脓毒症中炎症与凝血功能紊乱的发展进程
DOI:
CSTR:
作者:
作者单位:

云南中医药大学

作者简介:

通讯作者:

中图分类号:

基金项目:

云南省科学技术厅-云南中医药大学应用基础研究联合专项(202001A2070001-032),云南省教育厅科学研究基金(2023Y0441)


Development of inflammation and coagulation disorders in Sepsis
Author:
Affiliation:

Yunnan University of Traditional Chinese Medicine

Fund Project:

Yunnan Provincial Department of Science and Technology and Yunnan University of Traditional Chinese Medicine Joint Project on Applied Basic Research (202001A2070001-032), Yunnan Provincial Department of Education Scientific Research Fund (2023Y0441).

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 文章评论
    摘要:

    目的 探讨脓毒症病程中凝血功能的改变。方法 本研究采用基于盲肠结扎穿刺术(cecal ligation and puncture,CLP)改良的复合感染脓毒症大鼠模型(Multiple infection sepsis model,MIM),将 48只雄性 SD 大鼠随机分为空白组(Control组,n = 8)假手术组(Sham 组,n = 8)、复合感染脓毒症模型4h(4h组,n = 8)、8h(8h组,n = 8)、12h(12h组,n = 8)、16h(16h组,n = 8)组,检测炎症指标和凝血相关指标。结果 (1)所有组脓毒症模型大鼠LPS及IL-6含量较Sham组均显著升高(p<0.001),且术后随时间延长,LPS及IL-6含量逐渐升高, 12h后无明显变化;(2)脓毒症模型病程中后期组(8h及8h后)PT较Sham组明显延长(p<0.01);(3)与Sham组相比, 8h组、12h组、16h组APTT时间显著延长(P<0.05,P<0.01),且8h后APTT逐渐延长接近Control组;(4)8h后(不含8h)Fbg含量较Sham组显著增加(p<0.01);(5)脓毒症病程各时间段组均与Control组FDP有显著性差异(p<0.01),而与Sham组无显著差异;(6)脓毒症病程各时间段组AT-Ⅲ较Sham组均显著降低(p<0.01),且AT-Ⅲ随病程呈下降趋势,其中4h组及8h组与16h组比存在显著差异。结论 随着脓毒症病程发展,炎症水平不断升高并诱发凝血功能紊乱:脓毒症中后期PT及APTT时间明显增长,且Fbg快速升高,提示造模手术后内外源性途径快速活化,而后随病程推进凝血因子逐渐耗竭而诱发DIC;而病程发展中大量生成的FDP,也会干扰纤维蛋白多聚化造成出血倾向,加重DIC;同时脓毒症所导致的肝脏损伤引起AT-III表达减少,造成机体抗凝功能下降从而加剧DIC。

    Abstract:

    Objective:To study the changes in coagulation function and inflammation levels during sepsis. Methods: Multiple infection sepsis model (MIM), based on cecal ligation and puncture (CLP), was apllied to establish a rat model of sepsis. Forty-eight male SD rats were randomly divided into blank group (control group, n=8), sham operation group (sham group, n=8), 4-hour sepsis group (4h group, n=8), 8-hour sepsis group (8h group, n=8), 12-hour sepsis group (12h group, n=8), and 16-hour sepsis group (16h group, n = 8). ELISA and coagulation analysis were used to detect inflammatory markers and coagulation-related indicators. Results: (1) Compared with the sham group, the content of LPS and IL-6 in the model rats of all time points increased significantly(p<0.001). The LPS and IL-6 gradually increased as the disease progressed, however no significant changes after 12 hours. (2) In the middle and late stages of the septic model(starting from the 8h), PT was significantly prolonged compared with that in the sham groups(p<0.01). (3) Compared with the sham group, APTT time was significantly prolonged in 8h,12h,and 16h groups(P<0.05,P<0.01). The APTT time gradually lengthened from 8h group, and gradually approached control group after that. (4) Except for 8h group, the Fbg content in septic groups of all time points increased significantly than sham group (p < 0.01). (5) There was a significant difference between control group and sham group in FDP (p < 0.01), but no significant difference between sham group and septic groups. (6) Compared with the sham group, the level of AT-III in each period of progression in sepsis was decrease(p < 0.01), and there were significant differences in the proportions of 4h group,8h group, and 16h group. Conclusion: In the progression of sepsis, infection and inflammation levels gradually increase and cause coagulation dysfunction. The Fbg increases rapidly in the disease progresses, indicating the rapid activation of ogenous after model surgery. However, the PT and APTT time significantly increase in the middle and late stages of sepsis, suggesting the coagulation factors gradually depleted to induce DIC. At the same periods, multiorgan damage caused by sepsis leads to reduced expression of AT-III, further aggravating the coagulation/anticoagulant disorders. In addition, during the disease progression, a large amount of FDP interferes with fibrin polymerization, resulting in hemorrhagetendency and worsening DIC.

    参考文献
    相似文献
    引证文献
引用本文
分享
相关视频

文章指标
  • 点击次数:
  • 下载次数:
  • HTML阅读次数:
  • 引用次数:
历史
  • 收稿日期:2023-07-20
  • 最后修改日期:2024-01-15
  • 录用日期:2024-01-16
  • 在线发布日期:
  • 出版日期:
文章二维码
防诈骗提示!请勿点击不明链接或添加个人微信。编辑部所有邮箱后缀均为@cnilas.org
关闭