摘要
目的观察肢体缺血一再灌注对全身炎症反应与凝血一纤溶系统的影响，观察肢体缺血预处理对全身炎症反应和凝血～纤溶系统的干预作用。方法（40只）SD大鼠随机分为4组：假手术对照组（sc）、单纯缺血组（I），缺血再灌注（IR）组（夹闭两侧髂外动脉，再以橡皮带扎紧双后肢根部阻断血流，4h后放开动脉夹、松开橡皮带，恢复血液灌注4h；IR＋IPC组先阻断双后肢血流5min，然后恢复血流灌注5min，如此反复3次，其后操作同IR组，缺血再灌注组（IR）和缺血再灌注＋缺血预处理组（IR＋IPC）。缺血前、缺血4h及再灌注4h取外周静脉血，ELISA法测定肿瘤坏死因子一α（TNF一仪）、白介素一6（IL一6）、和组织因子（TF）、组织型纤溶酶原激活物（tPA）及纤溶酶原激活物抑制物一1（PAI一1）活性，比色法测定内毒素（ET），自动血凝仪检测凝血酶原时间（prothrombintime，PT）和活化部分促凝血激酶时间（activatedpartialthromboplastintime，APTT）。结果IR组和IR＋IPC组的血浆TNF一旺、IL一6、TF、ET含量均显著高于c和I组，但IR＋IPC组的IL一6、TF、ET均显著低于IR组，P〈O．05或P〈O．01；IR组的血浆tPA水平显著低于、PAI显著高于sc组，均P〈0．05，IR＋IPC组的tPA高于、PAI低于IR组，均P〈O．05；IR组的PT和AFYF均明显短于sc组、I组和IR＋IPC组。血浆ET、IL一6水平与PAl一1呈正相关，与PT、AlYl~均呈负相关。结论肢体缺血一再灌注导致全身炎症反应，同时凝血一纤溶系统功能紊乱，肢体缺血预处理干预可以减弱全身炎症反应，调节凝血一纤溶系统功能的平衡。
Objective To observe the effects of lower limb ischemia-reperfusion on systemic inflammatory response and coagulation-fibrinolysis system, and further explore the role of ischemic preconditioning in systemic inflammatory response and coagulation-fibrinolysis system during lower limb ischemia-reperfusion. Methods 40 SD rats were randomly divided into 4 groups, sham control （SC） group, ischemia （I） group, ischemia reperfusion （IR） group undergoing clamping of bilateral external iliac artery and blood flow occlusion with rubber band of two hind-limbs for 4 hours and then with the blood flow perfusion restored for 4 hours, and ischemic preconditioning （IR＋IPC） group undergoing occlusion of blood flow of the 2 hind-limbs for 5 minutes and then restoring blood flow perfusion for 5 rain three times. Peripheral venous blood samples were collected before ischemia, 4 hours after ischemia, and 5 rain after reperfusion. The concentrations of tumor necrosis factor-e （TNF-α）, interleukin-6 （IL-6）, plasma tissue factor （TF）, tissue plasminogen activator （tPA）, and plasminogen activator inhibitor 1 （PAl-l） were assayed by ELISA. The endotoxin （ET） level was measured by using tachypleus amebocyte lysate （TAL） assay. Prothrombin time （PT） and activated partial thromboplastin time （APTF） were measured by automatic coagulation analyzer. Results The plasma concentrations of TNF-α,IL-6, TF, and ET of the IR and IR＋IPC groups were significantly higher than those of the SC and I groups. The IL-6, TF, and ET concentrations of the IR＋IPC group were all significantly lower thanthose of the IR group P 〈0.05 or P 〈0.01. The plasma concentration of tPA of the IR group was significantly lower than that of the SC group group, and the PAI-1 of the IR group was significantly higher than that of the SC group （both P〈0.05）; and the plasma tPA concentration of the IR＋IPC group was significantly higher than that of the IR group, and the plasma PAI-1 of the IR＋IPC group was significantly lower than that of the IR group （both P〈0.05）. The PT and APTY of SC, I, and IR＋IPC groups were shorter than those of the IR group （P〈0.05 or P〈 0.01）. The PT and AFIT of the IR group were significantly shorter than those of SC, I, and IR＋IPC groups （all P 〈 0.05）. The plasma levels of ET and IL-6 were positively related with the PAI-1 concentration, and negatively related with the FF and APTT. Conclusion Lower limb ischemia-reperfusion may induces systemic inflammatory response and coagulation-fibrinolysis system imbalance. Limb ischemic preconditioning is considered being effective in reducing inflammatory response and corrects coagulation-fibrinolysis system imbalance.
出处
《中国急救复苏与灾害医学杂志》
2013年第10期896-899,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
温州市科技局科研基金资助（Y2003A112）
关键词
肢体
缺血一再灌注
炎症
凝血
纤维蛋白溶解
缺血预处理
Limb
Ischemia-reperfusion
Inflammation
Coagulation
Fibrinolysis
Ischemic preconditioning
