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氢气生理盐水对脓毒症的治疗作用
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Effects of hydrogen-rich saline treatment on polymicrobial.pdf
脓毒症（sepsis）是指由感染引起的全身炎症反应综合征（systemic inflammatory response syndrome, SIRS），临床上证实有细菌存在或有高度可疑感染灶。虽然脓毒症是由感染引起，但是一旦发生后，其发生发展遵循其自身的病理过程和规律，故从本质上讲脓毒症是机体对感染性因素的反应。脓毒症曾经被称为败血症。从严重程度上分为3种类型：脓毒症、严重脓毒症（severe sepsis）和脓毒性休克（septic shock）。脓毒症发生率高，全球每年有超过1800万严重脓毒症病例，美国每年有75万例脓毒症患者，并且这一数字还以每年1.5%～8.0%的速度上升。脓毒症病死率高，全球每天约1.4万人死于其并发症。流行病学调查显示，脓毒症病死率已经超过心肌梗死，成为重症监护病房内非心脏病人死亡的主要原因。脓毒症治疗花费高，医疗资源消耗大，严重影响人类的生活质量，已经对人类健康造成巨大威胁。
治疗和预防脓毒症最有效的方法是以脓毒症的发病机制为基础进行治疗和预防，但是遗憾的是目前脓毒症的发病机制仍未完全阐明，在这种情况下，针对发病原因应做好临床各方面的预防工作，努力降低诱发感染的危险因素对脓毒症的治疗和预防有着重要作用。
最近来自南京总医院麻醉科的一项研究在线发表在《外科研究杂志》上，证明氢气生理盐水对脓毒症的治疗作用。2009年天津医科大学谢克亮等的研究证明呼吸氢气可以对脓毒症具有治疗作用，随后他们用不同的模型证明了同样的治疗效果，最重要的发现是首次在世界上报道了氢气在治疗疾病的同时具有促进内源性抗氧化酶活性的作用，并发现对HMGB1具有影响。
氢气可以选择性中和毒性自由基羟基自由基和亚硝酸阴离子，对许多疾病和病理状态具有治疗效果，呼吸氢气对脓毒症的治疗作用早就有报道，本研究是观察氢气生理盐水对脓毒症的治疗作用。SD大鼠盲肠结扎和穿孔制备脓毒症疾病模型，24只动物平均分成假手术、脓毒症和氢气生理盐水等3组。在模型制备后0、6和18小时3次给动物腹腔注射5ml/Kg氢气生理盐水或无氢气正常生理盐水。手术后24小时分别检测MDA（脂质过氧化指标）、SOD（抗氧化酶）、炎症介质、肺组织NO、MPO（中性粒细胞）、干湿重（肺水肿程度）、组织病理学指数（病理变化）、细胞凋亡分析、丙氨酸转氨酶（肝细胞损伤）、肌酐和血尿素氮（肾脏功能）。手术后7天的动物生存率也进行了详细记录。结果发现氢气生理盐水可以使血清内HMGB1下降（这是最近几年研究比较热门的炎症因子，正常情况下分布在细胞内，在细胞核内和DNA结合发挥调节基因表达的作用，当细胞死亡或损伤时，可以被动或主动释放到细胞外，和一些重要炎症受体RAGE TLR结合，并启动炎症反应）。另外转氨酶、肌酐、尿素氮水平均显著下降。肺组织白介素6、HMGB1、NO、MDA；肺干湿比、组织学变化指数和细胞凋亡阳性细胞等君明显改善。SOD明显升高。但动物生存率无明显改变。研究结果证明氢气生理盐水可以对脓毒症具有治疗作用。
Effects of hydrogen-rich saline treatment on polymicrobial sepsis
Guo-min Li, MDa, 1,
a Department of Anesthesiology and Intensive Care, Jintan Hospital, Jiangsu University, Changzhou, China
Received 18 April 2012. Revised 18 June 2012. Accepted 22 June 2012. Available online 7 July 2012.
http://dx.doi.org/10.1016/j.jss.2012.06.058, How to Cite or Link Using DOI
Background
Hydrogen has been reported to selectively reduce hydroxyl radicals and peroxynitrite anion in many pathologic processes. This study aimed to test the hypothesis that hydrogen-rich saline (HRS) may ameliorate organ dysfunction in a rat model of polymicrobial sepsis.
Methods
Sepsis was induced in male Sprague-Dawley rats by cecal ligation and puncture (CLP). Twenty-four rats were equally assigned to Sham group, CLP group, and CLP + HRS group (n = 8). At 0, 6, and 18 h after CLP or sham operation, rats received an intraperitoneal injection of HRS (5 mL/kg) or the same volume of normal saline. Malondialdehyde, superoxide dismutase activities, inflammatory mediators, pulmonary nitric oxide, myeloperoxidase activities, wet-to-dry weight ratio, histologic scores, apoptotic analysis, alanine aminotransferase, creatinine, and blood urea nitrogen were assessed at 24 h after operation. The 7-d survival rate was also recorded.
Results
HRS administration significantly reduced the serum high-mobility group box, alanine aminotransferase, creatinine, and blood urea nitrogen levels; the pulmonary interleukin 6, high-mobility group box, nitric oxide, and malondialdehyde levels; and the wet-to-dry weight ratio, total histologic scores, and TUNEL-positive cells, whereas it increased the superoxide dismutase activities 24 h after CLP when compared with the CLP group. However, there was no significant difference in survival rate between the CLP + HRS and CLP groups.
Conclusions
HRS has potential protective effects against sepsis by decreasing proinflammatory responses, oxidative stress, and apoptosis in a rat model of polymicrobial sepsis.
https://blog.sciencenet.cn/blog-41174-590181.html
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