β-D-葡聚糖对类固醇诱导的结肠吻合口愈合损伤的影响。

Dinc S, Durmus E, Gulcelik M A, Kuru B, Ustun H, Renda N, Alagol H

Department of General Surgery, Ankara Oncology Training and Research Hospital, Hacettepe University, Ankara, Turkey.

Acta Chir Belg. 2006 Jan-Feb;106(1):63-7. doi: 10.1080/00015458.2006.11679836.

BACKGROUNDS/AIMS: Inflammation during the early phase of anastomotic wound healing is an essential cellular response and is suppressed by corticosteroids. The anti-inflammatory effect of corticosteroids is largely responsible for its impairment of wound healing in bowel anastomosis. Beta-D-glucan, a commonly used macrophage activator, has been shown to improve anastomotic wound healing under normal conditions. In the present study, we have investigated the effects of beta-D-glucan on anastomotic wound healing in rats treated with long-term corticosteroid.

METHODOLOGY

92 male Sprague-Dawley rats were randomized into four groups. 1 : control, 2: control + beta-D-glucan, 3 : steroid, 4 : steroid + beta-D-glucan. Methylprednisolone (5mg/kg) was injected IM daily for 14 days in groups 3 and 4. After 14 days, following anaesthesia and laparotomy, colonic anastomosis was performed 3 cm away from the peritoneal reflection of rectum. In groups 2 and 4, 100mg/kg beta-D-glucan was administered orally for 7 days before laparotomy. On postoperative day 3, relaparotomies were performed and bursting pressures, hydroxyproline levels and histopathological specimens were studied.

RESULTS

The mean values of bursting pressures groups were 50.8 (95% CI 46.99-56.50), 58.2 (95% CI 54.49-61.90), 32.0 (95% CI 29.21-34.98), 45.9 (95% CI 43.09-48.80) respectively. The differences of the mean values of the groups between group 1 and 2 and also 3 were significant (p = 0.002, p < 0.001). The mean values of hydroxyproline of the groups were 3.8 (95% CI 3.56-4.06), 4.7 (95% CI 4.50-5.04), 2.9 (95% CI 2.73-3.20), 3.9 (95% CI 3.65-4.22) respectively. The differences of the values of the groups between control (group1) and group 2 and also group 3 were significant (p = 0.001, p < 0.001). In histopathological examination, increased macrophages and fibroblast population were observed in specimens from beta-D-glucan-treated animals.

CONCLUSION

The results indicate that in rat model, oral administration of beta-D-glucan causes a significant improvement in the healing of anastomotic wound impaired by long-term corticosteroid administration.

背景/目的：吻合口伤口愈合早期的炎症是一种重要的细胞反应，可被皮质类固醇抑制。皮质类固醇的抗炎作用在很大程度上导致了其对肠吻合口伤口愈合的损害。β-D-葡聚糖是一种常用的巨噬细胞激活剂，已被证明在正常情况下可促进吻合口伤口愈合。在本研究中，我们调查了β-D-葡聚糖对长期接受皮质类固醇治疗的大鼠吻合口伤口愈合的影响。

方法

92只雄性Sprague-Dawley大鼠随机分为四组。1组：对照组；2组：对照组+β-D-葡聚糖；3组：类固醇组；4组：类固醇+β-D-葡聚糖组。第3组和第4组大鼠每天肌肉注射甲基强的松龙（5mg/kg），共14天。14天后，麻醉并剖腹，在距直肠腹膜反折3cm处进行结肠吻合。在第2组和第4组中，剖腹术前7天口服给予100mg/kgβ-D-葡聚糖。术后第3天再次剖腹，研究破裂压力、羟脯氨酸水平和组织病理学标本。

结果

各组破裂压力的平均值分别为50.8（95%可信区间46.99-56.50）、58.2（95%可信区间54.49-61.90）、32.0（95%可信区间29.21-34.98）、45.9（95%可信区间43.09-48.80）。第1组与第2组以及第3组之间的平均值差异具有统计学意义（p = 0.002，p < 0.001）。各组羟脯氨酸的平均值分别为3.8（95%可信区间3.56-4.06）、4.7（95%可信区间4.50-5.04）、2.9（95%可信区间2.73-3.20）、3.9（95%可信区间3.65-4.22）。对照组（第1组）与第2组以及第3组之间的值差异具有统计学意义（p = 0.001，p < 0.001）。在组织病理学检查中；在β-D-葡聚糖处理动物的标本中观察到巨噬细胞和成纤维细胞数量增加。