兔急性肺血栓栓塞及溶栓后TXA2?PGI2及ET-1水平的变化与血流动力学相关性研究
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The correlation study between levels of TXA2,PGI2,ET-1 and hemodynamic changes after thrombolysis in acute pulmonary embolism of rabbit
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    摘要:

    目的:探讨兔急性肺动脉血栓栓塞时血清炎症因子血栓素A2(TXA2)-前列环素(PGI2)和肺血管内皮-支气管和肺泡上皮等部位内皮素1(ET-1)变化和血流动力学指标变化及尿激酶(UK)溶栓的影响-方法:24只大耳白兔随机分为对照组-急性肺栓塞(acute pulmonary thromboembolism,APTE) 模型组-尿激酶(UK)治疗组,每组8只-采用自体血栓回输法建立动物模型-常规于造模前-造模后1-2-4-8 h放免法测定血清TXA2-PGI2,漂浮导管监测血流动力学指标,最后免疫组化法检测肺血管内皮-支气管和肺泡上皮各部位ET-1的表达水平-结果:①放免法测定结果:对照组各时间点无显著差异-模型组1 h升高,4 h达高峰,其后开始降低,1-2-4 h点与对照组比较都有统计学意义(P < 0.01)-UK组1 h升高,2 h达高峰,4 h后开始下降,UK组高峰值较模型组低,1-2-4 h UK组与模型组两者有统计学意义 (P < 0.01)-各组术前和8 h无统计学差异(P > 0.05);②血流动力学监测结果:对照组各时间点肺动脉平均压(PAMP)-中心静脉压(CVP)都无明显变化,模型组及UK组PAMP-CVP栓塞后立即升高,2 h升至最高,后有所下降,1-2-4-8 h模型组和UK组两组与对照组均有统计学差异(P < 0.01);UK组与模型组1-2 h有统计学差异(P < 0.01),4-8 h无统计学差异(P > 0.05);③免疫组化检测显示:模型组ET-1蛋白表达的相对含量显著高于对照组,UK组与对照组比较无统计学差异-结论:细胞因子TXA2-PGI2-ET-1参与了APTE早期肺血管阻力增加,APTE早期溶栓可明显降低TXA2- PGI2- ET-1以及减轻肺血管阻力的增加-

    Abstract:

    Objective:To study the expression levels of thromboxane A2(TXA2) and prostacyclin (PGI2) in the plasma,endothelin-1(ET-1)in vascular endothelium,bronchial and alveolar epithelia of lungs,and hemodynamic changes in acute pulmonary thromboembolism(APTE) of rabbit,and to explore the effects of thrombolytic(urokinase,UK)on their expressions. Methods:Twenty four rabbits were randomly divided into a control group,a APTE model group,a UK therapy group,with 8 rabbits each. The APTE model was established by intravenous injection of autologous blood clots. The plasma’s concentrations of TXA2 and PGI2 were examined by radioimmunoassay before and 1 h,2 h,4 h,8 h after injection. The hemodynamic monitoring were used by float catheter. The expression levels of ET-1 in lung vascular endothelium,bronchial and alveolar epithelia were examined by immunohistochemistry. Results:①The radioimmunoassay showed that TXA2 and PGI2 had no diference in the control group at each point;TXA2 and PGI2 in the APTE 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 UK group,TXA2 and PGI2 increased at 1 h,peaked 2 h,decreased after 2 h,also decreased faster than those in the APTE group at 1 h,2 h and 4 h,respectively(P < 0.01). There were no differences in TXA2 and PGI2 before injection and 8 h after injectionin in each group(P > 0.05). ②Hemodynamic monitoring showed that the PAMP and CVP were no change in the control group;and PAMP and CVP in the APTE group and UK group increased immediately after embolism,peaked at 2 h,then decreased,which also were higher than those in the control group at 1 h,2 h,4 h,8 h(P < 0.01). In the UK group PAMP and CVP also decreased faster than those in the APTE group at 1 h,2 h respectively(P < 0.01). There were no differences at 4 h and 8 h between the APTE group and the UK group. ③The immunohistochemistry results showed in the APTE,the expression levels of ET-1 in lung vascular endothelium,bronchial and alveolar epithelia were significantly higher compared with those in the control group. The UK group was significantly lower in ET-1 as compared to the APTE group. Conclusion:After APTE,TXA2,PGI2,ET-1 participated increasing of pulmonary vascular resistance,and early thrombolytic treatment could decrease TXA2,PGI2,ET-1,also relieved pulmonary vascular resistance.

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张劲松,黄培培,陈旭锋,吴〓昊.兔急性肺血栓栓塞及溶栓后TXA2?PGI2及ET-1水平的变化与血流动力学相关性研究[J].南京医科大学学报(自然科学版),2010,(3):375-379

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