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[亚低温对猪心肺复苏后肝损伤的保护作用及机制]

[Protective effect and mechanism of mild hypothermia on liver injury after cardiopulmonary resuscitation in pigs].

作者信息

Li Y Q, Wang Y, Song J, Xie D Y, Tang Z R, Li C S, Hao J Y, Jing M L, Hu X M, Zhai J L, Liu Z X

机构信息

Department of Gastroenterology, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China.

Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2020 Sep 22;100(35):2785-2790. doi: 10.3760/cma.j.cn112137-20200514-01539.

Abstract

To investigate the effect of mild hypothermia therapy on liver after cardiopulmonary resuscitation. Thirty-three inbred Chinese Wuzhishan (WZS) minipigs, weighted (28±2) kg, were used to establish a ventricular fibrillation model. And 30 animals survived after cardiopulmonary resuscitation reached basic life support. The surviving animals were randomly divided into two groups: mild hypothermia group (group M, 15) and conventional treatment group (group C, 15). All the animals were observed for 24 hours. Blood samples were extracted at baseline, 0.5, 1, 2, 4, 6, 12 and 24 h after successful resuscitation. The concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected at the time points. The enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α). The data were compared between the two groups, LSD test was used when the variance was homogeneous, and Tamhane T2 test was used when the variance was uneven. Eleven pigs (73.3%) in the group M and 8(53.3%) in the group C survived at 24 h after successful resuscitation, with no statistically significant difference between the two groups (χ(2)=1.229, 0.225). After successful resuscitation, the AST, ALT increased in both group but less in M group (all 0.05). After successful resuscitation, the concentrations of TFN-α and IL-6 in the blood increased in both groups, reached the peak at 4h, and then decreased gradually. The concentrations of TFN-α in group M were lower than those in group C at 0.5, 2, 4 and 6 h after successful resuscitation (0.01, 0.01, 0.87, 0.86, all 0.05). The concentrations of IL-6 in the group M were lower than those in group C at 0.5, 1, 2 and 4 h after successful resuscitation (0.23, 0.78, 0.11, 0.80, all 0.05). After successful resuscitation, the release of inflammatory mediators, such as TNF-α and IL-6, and cell apoptosis may involve in liver ischemia reperfusion injury. After successful resuscitation, the liver undergoes ischemia-reperfusion injury, which may be related to the release of inflammatory mediators such as TNF-α and IL-6. Mild hypothermia therapy can prevent the release of TNF-α, IL-6 to reduce the degree of liver damage after resuscitation.

摘要

探讨亚低温治疗对心肺复苏后肝脏的影响。选用33只体重(28±2)kg的中国近交系五指山(WZS)小型猪,建立心室颤动模型。30只动物心肺复苏成功后达到基本生命支持。将存活动物随机分为两组:亚低温组(M组,15只)和常规治疗组(C组,15只)。所有动物观察24小时。于复苏成功后基线、0.5、1、2、4、6、12和24小时采集血样。在这些时间点检测丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)的浓度。采用酶联免疫吸附测定(ELISA)法检测白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的浓度。比较两组数据,方差齐时采用LSD检验,方差不齐时采用Tamhane T2检验。复苏成功后24小时,M组11只猪(73.3%)存活,C组8只猪(53.3%)存活,两组间差异无统计学意义(χ(2)=1.229,P=0.225)。复苏成功后,两组AST、ALT均升高,但M组升高幅度较小(均P<0.05)。复苏成功后,两组血中TFN-α和IL-6浓度均升高,4小时达峰值,随后逐渐下降。复苏成功后0.5、2、4和6小时,M组TFN-α浓度低于C组(P分别为0.01、0.01、0.87、0.86,均P<0.05)。复苏成功后0.5、1、2和4小时,M组IL-6浓度低于C组(P分别为0.23、0.78、0.11、0.80,均P<0.05)。复苏成功后,TNF-α、IL-6等炎性介质的释放及细胞凋亡可能参与肝脏缺血再灌注损伤。复苏成功后,肝脏发生缺血再灌注损伤,可能与TNF-α、IL-6等炎性介质的释放有关。亚低温治疗可抑制TNF-α、IL-6的释放,减轻复苏后肝脏损伤程度。

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