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背景:急性脑血管病导致的多器官功能障碍综合征(multipleorgandysfunc-tionsyndrome,MODS)在临床上是常见的,而对其发生的机制研究较少。目的:探讨脑缺血模型内毒素受体CD14mRNA在肺、肝、肠和肾组织的表达变化规律及并发MODS的机制。设计:随机对照的前瞻性研究。地点和对象:在山东大学齐鲁医院实验动物中心将54只Wistar大鼠分为正常对照组、假手术组及缺血后5个亚组(12,24,36,48,72h组)。干预:实验人员采用两侧颈总动脉阻断法建立前脑缺血模型。主要观察指标:观察术后动物的一般情况,包括意识、精神状态、行动等。检测麻醉后大鼠的肛温和呼吸频率,测定血常规、肝功、肾功。观察缺血后各脏器大体标本的形态变化,检测各脏器组织CD14mRNA的表达。结果:大鼠急性前脑缺血后MODS发生率为53%;缺血后12,24,36,48,72h时相点动物肺、肝、肠和肾组织均有不同程度的损害,以肺脏和小肠改变为著;缺血后12h各脏器组织CD14mRNA表达升高,24～36h达高峰,48h后下降,以肺脏变化最显著(P<0.001);正常对照组和假手术组中各脏器组织CD14mRNA均有不同程度的表达,其中两组肺脏CD14mRNA的表达有显著性差异(P<0.01)。结论:脑缺血后各脏器组织CD14mRNA的异常表达和病理改变为肠道内毒素易位和内毒素血症的发生提供条件,为研究脑缺血
BACKGROUND: Multiple organ dysfunction syndrome (MODS) caused by acute cerebrovascular disease is clinically common, but its mechanism is rarely studied. Objective: To investigate the expression of endotoxin receptor CD14 mRNA in lung, liver, intestine and kidney and the mechanism of concurrent MODS in cerebral ischemia model. Design: A prospective, randomized, controlled study. Location and Subjects: Fifty-four Wistar rats were divided into normal control group, sham operation group and 5 subgroups after ischemia (12,24,36,48,72h group) in Experimental Animal Center of Qilu Hospital of Shandong University. Intervention: The experimenter used both sides of common carotid artery occlusion to establish forebrain ischemia model. MAIN OUTCOME MEASURES: To observe the general situation of post-operative animals, including consciousness, mental state, action and so on. The rectal temperature and respiratory rate of anesthetized rats were measured, and blood routine, liver function and renal function were measured. The morphological changes of gross specimens of various organs were observed after ischemia, and the expression of CD14 mRNA in various organs was detected. Results: The incidence of MODS in rats after acute forebrain ischemia was 53%. The lung, liver, intestine and kidney tissues of the animals at 12, 24, 36, 48 and 72 h after ischemia had different degrees of damage to the lung (P <0.001). In the normal control group and the sham operation group, the expression of CD14 mRNA increased in all organs at 12h after ischemia, reached the peak at 24-36h and decreased after 48h (P <0.001) There were significant differences in the expression of CD14 mRNA between two groups (P <0.01). Conclusion: The abnormal expression of CD14mRNA and pathological changes in various organs after cerebral ischemia provide conditions for the development of intestinal endotoxin translocation and endotoxemia. To study the relationship between cerebral ischemia