The role of gastric and duodenal agents in laryngeal injury: An experimental canine model
The role of gastric and duodenal agents in laryngeal injury: An experimental canine model
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DOI：
10.1111/j.1572-0241.2004.40170.x
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发表时间：
2004-11-01
影响因子：
9.8
通讯作者：
Vaezi, MF
中科院分区：
文献类型：
--
作者：
Adhami, T;Goldblum, JR;Vaezi, MF
背景：导致喉部症状和体征的具体因素目前尚不清楚。在实验犬模型中，我们系统地评估了胃（酸和胃蛋白酶）和十二指肠（胆汁酸和胰蛋白酶）成分单独或联合对不同喉部结构的损伤作用。方法：共研究了42只小猎犬（体重9-15公斤）。经五戊酚麻醉后，所有犬行喉镜检查。第1天右声带、内侧杓状壁和环状后壁损伤（穿刺活检）。将胃蛋白酶（0.5 mg/ml）、偶联胆汁酸（CBA）（熊去氧胆酸，300微摩尔）、未偶联胆汁酸（UBA）（胆酸，300微摩尔）、胰蛋白酶（0.5 mg/ml）在pH 1-2、4-5和6-7时双侧应用于喉部，每周3次，共9-12次。目测喉部的变化。所有犬在末次给药后1天处死。取喉部组织进行盲法病理检查。组织和视觉评分相互比较，并与对照组和假治疗的狗进行比较。结果：胃蛋白酶单用（8.5 +/- 1.66）或联合CBA（16.63 +/- 1.66）在pH 1-2时引起的严重组织学炎症显著（p < 0.001），明显大于其他药物。在所有pH值下，十二指肠成分均未引起或仅引起轻微的组织学损伤。在pH值为1-2的情况下，单独使用CBA或与胃蛋白酶联合使用胃蛋白酶后，小鼠轻度红斑以上的视觉评分显著（p < 0.001）升高。所有部位的组织学评分与视觉评分之间存在显著相关性（p < 0.01） （rho = 0.47; 95% Cl = 0.30-0.60）。在三个喉部中，声带对应用溶液的损伤最为敏感。结论：(1)在酸性反流中，胃蛋白酶和cba是影响喉组织的最大损伤因子。（ii）十二指肠药物在引起喉损伤中没有显著作用。（三）强力抑酸应消除任何胃十二指肠反流的潜在伤害。
BACKGROUND The specific agents responsible for producing laryngeal signs and symptoms are currently AND AIMS: unknown. We systematically evaluated the damaging role of gastric (acid and pepsin) and duodenal (bile acids and trypsin) ingredients individually and in combination on different laryngeal structures in an experimental canine model.METHODS: A total of 42 beagles were studied (wt 9-15 kg each). After pentathol anesthesia all dogs underwent laryngoscopy. Injury (punch biopsy) was caused to the right vocal cord, medial arytenoid wall, and posterior cricoid wall on day 1. Pepsin (0.5 mg/ml), conjugated bile acid (CBA) (ursodeoxycholic acid, 300 micromolar), unconjugated bile acids (UBA) (cholic, 300 micromolar), trypsin (0.5 mg/ml) at pH 1-2, 4-5, and 6-7 were applied bilaterally to laryngeal sites three times per week for a total of 9-12 applications. Changes in laryngeal sites were scored visually. All dogs were sacrificed 1 day post last application. Laryngeal tissue was harvested and sent for blinded pathological examination. Histologic and visual scores were compared to each other and to control- and sham-treated dogs.RESULTS: Pepsin alone (8.5 +/- 1.66) or combined with CBA (16.63 +/- 1.66) at pH 1-2 resulted in significant (p < 0.001) severe histological inflammation much greater than with other agents. Duodenal ingredients caused no or minimal degree of histological damage at all pH values. Visual scores above subtle erythema were significantly (p < 0.001) higher in the animals exposed to pepsin followed by CBA alone or in combination with pepsin at pH 1-2. There was a significant (p < 0.01) correlation between histology and visual scores (rho = 0.47; 95% Cl = 0.30-0.60) for all sites combined. Of the three laryngeal sites, vocal cords were the most sensitive to injury by applied solutions.CONCLUSIONS: (i) In acidic refluxate, pepsin and CBAs are the most injurious agents affecting laryngeal tissue. (ii) Duodenal agents do not play a significant role in causing laryngeal injury. (iii) Aggressive acid suppression should eliminate the injurious potential of any gastroduodenal refluxate.