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目的探讨组织因子(tissue factor,TF)在脑出血(intracerebral hemorrhage,ICH)后急性肺损伤(acute lung injury,ALI)中的作用。方法采用自体血尾状核注入法制备脑出血大鼠模型;将35只Wistar大鼠随机分为假手术组(5只)和脑出血组(30只),脑出血组又分为6、12、24、48h和3、5d6个亚组;应用HE染色观察各组脑出血周围组织与肺组织的炎症反应情况及炎症细胞计数;用RT-PCR法半定量检测TFmR-NA在脑和肺组织中的表达水平。结果脑出血6h可见轻度脑水肿,12h脑水肿明显,24h血肿周围炎症细胞浸润增多,48h脑水肿及炎症反应最重;脑出血6h即有间质性肺炎表现和局灶性肺气肿,48～72h炎症反应达高峰,肺泡结构破坏明显。脑出血6h在脑血肿周围组织中TFmRNA表达增高(P<0.01),12h达高峰(P<0.01),3～5d表达仍高于假手术组(P<0.01);肺中TFmRNA于12h表达开始增高(P<0.01),24h表达最高(P<0.01),2～3d仍明显高于假手术组(P<0.01),5d时与假手术组比较无明显差异(P>0.05)。结论脑出血可导致急性肺损伤,TF在其中可能发挥重要作用;凝血反应和炎症反应可能共同参与了脑出血后的急性肺损伤。
Objective To investigate the role of tissue factor (TF) in acute lung injury (ALI) after intracerebral hemorrhage (ICH). Methods Fifty-five Wistar rats were randomly divided into sham-operated group (n = 5) and intracerebral hemorrhage group (n = 30). The cerebral hemorrhage group was divided into 6, 12 , 24,48h and 3,5d6 subgroups respectively. Inflammatory reaction and inflammatory cell count were observed by HE staining in peripheral tissues and lung tissues of each group. Semi-quantitative RT-PCR was used to detect the expression of TFmR-NA in brain and lung tissues In the expression level. Results 6h cerebral hemorrhage can be seen mild cerebral edema, 12h brain edema significantly increased 24h inflammatory cells around the hematoma infiltration, 48h brain edema and inflammatory response heaviest; 6h cerebral hemorrhage that interstitial pneumonia and focal emphysema, 48 ~ 72h peak inflammatory response, alveolar structural damage significantly. The expression of TFmRNA in cerebral hematoma tissue increased 6h after cerebral hemorrhage (P <0.01), peaked at 12h (P <0.01), and remained higher at 3 ~ 5d than that in sham operation group (P <0.01) (P <0.01), the highest expression was observed at 24 h (P <0.01), and the level at 2 ~ 3d was still significantly higher than that at sham operation (P <0.01). Conclusions Cerebral hemorrhage can lead to acute lung injury, and TF may play an important role in it. Coagulation and inflammatory reactions may participate in acute lung injury after intracerebral hemorrhage.