中性粒细胞去除对内毒素血症犬凝血功能及肺损伤-第三军医大学学报.docVIP

白细胞去除对内毒素血症犬凝血功能及肺损伤的影响 周顺刚 贺志高2 黄显凯2 文爱清 1 何静1 胡波3 陈方祥1 (400042 重庆 第三军医大学大坪医院野战外科研究所 1输血科, 2创伤外科，3检验科) [摘要] 目的 观察循部分白细胞去除对内毒素血症犬凝血纤溶系统和肺损伤的影响，探讨白细胞去除影响内毒素血症犬肺损伤的凝血纤溶机制。方法 30只雄性杂种犬采用随机数字表法分为对照组(C组)，治疗1组(T1组)，治疗2组(T2组)，每组10只。LPS(650μg/kg)经中心静脉一次性给药，30分钟内输毕，建立内毒素血症犬模型，运用血细胞分离机行白细胞去除。各组均在LPS输注前4h、后16h两次去(/伪去)白细胞：C组两次均为伪去白细胞，T1组为LPS输注前4h，T2组在LPS输注后16h进行白细胞去除，T1、T2组另一时间点为伪去白细胞。观察每组动物LPS输注前4h (正常值)、LPS输注0h (去/伪去白细胞后即刻)、LPS输毕后0h、6h、16h、20h及36h外周血白细胞计数及分类、动脉血气、可溶性血栓调节蛋白(soluble thrombomodulin,sTM)、活化蛋白C(activated protein C,APC)、纤溶酶原激活物抑制物1(plasminogen activator inhibitor 1,PAI-1)及D-二聚体(D-Dimer,D-D)的变化，36h时或肺损伤发生后立即取肺组织行病理学、肺湿/干重检测。结果 内毒素输注后受试动物白细胞(white blood cells,WBC)及中性粒细胞(polymorphonuclear neutrophils,PMN)计数均迅速下降，约在16h时上升至基础值，并在观察期内逐渐升高；去白细胞后受试动物WBC及PMN计数显著降低；36h时T1、T2组APC较C组明显升高，sTM、PAI-1、D-D较C组明显降低，急性肺损伤发生例数：C组8例、T1组2例、T2组3例。 结论 LPS诱导的内毒素血症犬在早期即发生凝血纤溶功能异常，白细胞去除能减少血WBC计数，并改善凝血纤溶功能，从而降低内毒素引起的肺损伤发率。 [关键词]内毒素血症；中性粒细胞；白细胞去除术；凝血/纤溶功能 The effect of partially removing peripheral WBC on the coagulation and lung injury in endotoxemia dog Zhou Shun-gang1,He Zhi-gao2, Huang Xian-kai2,Wen Ai-qing1,He Jing1,Hu Bo3.Cheng Fang-xiang1 (1Department of Blood Transfusion, 2Traumatology Department, 3Department of Clinical Laboratory,Research Institute of Surgery,Daping Hospital the Third Military Medical University,Chongqing 400042,China) [Abstract] Objective To observe the effection of partially removing peripheral WBC on the coagulation and fibrinolysis system and lung injury in endotoxemia dog, and explore the mechanism that leukapheresis action to the coagulation and fibrinolysis system in endotoxin-induced lung injury dog. Methods: 30 male mongrel dogs were randomly divided into three groups（10 per group）: control group(group C), treat group 1(T1), treat group 2(T2). Endotoxemia-induced lung injury model in dog was established by administration of lipopolysaccharide(LPS)at 650μg/kg through the central veins within 30 minutes, Separation of white blood cells with automated con