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目的观察不同时相点切痂对烫伤大鼠外周血淋巴细胞凋亡及单核细胞抗原呈递功能的影响。方法将136只雄性Wistar大鼠随机分为对照组(8只)、单纯烫伤组(64只)、休克期切痂组(40只)、非休克期切痂组(24只)。对照组不作烫伤处理;其他组均造成30％TBSAⅢ度烫伤,其中后两组分别于伤后36、120 h行切痂植皮术。单纯烫伤组分别于伤后6、12、24、72、120、168、216、288 h处死;两个切痂组分别于伤后72～288 h、168～288 h(时间间隔同上)处死,留取血液标本检测淋巴细胞凋亡率、单核细胞主要组织相容性抗原(MHC)Ⅱ类分子阳性表达率、干扰素(IFN)γ及白细胞介素(IL)4浓度的变化,并行相关性分析。结果伤后6 h开始,单纯烫伤组淋巴细胞凋亡率迅速升高,24 h达峰值(18．19±1．42)％,之后迅速回落,于伤后72 h降至低谷(8．25±0．56)％,随着时间延长又逐渐升高,288 h时(17．81±1．99)％接近峰值,均明显高于对照组(P<0．05);伤后168～288 h两个切痂组淋巴细胞凋亡率明显低于单纯烫伤组(P<0．01)。单纯烫伤组伤后6 h单核细胞MHC-Ⅱ类分子阳性表达率急剧下降,伤后24 h已低于对照组[(37．2±2．4)％]的20％,之后逐渐升高,伤后288 h为(18．8±2．8)％,明显低于两个切痂组(P<0．01)。伤后6 h开始,单纯烫伤组血浆IFN-γ浓度迅速上升,24 h时达峰值(440．8±25．1)ng／L,之后逐渐回落,288 h降至低谷(51．3±37．0)ng／L;而IL-4水平则呈线性上升,于伤后288 h达峰值(78．1±2．8)ng／L;伤后72～288 h单纯烫伤组单核细胞MHC-Ⅱ类分子阳性表达率与休克期切痂组IFN-γ／IL-4比值呈明显的负相关(r= -0．96,P<0．05)。结论大鼠烫伤后切痂能明显抑制淋巴细胞凋亡,减缓IFN-γ／IL-4倒置的趋势,改善单核细胞抗原呈递功能。其中在单核细胞免疫功能恢复方面,休克期切痂较非休克期切痂效果显著。
Objective To observe the effects of escharectomy at different time points on apoptosis of peripheral blood lymphocytes and monocyte antigen presenting function in scalded rats. Methods Thirty - six male Wistar rats were randomly divided into control group (n = 8), scald group (n = 40), non - shock group (n = 24). The control group was not scalded; other groups were caused by 30% TBSA degree scald, in which the latter two groups were esophageal skin grafting 36,120 h after injury respectively. The wounds were sacrificed at 6, 12, 24, 72, 120, 168, 216 and 288 h after injury respectively. The two escharectomy groups were sacrificed 72 to 288 h and 168 to 288 h post-injury, respectively, Blood samples were collected to detect the changes of lymphocyte apoptosis rate, the positive expression rate of MHC class II molecules, the concentrations of interferon (IFN) γ and interleukin (IL) 4 in parallel, Sexual analysis. Results The apoptosis rate of lymphocytes in the scald group increased rapidly at 6 h after injury, reaching the peak at 24 h (18.19 ± 1.42)%, then dropping rapidly and dropping to the trough at 72 h ± 0.56)%, and then gradually increased with time, reaching a peak at 288 h (17.81 ± 1.99)%, which were significantly higher than those in the control group (P <0.05) The apoptotic rates of lymphocytes in two escharectomy groups at 288 h were significantly lower than those in simple scald group (P <0.01). The positive rate of MHC-Ⅱ expression in mononuclear cells decreased sharply at 6 h after injury in the scalded group, which was lower than that in the control group [(37.2 ± 2.4)%] at 24 h after injury, and then gradually increased (18.8 ± 2.8)% after 288 h, which was significantly lower than that of the two escharectomy groups (P <0.01). At 6 h after injury, the plasma IFN-γ level increased rapidly in the scald group, reaching a peak at 440 h (440.8 ± 25.1) ng / L at 24 h, then gradually decreased and dropped to a trough at 288 h (51.3 ± 37 .0) ng / L, while the level of IL-4 increased linearly and peaked at 288 h after injury (78.1 ± 2.8) ng / L, while that of the scalded mononuclear cells at 72 ~ 288 h The positive rate of IFN-γ / IL-4 was negatively correlated with the level of IFN-γ / IL-4 in the escharectomy group (r = -0.96, P <0.05). Conclusion Scald after scald in rats can significantly inhibit lymphocyte apoptosis, slow down the tendency of IFN-γ / IL-4 upside down and improve the antigen presenting function of monocytes. Among them, in the recovery of monocyte immune function, the escharectomy during shock stage is more effective than the non-shock period.