摘要
目的探讨目标温度管理(TTM)对猪心肺复苏后高迁移率族蛋白B1(HMGB1)、晚期糖基化终产物受体(RAGE)表达的影响。方法将24头猪按照随机数字表法分为假手术组(n=4)、常温组(n=10)和TTM组(n=10)。通过程控刺激法制作心脏骤停模型,室颤8 min后开始心肺复苏。TTM组动物在自主循环恢复(ROSC)后给予血管内降温,将核心体温以最快速度降至33℃,维持12 h,然后被动复温(0.5℃/h)至37℃。复苏后24 h采用神经功能缺损评分(NDS)评价神经功能,动物实施安乐死后,留取脑皮质,采用脑皮质含水量评价脑水肿。采用酶联免疫吸附方法检测基线、ROSC 0.5、6、12、24 h血清HMGB1、单核细胞趋化蛋白-1(MCP-1)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)的含量;采用RT-PCR法检测ROSC后24 h脑皮质HMGB1、RAGE及MCP-1 mRNA表达水平。结果TTM组ROSC后24 h时的NDS评分显著优于常温组[150.0(70.0,177.5)分vs.237.5(190.0,371.3)分],脑皮质水含量显著低于常温组[(81.2±1.1)%vs.(83.3±1.3)%],差异均有统计学意义(P<0.05)。与假手术组自同时间点比较,常温组ROSC后6、12、24 h的血清HMGB1、MCP-1及IL-6蛋白含量显著升高,ROSC后0.5、6、12、24 h的TNF-α蛋白含量显著升高,差异均有统计学意义(P<0.05);与常温组各自同时间点相比较,TTM组ROSC后6、12、24 h的血清HMGB1、MCP-1及IL-6蛋白含量明显降低,ROSC后0.5、6、12、24 h血清TNF-α蛋白含量显著降低,差异均有统计学意义(P<0.05)。与假手术组比较,常温组ROSC后24 h的脑皮质HMGB1、RAGE及MCP-1 mRNA均明显增加,差异均有统计学意义(P<0.05);与常温组相比较,TTM组ROSC后24 h的脑皮质HMGB1、RAGE及MCP-1 mRNA均显著降低,差异均有统计学意义(P<0.05)。结论TTM可减轻复苏后脑水肿,改善神经功能,其保护机制可能部分与早期抑制HMGB1、RAGE表达有关。
Objective To investigate the effects of target temperature management(TTM)on the expression of high mobility group protein B1(HMGB1)and receptor for advanced glycation end products(RAGE)after cardiopulmonary resuscitation in a porcine model.Methods Twenty-four pigs were divided into Sham surgery group(n=4),normothermia group(n=10)and TTM group(n=10)according to random number table method.Cardiac arrest was electrically induced with ventricular fibrillation and left untreated for 8 min.TTM was intravascularly induced immediately after the return of spontaneous circulation(ROSC).The core temperature was reduced to 33℃and maintained for 12 h after ROSC,followed by gradual rewarming(0.5℃/h)to 37℃.The serum levels of HMGB1,monocyte chemoattractant protein-1(MCP-1),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were measured using enzyme immunoassay kits at 0.5,6,12 and 24 h after ROSC.The expression of HMGB1,RAGE and MCP-1 in cerebral cortical tissue was measured by RT-PCR 24 h after ROSC.Neurological deficit scores were evaluated 24 h after ROSC.The cerebral cortex was collected after pigs were euthanized and brain oedema was evaluated via brain cortical tissue water content.Results The NDS score of the TTM group at 24 hours after ROSC was significantly better than that of the normothermic group[150.0(70.0,177.5)pionts vs.237.5(190.0,371.3)pionts],and the cortical water content was significantly lower than that of the normothermic group[(81.2±1.1)%vs.(83.3±1.3)%],the differences were statistically significant(P<0.05).Compared with the Sham surgery group at the same time point,the serum HMGB1,MCP-1 and IL-6 protein levels in the normothermia group were significantly increased at 6,12 and 24 hours after ROSC,and the TNF-αprotein levels were significantly increased at 0.5,6,12 and 24 hours after ROSC,the differences were statistically significant(P<0.05);compared with the normal temperature group at the same time point,the serum HMGB1,MCP-1,and IL-6 protein levels in the TTM group were significantly de
作者
李杰宾
贵玉
武军元
袁伟
LI Jie-bin;GUI Yu;WU Jun-yuan(Department of Emergency Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Ultrasound,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Emergency Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《临床和实验医学杂志》
2023年第13期1345-1349,共5页
Journal of Clinical and Experimental Medicine
基金
国家自然科学基金项目(编号:81801882)。
关键词
心肺复苏
脑水肿
目标温度管理
高迁移率族蛋白B1
晚期糖基化终末产物受体
Cardiopulmonary resuscitation
Brain edema
Target temperature management
High mobility group protein B1
Receptor for advanced glycation end products
