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亚甲蓝对脓毒症大鼠心肌损伤的保护作用及机制研究

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目的 探讨亚甲蓝(MB)对脓毒症大鼠心肌损伤的保护作用及其可能的信号通路.方法 将32只雌性Wistar大鼠按随机数字表法分为假手术组、脓毒症模型组、MB预防组和MB治疗组,每组8只.MB预防组于制模前 6h腹腔注射MB 15 mg/kg;其余 3 组腹腔注射生理盐水 4 mL/kg.采用盲肠结扎穿孔术(CLP)制备脓毒症大鼠模型;假手术组仅行开腹探查,不结扎和穿刺盲肠.MB治疗组于制模后 0.5 h腹腔注射MB 15 mg/kg;其余 3 组腹腔注射生理盐水 4 mL/kg.分别于制模 6h和 12h取各组大鼠腹主动脉血、心肌组织.光镜下观察各组大鼠心肌组织病理学改变;采用酶联免疫吸附试验(ELISA)检测血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平;采用蛋白质免疫印迹试验(Western blotting)检测心肌组织诱导型一氧化氮合酶(iNOS)、微管相关蛋白 1 轻链 3(LC3)和p62 的蛋白表达.结果 光镜下显示,假手术组心肌组织无明显异常;脓毒症模型组心肌组织出现明显炎症改变;MB预防组制模 6h心肌组织出现轻微炎症改变,制模 12h炎症改变严重但较脓毒症模型组减轻;MB治疗组制模 6h心肌组织炎症改变较明显但轻于制模 12hMB预防组,制模 12h炎症改变有所缓解但重于制模后 6hMB预防组.与假手术组比较,MB预防组制模 6h和 12h血清cTnI、CK-MB、TNF-α、IL-6 水平均无明显变化;与脓毒症模型组比较,MB预防组及MB治疗组制模 6h和 12h血清cTnI、CK-MB、TNF-α、IL-6 水平均明显降低[cTnI(ng/L):制模6h为175.03±12.26、411.24±21.20比677.79±43.95,制模12h为159.52±6.44、412.46±32.94比 687.61±55.09;CK-MB(ng/L):制模 6h为 8.38±0.49、16.87±1.41 比 24.87±1.74,制模 12h为 7.94±0.30、16.66±2.03 比 25.02±7.29;TNF-α(ng/L):制模 6h为 26.98±3.31、46.95±3.74 比 112.60±6.64,制模 12h为31.31±5.83、90.97±5.14 比 149.30±4.67;IL-6(ng/L):制模 6h为 40.86±4.48、128.90±3.14 比 248.90±12.76,制模 12h为 80.13±7.94、190.40±9.56 比 288.90±6.01;均P<0.05].Western blotting检测结果显示,与假手术组比较,脓毒症模型组制模后 6h和 12h心肌组织iNOS、LC3、p62 的蛋白表达均明显升高;与脓毒症模型组比较,MB预防组及MB治疗组制模6h和12h心肌组织iNOS、LC3、p62的蛋白表达均明显降低(iNOS/GAPDH:制模6h为0.38±0.04、0.60±0.04比0.77±0.04,制模12h为0.38±0.02、0.66±0.04比0.79±0.05;LC3/GAPDH:制模6h为0.13±0.07、0.42±0.07比1.05±0.16,制模12h为0.08±0.02、0.25±0.03比0.48±0.09;p62/GAPDH:制模6h为0.17±0.05、0.44±0.10比1.19±0.07,制模12h为0.07±0.00、0.28±0.08比0.69±0.02;均P<0.05).结论 MB通过抑制脓毒症大鼠iNOS表达和线粒体自噬,降低心肌氧化应激反应,从而减轻脓毒症心肌损伤,对脓毒症心肌损伤具有保护作用.
Protective effect and mechanism of methylene blue on myocardial injury in rats with sepsis
Objective To explore the protective effect of methylene blue(MB)on myocardial injury in sepsis and its possible signaling pathway.Methods A total of 32 female Wistar rats were randomly divided into sham operation group,sepsis model group,MB prevention group,and MB treatment group,with 8 rats in each group.The MB prevention group was injected with 15 mg/kg MB in the peritoneal cavity 6 hours before modeling;the other 3 groups were injected with 4 mL/kg saline in the peritoneal cavity.The sepsis model was established by cecal ligation puncture(CLP);the sham operation group was only subjected to an exploratory incision without ligation or puncture of the caecum.The MB treatment group was injected with 15 mg/kg MB in the peritoneal cavity 0.5 hours after modeling;the other 3 groups were injected with 4 mL/kg saline in the peritoneal cavity.Peripheral blood and myocardial tissue were collected from each group at 6 hours and 12 hours after modeling.Histological changes in the myocardial tissue were observed under the microscope;the levels of serum cardiac troponin I(cTnI),MB isoenzyme of creatine kinase(CK-MB),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were detected by enzyme-linked immunosorbent assay(ELISA);and the expressions of inducible