罗东林 周继红 刘宝华 熊仁平 叶秀峰 徐祥 陈金萍

    【摘要】 目的 从组织细胞受体水平探讨糖皮质激素受体(GR)和热休克蛋白70 (HSP70)在创伤失血性休克后肝脏中的变化及其作用。 方法 采用双侧股骨骨折伴失血性休克致严重创伤模型，动态观察伤后8 h大鼠肝组织GR、HSP70、血清肝功能生化指标、肝脏病理等变化。采用蛋白质免疫印迹法(Western blot)测定肝组织GR、HSP70含量，并进行计算机图像分析。结果单纯股骨骨折伤后，肝组织GR含量于伤后1 h即开始下降，6 h降至最低，8 h仍显著低于正常对照组；创伤合并休克后，GR下降更加明显。HSP70在单纯股骨骨折伤后迅速增加，6 h达到峰值，8 h仍持续在较高水平；创伤合并休克后，HSP70升高更加显著。单纯股骨骨折伤后，血清丙氨酸转氨酶(ALT)、总胆红素(TB)和白蛋白与正常对照组比较，差异均无显著性。但创伤合并休克后4 h和2 h血清ALT和TB分别开始明显增高(P均<0.01)，白蛋白则均下降(P均<0.01)。创伤合并休克后6 h肝脏镜下肝窦内即出现较多炎性细胞浸润。结论GR不足在严重创伤失血性休克后肝脏继发性损害过程中起重要作用，HSP70可能参与了肝组织细胞抗损伤机制的启动。

    【关键词】 创伤；休克，失血性；受体，糖皮质激素；热休克蛋白；肝损伤

    Changes in glucocorticoid receptor and heat shock protein 70 in liver tissue after trauma with hemorrhagic shock in rats LUO Donglin, ZHOU Jihong, LIU Baohua, XIONG Renping, YE Xiufeng, XU Xiang, CHEN Jinping. Research Institute of Surgery, Daping Hospital, The Third Military Medical University, Chongqing 400042, China

    【Abstract】 Objective To investigate changes and functions of glucocorticoid (GR) and heat shock protein 70 (HSP70) at the level of cellular receptor in liver in hemorrhagic shock after trauma. Methods Adult Wistar rats were used and a rat model of shock was reproduced by hemorrhaging accompanied by bilateral femur fracture. Changes in hepatic tissue GR, HSP70, pathology of liver, hepatic function markers in serum were dynamically observed. The expression of GR and HSP70 in hepatic tissue was assayed by Western blot and then analyzed with computer imaging system. Results Protein content of GR gradually decreased in hepatic tissue after trauma, reduced to the nadir at 6 hours after trauma, and it was decreased even more when trauma was added to bleeding. Protein content of HSP70 was gradually increased in hepatic tissue after severe trauma, peaking at 6 hours after trauma, and it maintained at a rather high level at 8 hours after trauma. It was even more increased in when hemorrhagic shock was followed by trauma. Alterations in hepatic function markers and pathology were not obvious after simple trauma. But after trauma was added to hemorrhagic shock, significant increase in alaine aminotransferase (ALT) and total bilirubin (TB) in serum was noted at 4 and 2 hours after trauma respectively (all P<0.01), and albumin content was obviously decreased (P<0.01). There were more inflammatory cell infiltration in hepatic sinusoids at 6 hours after trauma. Conclusion GR may play an important role in antiinjury mechanism of hepatic tissue cell after trauma with hemorrhagic shock. HSP70 may participate in initiating antiinjury mechanism of hepatic cells. ......