［摘要］ 目的：探讨清热通下中药在急性胆管炎治疗中对肠黏膜屏障保护和炎症调控的作用。方法：60只SD大鼠分为3组，每组20只。模型组（A组）制作急性胆管炎模型；治疗组（B组）制作急性胆管炎模型并喂清热通下中药治疗；假手术组（C组）仅剖腹后缝合。取血检测细胞因子、炎症介质、内毒素和细菌移位等指标。结果：A组白细胞介素6（interleukin6, IL6）、白细胞介素8（interleukin8, IL8）、肿瘤坏死因子α（tumor necrosis factorα, TNFα）、血清C反应蛋白(C reactive protein, CRP)和一氧化氮(nitric oxide, NO)明显高于B组和C组（P<0.01），IL2则显著低于B组和C组（P<0.01）；A组的血清内毒素和肝、脾、肠系膜淋巴结细菌移位数显著高于B组和C组（P<0.01）。结论：具有清热通下作用的中药在治疗急性胆道感染中具有保护肠黏膜屏障、降低血清内毒素和调节机体炎症反应的作用。
［关键词］ 清热通下中药; 胆管炎; 细胞因子; 炎症介质
Impact of antipyretic and purgative herbs on intestinal mucosal barrier and inflammatory response in treatment of acute cholangitis in rats
ABSTRACT Objective: To investigate the effects of antipyretic and purgative herbs on intestinal mucosal barrier and inflammatory response in the treatment of acute cholangitis. Methods: Sixty SD rats were randomly divided into group A (untreated group, acute cholangitis was induced, n=20), group B (treatment group, acute cholangitis was induced and treated with antipyretic and purgative herbs, n=20) and group C (sham operation group, n=20). At the third or fifth day after operation, the rats were sacrificed and sampled. The serum endotoxin, cytokines and inflammatory mediators were tested and the numbers of labeled bacteria in the liver, spleen and mesenteric lymph nodes translocated from the gut were assayed. Results: As compared with group A, the serum content of endotoxin, IL6, IL8, TNFα, CRP and NO was significantly lower and that of IL2 was significantly higher, and the translocated numbers of labeled bacteria from gut were reduced in both group B and group C（P<0.01）. Conclusion: Antipyretic and purgative herbs can play therapeutic roles in the treatment of acute biliary tract infections, including the protection of intestinal mucosal barrier from bacterial translocation, reduction of serum endotoxin content and regulation of inflammatory response.
KEY WORDS antipyretic and purgative herbs; cholangitis; cytokines; inflammatory mediators
近年，随着对重症感染研究的不断深入，国内外学者更加注重保护机体防御功能和调节机体适度炎症反应在抗感染治疗中的地位。稳定和保护机体天然屏障以及调控炎症时机体体液性因子与细胞因子的平衡，正成为提高外科重症感染治疗效果的重要研究方向。急性胆管炎是外科常见和危重感染性疾病，迄今为止，手术和抗生素疗法是治疗这一疾病的主要手段，其病死率和病残率还很高。以往中西医结合治疗急性胆道感染的临床实践已经显示，清热通下中药具有较为理想的疗效，尤其在缓解症状、减少并发症和加速康复等方面作用显著［1］。中医中药在治疗急性胆道感染中的独特作用正引起临床上广泛关注。本研究旨在探讨清热通下中药在胆道感染时对机体肠黏膜防御屏障和全身炎症反应的干预作用。
1 材料与方法
1.1 实验动物与分组 选择SD大鼠60只，雌雄各半，体质量225～245 g，随机分为3组，每组20只(上海中医药大学实验动物中心提供，纯系清洁级动物)。模型组（A组）大鼠参照龚建平等［2］的方法，将胆总管结扎，同时向胆总管内注入致病性大肠杆菌，制作大鼠急性胆道感染模型，手术后喂生理盐水。清热通下中药治疗组(B组)大鼠同上造模，手术后喂清热通下中药锦红片悬液。假手术组（C组）大鼠剖腹后缝合，手术后喂生理盐水。
1.2 实验材料
1.2.1 药物 锦红片系已故中医名家顾伯华教授和著名中西医结合外科专家徐长生教授的经验方，主要成分为红藤、蒲公英、生大黄。由上海中药制药一厂提供锦红片干粉，以蒸馏水配成含干粉110 mg/ml的悬混液，用于动物灌胃。
1.2.2 标记细菌&n 1 2 3 4 下一页
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