Narita Kiyoshi, Kuwabara Yoshiyuki, Fujii Yoshitaka
Department of Surgery II, Nagoya City University Medical School, 1 Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan.
Surg Today. 2004;34(11):937-42. doi: 10.1007/s00595-004-2847-9.
It has been suggested that inflammatory mediators such as cytokines released during intestinal ischemia and reperfusion increase permeability in the lungs. Cytokines exist at concentrations several hundred times higher at the site of inflammation than in the blood. When absorbed, the locally produced cytokines may affect multiple remote organs. We thus investigated whether the isolation of the intestine in a bag during ischemia and reperfusion can reduce subsequent lung injury.
Rats were divided into three groups: group 1, simple laparotomy (sham); group 2, intestinal ischemia and reperfusion (I/R); and group 3, intestinal ischemia and reperfusion with an intestinal bag (IB). Lung permeability was assessed using the Evans Blue leakage method. Cytokines (interleukin-1beta, tumor necrosis factor alpha, interleukin-8) in the plasma and ascites were measured by enzyme-linked immunosorbent assay.
The increase in lung permeability of I/R significantly decreased in IB (1.73 +/- 0.48 vs 1.05 +/- 0.22, P < 0.01). The plasma cytokine concentrations were also lower in IB than in I/R. In addition, the cytokine levels in the intestinal bag fluid were extremely high.
The isolation of the intestine during ischemia and reperfusion was found to reduce the degree of subsequent lung injury, possibly due to the reduced absorption of locally produced cytokines via the parietal peritoneum.
有人提出，诸如在肠道缺血和再灌注期间释放的细胞因子等炎症介质会增加肺部的通透性。细胞因子在炎症部位的浓度比在血液中高数百倍。当被吸收时，局部产生的细胞因子可能会影响多个远处器官。因此，我们研究了在缺血和再灌注期间将肠道置于袋中是否能减轻随后的肺损伤。
将大鼠分为三组：第1组，单纯剖腹术（假手术）；第2组，肠道缺血和再灌注（I/R）；第3组，肠道缺血和再灌注并使用肠袋（IB）。使用伊文思蓝渗漏法评估肺通透性。通过酶联免疫吸附测定法测量血浆和腹水中的细胞因子（白细胞介素-1β、肿瘤坏死因子α、白细胞介素-8）。
I/R组肺通透性的增加在IB组中显著降低（1.73±0.48对1.05±0.22，P<0.01）。IB组的血浆细胞因子浓度也低于I/R组。此外，肠袋液中的细胞因子水平极高。
发现在缺血和再灌注期间隔离肠道可减轻随后的肺损伤程度，这可能是由于通过壁腹膜吸收的局部产生的细胞因子减少所致。
