Meleagros L, Ghatei M A, Bloom S R
Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.
Gut. 1994 Dec;35(12):1701-6. doi: 10.1136/gut.35.12.1701.
Reperfusion of ischaemic intestine is characterised by an initial hyperaemia with ensuing mucosal repair. This study investigated possible roles for gut vasoactive neuropeptides and trophic peptides in these phenomena. Groups of rats were monitored during superior mesenteric artery occlusion for five or 20 minutes, with or without subsequent reperfusion for five minutes. Peptide concentrations (fmol/ml) in arterial blood, were measured using specific radioimmunoassays. Intestinal ischaemia alone did not cause haemodynamic disturbance or peptide release. Reperfusion, after five minutes of ischaemia, resulted in arterial hypotension and a rise in plasma vasoactive intestinal polypeptide (mean (SEM)) (37 (3), control 11 (4), p < 0.001). After 20 minutes of ischaemia, reperfusion resulted in greater hypotension (p < 0.05) and release of both vasoactive intestinal polypeptide (31 (3), p < 0.05 v control) and the more potent vasodilator beta-calcitonin gene related peptide (49 (3), control 23 (1), p < 0.001). By contrast, the vasodilators alpha-calcitonin gene related peptide and substance P and the vasoconstrictors neuropeptide Y, peptide YY, and somatostatin were not released. Bombesin, a stimulatory neuropeptide, was released after 20 minutes of ischaemia/reperfusion (13 (2), control 7 (3), p < 0.05). Plasma enteroglucagon rose from control (51 (4)) to 110 (16) (p < 0.001) and to 158 (27) (p < 0.005) after five and 20 minutes of ischaemia/reperfusion. The potent enteric vasodilators vasoactive intestinal polypeptide and beta-calcitonin gene related peptide, unopposed by vasoconstrictors, may promote post-ischaemic intestinal hyperaemia. The rise in plasma enteroglucagon may point to diffuse mucosal injury and is consistent with the putative trophic role of this peptide.
缺血性肠再灌注的特征是最初的充血以及随后的黏膜修复。本研究调查了肠道血管活性神经肽和营养肽在这些现象中可能发挥的作用。对几组大鼠进行肠系膜上动脉闭塞5分钟或20分钟的监测,有无随后5分钟的再灌注。使用特定的放射免疫分析法测量动脉血中的肽浓度(fmol/ml)。单纯肠道缺血不会引起血流动力学紊乱或肽释放。缺血5分钟后再灌注导致动脉低血压和血浆血管活性肠肽升高(均值(标准误))(37(3),对照组11(4),p<0.001)。缺血20分钟后,再灌注导致更严重的低血压(p<0.05)以及血管活性肠肽(31(3),与对照组相比p<0.05)和更强效的血管舒张剂β-降钙素基因相关肽(49(3),对照组23(1),p<0.001)的释放。相比之下,血管舒张剂α-降钙素基因相关肽和P物质以及血管收缩剂神经肽Y、肽YY和生长抑素未释放。蛙皮素,一种刺激性神经肽,在缺血/再灌注20分钟后释放(13(2),对照组7(3),p<0.05)。血浆肠高血糖素在缺血/再灌注5分钟和20分钟后从对照组的(51(4))升至110(16)(p<0.001)和158(27)(p<0.005)。强效的肠道血管舒张剂血管活性肠肽和β-降钙素基因相关肽,在没有血管收缩剂拮抗的情况下,可能促进缺血后肠道充血。血浆肠高血糖素的升高可能表明弥漫性黏膜损伤,并且与该肽假定的营养作用一致。