腺苷注射液治疗胸部撞击后肺挫伤的作用机制

doi:10.3877/cma.j.issn.2095-8773.2015.03.012

中华胸部外科电子杂志 ›› 2015, Vol. 02 ›› Issue (03) : 197 -201. doi: 10.3877/cma.j.issn.2095-8773.2015.03.012

所属专题：文献；

论著

腺苷注射液治疗胸部撞击后肺挫伤的作用机制

吴卫春¹^,^†(

), 张丽萍¹, 杜峰¹, 许坚¹, 梁治¹, 林伟¹, 王胜利²

^1. 311100　浙江大学医学院附属第二医院余杭分院，余杭第一人民医院心胸外科
^2. 325035　温州医科大学附属第二医院心胸外科

收稿日期:2015-05-12 出版日期:2015-08-28
通信作者: 吴卫春
基金资助:
杭州市卫生科技计划资助项目(2012B029)

Mechanism of adenosine injection in treatment of lung contusion following chest impact

Weichun Wu¹^,^†(), Liping Zhang¹, Feng Du¹, Jian Xu¹, Zhi Liang¹, Wei Lin¹, Shengli Wang²

^1. Department of Cardiothoracic Surgery, Yuhang Hospital, Hangzhou Normal University College of Medicine, Hangzhou 311100, China
^2. Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, China

Received:2015-05-12 Published:2015-08-28
Corresponding author: Weichun Wu
About author:
Corresponding author: Wu Weichun, Email: zjwuweichun@163.com

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目的

探讨腺苷注射液对撞击所致肺挫伤的治疗作用机制。

方法

选取30只健康日本大耳兔，随机分为对照组和腺苷注射液治疗组，每组15只。用BIM-Ⅱ型生物撞击机制备兔肺挫伤模型，分别于撞击前10 min和撞击后1、3、5、7 h采集颈总动脉血，采用硫代巴比妥酸(TBA)比色法检测丙二醛(MDA)浓度，ELASA试剂盒检测白介素-10(IL-10)浓度。于伤后7 h取下兔右肺，采用比色法检测肺组织中髓过氧化物酶(MPO)含量，ELISA法检测支气管肺泡灌洗液(BALF)中肿瘤坏死因子α(TNF-α)含量，并测定肺泡表面活性物质水平。解剖并观察兔肺大体和显微病理学改变。

结果

对照组受伤后不同时间点的血浆MDA浓度、肺组织中MPO含量、BALF中TNF-α浓度和中性粒细胞弹性蛋白酶(NE)活性均较腺苷组显著升高(P<0.05或P<0.01)，而腺苷治疗组血浆IL-10浓度和BALF中总磷脂(TPL)含量均较对照组明显升高(P<0.05或P<0.01)。对照组肺组织实变明显，肺泡结构破坏，大量中性粒细胞(PMNs)为主的炎症细胞及红细胞、血小板等聚集，相邻肺泡间质水肿增厚，线粒体肿胀空泡化，微绒毛和板层小体稀少；腺苷组肺泡结构基本正常，可见腺苷治疗组肺组织的病理损害明显较对照组减轻。

结论

腺苷注射液对肺挫伤有治疗作用，其机制可能与调节肺挫伤早期炎症因子浓度有关。

关键词: 胸部损伤, 肺, 腺苷注射液

Objective

To investigate the mechanism of adenosine injection in treatment of lung contusion following chest impact.

Methods

Thirty healthy Japanese big-ear rabbits were randomly assigned to control groupand adenosine injection treatment group, with 15 rabbits in each group. The lung contusion model was prepared by BIM-Ⅱ bioimpact machine. Blood samples were taken from common carotid artery 10 min before impact and 1 h, 3 h, 5 h and 7 h after impact, the plasma concentrations of malondialdehyde(MDA) were measured by thiobarbituric acid(TBA) method, and the levels of interleukin-10(IL-10) were determined by ELISA. The right lungs of rabbits were obtained 7 h after injury, the contents of myeloperoxidase(MPO) in lung tissues were decected by colorimetric assay, the concentrations of tumor necrosis factor α(TNF-α) in bronchoalveolar lavage fluid(BALF) were examined by ELISA, and levels of alveolus surface active substance were also determined. The gross and microscopic appearance was observed.

