血必净对急性肺动脉栓塞有保护作用
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The investigate of Xuebijing's protection in acute pulmonary embolism
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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1-2-4-8 h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1 h升高,2 h达高峰,4 h后开始降低,1-2-4 h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1 h升高,2 h达高峰,2 h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;1-2-4 h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-8 h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-

    Abstract:

    Objective:To study the expression levels of endothelin-1(ET-1)in lung vascular endothelium,bronchial and alveolar epithelia,thromboxane A2(TAX2)and prostacyclin(PGI2)in plasma and arterial blood gas in acute pulmonary thromboembolism(APTE)of rabbit,and explore the effects of thrombolytic(urokinase,UK)and ant-inflammatory therapy(xuebijing)on their expressions. Methods:Thirty rabbits were randomly divided into the control group,the pulmonary thromboembolism(PTE)model group,the Xuebijing therapy group,the UK therapy group and an UK + Xuebijing therapy group,with 6 rabbits in each group. The PTE model was established by intravenous injection of autologous blood clots. Arterial bloodgas were analyzed,and Plasma’s concentrations of TXA2 and PGI2 by were examined by radioimmunoassay before and 1 h,2 h,4 h,8 h after injection. Pathological changes of the lung were examined with light microscope,and the expression levels of ET-1 in lung vascularendothelium,bronchial and alveolar epithelia were examined by immunohistochemistry. Results:①Arterial blood gas analysis showed that PO2 and PCO2 were obviously lower in PTE model group than the control group,no significance found in Xuebijing group and PTE group;the PO2 improved earlier in UK and UK + Xuebijing groups than in PTE group;②radioimmunoassay showed that TXA2 and PGI2 in the PTE group increased at 1 h,peaked at 2 h,decreased at 4 h,which also were higher than those in the control group at 1 h,2 h,4 h(P < 0.01),In the treat group TXA2 and PGI2 increased at 1 h,peaked 2 h,decreased after 2 h,also decreased fasted than those in PTE group at 1 h,2 h and 4 h irrespectively(P < 0.01),especially in UK + Xuebijing group. There were no differences in TXA2 and PGI2 before injection and 8 h after injectionin in each groups;③Histopathological study showed that lung injury was obvious in the PTE,but was less inUK and Xuebijing groups,and least inthe UK + Xuebijing group;④the immunohistochemistry results showed in the PTE and Xuebijing groups,the expression levels of ET-1 in lung vascular endothelium,bronchial and alveolar epithelia were significantly higher compared those in the control group. The UK and UK + Xuebijing groups were significantly lower in ET-1 as compared to the PTE group. Conclusion:After APTE,thrombolytic and anti-inflammatory treatment could improve arterial blood gas,decrease TXA2,PGI2 and acute lung injury induced by ET-1. Thus,Xuebijing injection may alleviate pulmonary inflammation and decrease acute lung injury in APTE . Anti-inflammatory therapy should be considered in APTE when thrombolytic treatment was used.

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陈旭锋,黄培培,吴 昊,陈 彦,张劲松.血必净对急性肺动脉栓塞有保护作用[J].南京医科大学学报(自然科学版),2009,29(5):695-701

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  • 收稿日期:2009-01-19
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