Monnot Antoine, Dumesnil Anaïs, Renet Sylvanie, Roquet Marie Laurence, Richard Vincent, Plissonnier Didier
Service de chirurgie vasculaire, CHU de Rouen, Rouen, France.
Unité Inserm 1096, Faculté de médecine de Rouen, Rouen, France.
Ann Vasc Surg. 2018 Oct;52:192-200. doi: 10.1016/j.avsg.2017.12.027. Epub 2018 Apr 16.
The treatment of thoracoabdominal aortic aneurysms through an open approach has general and pulmonary consequences of multiple etiologies. Our assumption was that the supraceliac aortic clamping needed for this operation causes a systemic inflammatory response associated with a pulmonary attack.
We developed a model of 30-min supraceliac aortic clamping in Wistar rats weighing 300 g. After 90 min of reperfusion, the rats were sacrificed. The effects on the digestive tract wall were analyzed by measurement of the mucosal thickness/total thickness ratio. The effects on the mesenteric endothelial function were determined by an ex situ measurement of the arterial pressure/volume curves (third branch). The systemic consequences of the procedure were analyzed by dosing tumor necrosis factor alpha (TNFα), interleukin (IL)1β, and IL10 in the blood. The pulmonary consequences were analyzed by the measurement of macrophages, polymorphonuclear neutrophils (PNs), T lymphocyte infiltration, pulmonary apoptosis (TUNEL) and active caspase 3. The experimental scheme included 20 rats with ischemia-reperfusion (IR) and 20 control rats. An analysis of survival was carried out on 20 other rats (10 IR and 10 controls).
The results were expressed as average ± standard error of the mean. The statistical tests were Student's t-test and Mann-Whitney test. This visceral IR model decreased the ratio of the thickness of the intestinal mucosa compared with that of the control rats (0.77 ± 0.008 vs. 0.82 ± 0.009 [P < 0.001]). This local effect was not accompanied by any mesenteric endothelial dysfunction (P = 0.91). On a systemic level, IR increased TNFα (37.9 ± 1.5 vs. 28.2 ± 0.6 pg/mL; P < 0.0001), IL1β (67.1 ± 9.8 vs. 22.5 ± 5.6 pg/mL; P < 0.001), and IL10 (753.3 ± 96 vs. 3.7 ± 1.7 pg/mL; P < 0.0001). As regards the lungs, IR increased the parenchymal cellular infiltration by macrophages (6.8 ± 0.8 vs. 4.5 ± 0.4 cells per field; P < 0.05) and PNs (7.4 ± 0.5 vs. 6.2 ± 03 cells per field; P < 0.05). There was no increase in the pulmonary cellular apoptosis measured by TUNEL (P = 0.77) or in the caspase 3 activity (P = 0.59). The mortality of the visceral IR rats was 100% at 36 hr vs. 0% in the animals without IR.
This work showed that the inflammatory response to visceral IR had systemic and pulmonary effects which always results in the death in the rat.
通过开放手术治疗胸腹主动脉瘤会产生多种病因导致的全身和肺部影响。我们的假设是，该手术所需的膈上主动脉钳夹会引发与肺部攻击相关的全身炎症反应。
我们在体重300克的Wistar大鼠中建立了30分钟膈上主动脉钳夹模型。再灌注90分钟后，处死大鼠。通过测量黏膜厚度/总厚度比值分析对消化道壁的影响。通过离体测量动脉压力/容积曲线（第三分支）确定对肠系膜内皮功能的影响。通过检测血液中肿瘤坏死因子α（TNFα）、白细胞介素（IL）1β和IL10的剂量分析该手术的全身影响。通过测量巨噬细胞、多形核中性粒细胞（PNs）、T淋巴细胞浸润、肺细胞凋亡（TUNEL）和活性半胱天冬酶3分析肺部影响。实验方案包括20只缺血再灌注（IR）大鼠和20只对照大鼠。对另外20只大鼠（10只IR和10只对照）进行生存分析。
结果以平均值±平均标准误差表示。统计检验采用学生t检验和曼-惠特尼检验。与对照大鼠相比，这种内脏IR模型降低了肠黏膜厚度比值（0.77±0.008对0.82±0.009 [P<0.001]）。这种局部影响未伴有任何肠系膜内皮功能障碍（P = 0.91）。在全身水平上，IR增加了TNFα（37.9±1.5对28.2±0.6 pg/mL；P<0.0001）、IL1β（67.1±9.8对22.5±5.6 pg/mL；P<0.001）和IL10（753.3±96对3.7±1.7 pg/mL；P<0.0001）。关于肺部，IR增加了巨噬细胞（6.8±0.8对4.5±0.4个/视野；P<0.05）和PNs（7.4±0.5对6.2±0.3个/视野；P<0.
