摘要:目的:探讨电针“足三里”对脓毒症大鼠肠黏膜免疫屏障的影响及其可能机制。方法:SD大鼠按随机数字表法分为假手术组6只,模型组、非经非穴组、电针组各15只。以盲肠结扎穿孔法制备脓毒症大鼠模型。电针组大鼠于造模后给予电针双侧“足三里”,非经非穴组造模后给予电针非经非穴处,每次30 min每日1次,连续3 d。观察各组大鼠一般情况及造模后3 d的病死率;检测各组大鼠肠内细菌移位率;HE染色法观察肠黏膜病理形态学变化,TUNEL法检测肠黏膜淋巴细胞凋亡情况,流式细胞术检测CD4+和CD8+和CD8+T细胞,酶联免疫吸附法检测肠黏膜IL-4和肠黏液sIgA含量,Western blot法检测小肠组织Bcl-2、Bax蛋白表达水平。结果:电针组大鼠病死率为13.33%(2/15),模型组、非经非穴组均为46.67%(7/15),电针组较模型组、非经非穴组明显降低(P<0.05)。与假手术组比较,模型组肠内细菌移位升高(P<0.05),光镜下肠黏膜病理损伤严重,肠黏膜Chiu评分、淋巴细胞凋亡指数、小肠组织Bax表达均升高(P<0.05),小肠组织CD4+T细胞,酶联免疫吸附法检测肠黏膜IL-4和肠黏液sIgA含量,Western blot法检测小肠组织Bcl-2、Bax蛋白表达水平。结果:电针组大鼠病死率为13.33%(2/15),模型组、非经非穴组均为46.67%(7/15),电针组较模型组、非经非穴组明显降低(P<0.05)。与假手术组比较,模型组肠内细菌移位升高(P<0.05),光镜下肠黏膜病理损伤严重,肠黏膜Chiu评分、淋巴细胞凋亡指数、小肠组织Bax表达均升高(P<0.05),小肠组织CD4+、CD8+、CD8+T细胞百分比及肠黏膜IL-4含量、肠黏液sIgA含量、小肠组织Bcl-2表达均明显降低(P<0.05)。与模型组及非经非穴组比较,电针组肠内细菌移位率、肠黏膜淋巴细胞凋亡指数、小肠组织Bax表达均降低(P<0.05),小肠组织CD4+T细胞百分比及肠黏膜IL-4含量、肠黏液sIgA含量、小肠组织Bcl-2表达均明显降低(P<0.05)。与模型组及非经非穴组比较,电针组肠内细菌移位率、肠黏膜淋巴细胞凋亡指数、小肠组织Bax表达均降低(P<0.05),小肠组织CD4+、CD8+、CD8+T细胞百分比及肠黏膜IL-4含量、肠黏液sIgA含量、小肠组织Bcl-2表达均升高(P<0.05)。结论:电针“足三里”可抑制脓毒症大鼠肠黏膜淋巴细胞凋亡,保护肠黏膜免疫屏障功能,降低肠道通透性,其机制可能与调控Bcl-2家族蛋白有关。Objective To observe the effect of electroacupuncture(EA) at “Zusanli”(ST36) on apoptosis of intestinal T lymphocytes, translocation of intestinal bacteria and expression of intestinal Bcl-2 and Bax proteins and intestinal mucosal immune barrier in sepsis rats, so as to explore its underlying mechanism in relieving sepsis. Methods SD rats were randomly divided into sham operation(n=6), model(n=15), non-meridian and non-acupoint(non-acupoint, n=15) and acupoint EA(n=15) groups by using random number table method. The sepsis model was established by using cecal ligation and perforation(CLP) method. EA(2 Hz, 2 mA) was applied to bilateral ST36 or non-acupoint for 30 min one hour after modeling, once every day for 3 days. The rats' general conditions and fatality rate in 3 days after modeling were recorded. The liver, spleen and mesenteric lymph nodes were taken for bacterial culture to detect the translocation rate of intestinal bacteria. The small intestinal tissue was taken for observing histopathological changes(Chiu's score: 0-5 points) after HE staining, and for determining the expression levels of Bcl-2 and Bax proteins using Western blot. The intestinal mucosa was sampled for detecting the apop-tosis(apoptotic index) of lymphocytes by using terminal deoxynucleoitidyl transferase-mediated deoxyuridine triphosphate biotin nick end labeling(TUNEL) assay, and the counts of CD4+T细胞百分比及肠黏膜IL-4含量、肠黏液sIgA含量、小肠组织Bcl-2表达均升高(P<0.05)。结论:电针“足三里”可抑制脓毒症大鼠肠黏膜淋巴细胞凋亡,保护肠黏膜免疫屏障功能,降低肠道通透性,其机制可能与调控Bcl-2家族蛋白有关。