、EP[40 mg/(kg·d)]、INS+EP[2.0 U(kg·d)+40 mg/(kg·d)]及等体积林格液。测定并比较各组伤前及伤后1、3、5、7 d血糖、丙氨酸转氨酶(ALT)、肌酸激酶同工酶(CK-MB)、肌酐(Cr)及肿瘤坏死因子-α(TNF-α)、高迁移率族蛋白1(HMGB1)、丙二醛(MDA)、总抗氧化能力(TAC)。结果 INS组、EP组和INS+EP组伤后各时点血糖、ALT、CK-MB、Cr及血TNF-α、HMGB1和MDA水平均明显低于对照组(P<0.01),TAC水平明显高于对照组(P<0.01);INS+EP组伤后各时点血ALT、CK-MB、Cr、TNF-α、HMGB1和MDA水平均明显低于INS组和EP组(P<0.01),TAC水平明显高于INS组和EP组(P<0.01);INS+EP组和INS组伤后各时点血糖均明显低于EP组(P<0.01),INS+EP组伤后各时点血糖和INS组比较无显著差异(P>0.05),INS组伤后各时点血TNF-α、HMGB1、TAC水平均明显低于EP组(P<0.01),血MDA水平均明显高于EP组(P<0.01)。结论 INS和EP可有效降低严重烫伤后MODS大鼠机体过度炎症反应和改善氧化应激程度,但作用各有侧重,二者联合治疗效果优于单独治疗。
Objective To observe the effects of insulin and ethyl pyruvate (EP) on the inflammatory reaction and oxidative stress in rats with multiple organ dysfunction syndrome (MODS) after severe scald. Methods Eighty MODS rats with SD grade Ⅲ, 30% body surface were randomly divided into two groups: INS treatment group (n = 20), EP treatment group (n = 20), INS and EP combined treatment group (INS + EP group, n = 20) and control group (control group, n = 20). INS [2.0 U / (kg · d)], EP [40 mg / (kg · d)], INS + EP [2.0 U (kg · d) ) +40 mg / (kg · d)] and an equal volume of Ringer’s solution. Blood glucose, alanine aminotransferase (ALT), creatine kinase (CK) and creatinine (Cr) and tumor necrosis factor-α (TNF-α), high mobility group 1 (HMGB1), malondialdehyde (MDA) and total antioxidant capacity (TAC). Results The levels of blood glucose, ALT, CK-MB, Cr and TNF-α, HMGB1 and MDA in INS group, EP group and INS + EP group were significantly lower than those in control group (P <0.01) (P <0.01). The levels of ALT, CK-MB, Cr, TNF-α, HMGB1 and MDA in INS + EP group were significantly lower than those in INS group and EP group (P <0.01). The levels of TAC in INS + EP group and INS group were significantly lower than those in EP group (P <0.01) There was no significant difference between point blood glucose and INS group (P> 0.05). The levels of TNF-α, HMGB1 and TAC in INS group were significantly lower than those in EP group (P <0.01) EP group (P <0.01). Conclusion INS and EP can effectively reduce excessive inflammatory reaction and improve the degree of oxidative stress in MODS rats after severe scald injury, but their effects are different. The combined treatment is better than single treatment.