nitric oxide synthase(iNOS),light chain 3(LC3),and p62 in the myocardial tissue were detected by Western blotting.Results Under light microscopy,no obvious abnormalities were found in the myocardium of the sham operation group;the myocardium of the sepsis model group showed obvious inflammatory changes;the myocardium of the MB prevention group showed mild inflammatory changes at 6 hours after modeling,severe inflammatory changes at 12 hours but less severe than the sepsis model group;the myocardium of the MB treatment group showed more obvious inflammatory changes at 6 hours after modeling but less severe than the MB prevention group at 12 hours after modeling,and the inflammatory changes at 12 hours after modeling were alleviated but more severe than the 6 hours after modeling in MB prevention group.Compared with the sham operation group,the levels of cTnI,CK-MB,TNF-α and IL-6 in the MB prevention group at 6 hours and 12 hours after modeling were not significantly changed;compared with the sepsis model group,the cTnI,CK-MB,TNF-α and IL-6 levels in the MB treatment group at 6 hours and 12 hours after modeling were significantly lower[cTnI(ng/L):175.03±12.26,411.24±21.20 vs.677.79±43.95 at 6 hours of modeling,159.52±6.44,412.46±32.94 vs.687.61±55.09 at 12 hours of modeling;CK-MB(ng/L):8.38±0.49,16.87±1.41 vs.24.87±1.74 at 6 hours of modeling,7.94±0.30,16.66±2.03 vs.25.02±7.29 at 12 hours of modeling;TNF-α(ng/L):26.98±3.31,46.95±3.74 vs.112.60±6.64 at 6 hours of modeling,31.31±5.83,90.97±5.14 vs.149.30±4.67 at 12 hours of modeling;IL-6(ng/L):40.86±4.48,128.90±3.14 vs.248.90±12.76 at 6 hours of modeling,80.13±7.94,190.40±9.56 vs.288.90±6.01 at 12 hours of modeling;all P<0.05].Western blotting showed that compared with the sham operation group,the protein expressions of iNOS,LC3,and p62 in the sepsis model group were significantly higher at 6 hours and 12 hours after modeling;compared with the sepsis model group,the protein expressions of iNOS,LC3,and p62 in the MB treatment group and MB prevention group were significantly lower at 6 hours and 12 hours after modeling(iNOS/GAPDH:0.38±0.04,0.60±0.04 vs.0.77±0.04 at 6 hours of modeling;0.38±0.02,0.66±0.04 vs.0.79±0.05 at 12 hours of modeling;LC3/GAPDH:0.13±0.07,0.42±0.07 vs.1.05±0.16 at 6 hours of modeling;0.08±0.02,0.25±0.03 vs.0.48±0.09 at 12 hours of modeling;p62/GAPDH:0.17±0.05,0.44±0.10 vs.1.19±0.07 at 6 hours of modeling;0.07±0.00,0.28±0.08 vs.0.69±0.02 at 12 hours of modeling;all P<0.05).Conclusion MB can reduce myocardial oxidative stress by inhibiting iNOS expression and mitochondrial autophagy in septic rats,thereby alleviating myocardial damage in sepsis,and has protective effect on myocardial damage in sepsis.

SepsisMethylene blueSepsis-induced myocardial injuryInducible nitric oxide synthase

郭仁楠、唐雯、刘艳

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新疆维吾尔自治区人民医院重症医学科,乌鲁木齐 830000

脓毒症 亚甲蓝 脓毒症心肌损伤 诱导型一氧化氮合酶

新疆维吾尔自治区自然科学基金项目新疆维吾尔自治区人民医院院内项目

2022D01C11820200402

2024

中华危重病急救医学
中华医学会

中华危重病急救医学

CSTPCD北大核心
影响因子:3.049
ISSN:2095-4352
年,卷(期):2024.36(6)