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目的:探讨兔急性肺血栓栓塞症(APTE)时肺血管内皮、支气管和肺泡上皮等部位内皮素1(ET-1)、血清炎症因子血栓素A2(TXA2)和前列环素(PGI2)、动脉血气的表达状况及尿激酶(UK)溶栓或血必净抗炎治疗对其的影响。方法:30只大耳白兔随机分为对照组、PTE模型组、UK组、血必净组、和UK+血必净组,每组6只。采用自体血栓回输法建立动物模型。常规取造模前、造模后1、2、4、8h行动脉血气分析、放免法测定TXA2和PGI2、最后病理学检查及免疫组化法检测肺血管内皮、支气管和肺泡上皮等部位ET-1的表达水平。结果:①血气分析:模型组栓塞后血氧分压(PO2)、二氧化碳分压(PCO2)与对照组相比均明显下降,血必净组与模型组比较无差异。UK及UK+血必净组后PO2指标较模型组提前好转;②放免法测定结果:TXA2、PGI2栓塞组1h升高,2h达高峰,4h后开始降低,1、2、4h与对照组比较都有显著性差异(P<0.01),血必净组、UK组及血必净+UK组均1h升高,2h达高峰,2h后开始下降,且各治疗组高峰值均较栓塞组低。各组术前无显著性差异;1、2、4h各治疗组与模型组和对照组相比有显著性差异(P<0.01)。且各治疗组组间比较也有显著性差异,其中以血必净+UK组浓度下降最快,UK组次之,血必净组较慢。8h各组无显著性差异;③病理检查显示:PTE组兔肺组织病理损伤明显,血必净、UK组肺组织损伤较PTE组减轻,UK+血必净组肺组织损伤最轻;④免疫组化检测显示:PTE组和血必净组ET-1蛋白表达的相对含量显著高于对照组,UK组和UK+血必净组与对照组比较无统计学意义。结论:APTE后溶栓结合抗炎治疗可明显改善动脉血气,降低TXA2、PGI2炎症因子和ET-1介导的急性肺损伤,提示血必净能减轻APTE时的肺损伤,同时对患者开展溶栓治疗时,也要重视必要的抗炎治疗使用。
OBJECTIVE: To investigate the endothelin-1 (ET-1), thromboxane A2 (TXA2), and prostacyclin (PGI2), arterioles in pulmonary vascular endothelium, bronchial and alveolar epithelium in rabbits with acute pulmonary thromboembolism (APTE) The expression of blood gas and the effect of urokinase (UK) thrombolysis or Xuebijing anti-inflammatory treatment on it. Methods: Thirty white rabbits were randomly divided into control group, PTE model group, UK group, Xuebijing group, and UK+ Xuebijing group, with 6 rats in each group. An animal model was established using autologous thrombus reinfusion. Arterial blood gas analysis, radioimmunoassay (TXA2, PGI2), pathological examination, and immunohistochemistry before and after the model were performed to detect the ET-related sites of the pulmonary vascular endothelium, bronchi and alveolar epithelium. 1 expression level. Results:1 Blood gas analysis: The blood oxygen partial pressure (PO2) and carbon dioxide partial pressure (PCO2) of the model group were significantly decreased compared with the control group. There was no difference between the Xuebijing group and the model group. After the UK and UK+ Xuebijing group, the PO2 index was improved earlier than the model group;2 The results of radioimmunoassay: TXA2, PGI2 embolism group increased 1h, peaked at 2h, decreased after 4h, compared with the control group at 1,2,4h There was a significant difference (P<0.01). Xuebijing group, UK group and Xuebijing+UK group all increased 1h, peaked at 2h, and began to decline after 2h. The peak value of each treatment group was lower than that of embolization group. There was no significant difference between the groups before surgery; there was a significant difference between the treatment groups at 1, 2 and 4 hours compared with the model group and the control group (P<0.01). There was also a significant difference between the treatment groups. Among them, the concentration of Xuebijing + UK decreased the fastest, followed by UK, followed by Xuebijing. At 8h, there was no significant difference between the groups; 3 Pathological examination showed that the lung tissues of PTE group had obvious pathological lesions. Xuebijing and UK group had less lung tissue injury than PTE group. UK+ Xuebijing group had the lightest lung tissue injury; 4 immunization group. The results showed that the relative contents of ET-1 protein in the PTE group and Xuebijing group were significantly higher than those in the control group. There was no significant difference between the UK group and the UK+ Xuebijing group compared with the control group. Conclusion: Post-APTE thrombolysis combined with anti-inflammatory treatment can significantly improve arterial blood gas, reduce TXA2, PGI2 inflammatory factors and ET-1 mediated acute lung injury, suggesting that Xuebijing can reduce lung injury during APTE, and at the same time, it can be dissolved in patients. When thrombolytic therapy is performed, it is also necessary to pay attention to the necessary anti-inflammatory treatment.