Results

The concentration of plasma MDA, content of MPO in lung tissues, concentrations of TNF-α and activity of neutrophil elastase (NE) in BALF in control group were significantly higher than those in adenosine injection treatment group(P<0.05 or P<0.01). However, the plasma concentration of IL-10 and content of total phospholipids (TPL) in BALF in adenosine injection treatment group were significantly higher than those in control group (P<0.05 or P<0.01). The morphological observation found serious lung consolidation in control group, with damaged alveolar structure and congregation of large amount of inflammatory cells, red blood cells and blood platelets, while revealed almost normal alveolar structure in adenosine injection treatment group, which indicated that the injury in adenosine injection treatment group was less severe than that in control group.

Conclusions

Adenosine injection has a therapeutic effect onlung contusion, the mechanism of which may be related to the regulation of inflammatory factors in the early stage of lung contusion.

Key words: Thoracic injury, Lung, Adenosine injection

表1 两组兔血浆丙二醛(MDA)浓度的变化(±s，nmol/ml)

组别	兔数	受伤前	受伤后
组别	兔数	受伤前	1 h	3 h	5 h	7 h
对照组	15	15.01±1.98	21.90±3.07	22.86±3.11	24.95±1.29	23.00±2.58
腺苷治疗组	15	15.11±1.69	15.90±2.20	16.26±1.52	16.71±2.62	15.28±2.08
t值	?	1.21	5.12	5.78	8.87	6.59
P值	?	>0.05	<0.01	<0.01	<0.01	<0.01

表1 两组兔血浆丙二醛(MDA)浓度的变化(±s，nmol/ml)

组别	兔数	受伤前	受伤后
组别	兔数	受伤前	1 h	3 h	5 h	7 h
对照组	15	15.01±1.98	21.90±3.07	22.86±3.11	24.95±1.29	23.00±2.58
腺苷治疗组	15	15.11±1.69	15.90±2.20	16.26±1.52	16.71±2.62	15.28±2.08
t值	?	1.21	5.12	5.78	8.87	6.59
P值	?	>0.05	<0.01	<0.01	<0.01	<0.01

表2 两组兔血浆白介素-10(IL-10)浓度的变化(±s，pg/ml)

组别	兔数	受伤前	受伤后
组别	兔数	受伤前	1 h	3 h	5 h	7 h
对照组	15	0.090±0.002	0.071±0.003	0.066±0.001	0.058±0.003	0.062±0.002
腺苷治疗组	15	0.084±0.003	0.079±0.001	0.073±0.003	0.075±0.002	0.080±0.001
t值	?	1.32	2.58	3.42	3.54	1.94
P值	?	>0.05	<0.05	<0.01	<0.01	>0.05

表2 两组兔血浆白介素-10(IL-10)浓度的变化(±s，pg/ml)

组别	兔数	受伤前	受伤后
组别	兔数	受伤前	1 h	3 h	5 h	7 h
对照组	15	0.090±0.002	0.071±0.003	0.066±0.001	0.058±0.003	0.062±0.002
腺苷治疗组	15	0.084±0.003	0.079±0.001	0.073±0.003	0.075±0.002	0.080±0.001
t值	?	1.32	2.58	3.42	3.54	1.94
P值	?	>0.05	<0.05	<0.01	<0.01	>0.05

表3 两组兔肺组织指标比较(±s)

组别	兔数	MPO(IU/g)	TNF-α(μg/L)	NE(IU/ml)	TPL(μg/g)
对照组	15	1.25±0.69	1.12±0.45	15.11±4.37	235.58±43.71
腺苷治疗组	15	0.70±0.41	0.58±0.22	7.92±3.55	518.92±66.14
t值	?	3.86	3.69	5.75	6.45
P值	?	<0.01	<0.01	<0.01	<0.01

表3 两组兔肺组织指标比较(±s)

组别	兔数	MPO(IU/g)	TNF-α(μg/L)	NE(IU/ml)	TPL(μg/g)
对照组	15	1.25±0.69	1.12±0.45	15.11±4.37	235.58±43.71
腺苷治疗组	15	0.70±0.41	0.58±0.22	7.92±3.55	518.92±66.14
t值	?	3.86	3.69	5.75	6.45
P值	?	<0.01	<0.01	<0.01	<0.01

图2 腺苷组肺组织细胞改变。2A：光镜下观察，HE染色×100；2B：电镜下观察×10 000

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