坠落性肝撞击损伤后肝功能指标和细胞因子表达的实验研究_临床医学论文.docVIP

坠落性肝撞击损伤后肝功能指标和细胞因子表达的实验研究_临床医学论文 坠落性肝撞击损伤后肝功能指标和细胞因子表达的实验研究_临床医学论文 作者：张洪义　孔亚林　何晓军　刘承利　 张宏义　张希东　张辉　徐新保　赵刚　肖梅 【摘要】 目的：通过空中坠落性肝脏撞击伤后肝脏功能指标的检测，探讨该型肝脏损伤的早期敏感指标。方法：采用高空动物坠落撞击地面障碍物造成犬肝脏撞击伤模型，分别于犬伤前、伤后15、30、45 min，1、3、6、9 h抽血检测肿瘤坏死因子ɑ(tumor necrosis factor ɑ，TNFɑ)、白细胞介素2（interleukin2， IL-2）、谷丙转氨酶（alaninetransaminase，ALT）、谷草转氨酶（aspartate aminotransferase，AST）、乳酸脱氢酶-L（lactate dehydrogenase， LD-L）、谷氨酰基转肽酶（glutamyl transpeptidase，GGT）、碱性磷酸酶（alkaline phosphatase，ALP）等肝功能指标，进行统计学分析。结果：TNFɑ在伤后15 min、IL-2在伤后30 min开始明显升高（P均＜0.05），至3 h开始达到并维持在高峰水平（0.05,0.01）；ALT和AST 在伤后1 h开始显著升高（0.05, 0.01），但在伤后9 h AST浓度与伤前比较差异无统计学意义（P＞0.05）；LD-L在伤后30 min开始各时相点与伤前比较差异均有统计学意义（0.05）；其他检测指标与伤前比较差异均无统计学意义（P＞0.05）。结论：空中坠落性肝脏撞击伤后，TNFɑ和IL-2是反应肝功能状况的灵敏指标，结合ALT、AST、LD-L的检测，在该型肝脏损伤的早期诊断和伤情判断方面具有重要的临床参考价值。 【关键词】 坠落性肝损伤·肝功能·细胞因子类·狗 【ABSTRACT】 Objective: To explore the parameters used for the clinical evaluation of post-traumatic hepatic function crashing down to the ground. Methods: By establishing the animal model of liver impact injury in simulation of parachuter,blood were sampled before injuries and 15 min, 30 min, 45 min,1 h, 3 h, 6 h ,9 h after injuries. Cytokines including TNFɑ、IL-2 and liver function parameters including ALT,AST,LD-L,GGT,ALP were measured and analyzed statistically. Results: TNFɑ increased after 15 minutes, and IL-2 increased after 30 minutes（0.05）, which all remained the high level after 3 hours（0.05,0.01）. ALT and AST were increased at 30min after injuries, but no statistical significance（Pgt;0.05）. These two parameters were significantly increased all the time after injuries（0.05, 0.01）, except that AST showed no difference at 9 h after injuries, the wounded animal showed increased level of LD-L（0.05, 0.01）.There was no difference for other parameters measured following injuries. Conclusion: ALT, AST and LD-L are sensitive parameters for the detection of liver function which can be used for diagnosis of crashing liver injuries. 【KEY WORDS】 Following crashing liver injury·Liver fu