Effect Of Ghrelin On Gastrointestinal Motility After Traumatic Brain Injury

Object:Traumatic brain injury is a common disease which is a serious threat to human health.The mortality and disability rate of all types of trauma were the highest.It is the primary cause of the disability and death of the young and young people at present.The incidence of the European and American countries is as high as 150-200/10 million people / year,and our country reaches 100-150/10 million people / year.TBI of gastrointestinal dysfunction after the main clinical manifestations are: one is the gastrointestinal mucosa ischemia,which usually leads to stress ulcer and gastrointestinal bleeding;two is the intestinal barrier damage,leading to translocation of bacteria and endotoxin,leading to systemic inflammatory response syndrome(SIRS)and septicemia;three is the motor dysfunction.The manifestation is abdominal distension,diarrhea,gastric retention,even toxic intestinal paralysis;four is the cause of malabsorption of nutrients of gastrointestinal mucosa,cause the malnutrition.For the first two aspects,there are many studies on Endotoxin Translocation Induced by gastrointestinal mucosal injury and intestinal barrier destruction after TBI,but few reports have been done on gastrointestinal dynamics after TBI.The reason is the lack of enough attention and the lack of standard criteria for the evaluation of gastrointestinal dynamics.A large number of studies have shown that the nutritional status of patients after TBI is positively correlated with the prognosis.The TBI patients are not only in the high metabolic state of the brain tissue and the whole body in the acute phase,but still in the state of protein high decomposition in the recovery period.Resting metabolic expenditure(RME)in TBI patients was significantly higher than that in non TBI patients.RME values in severe TBI patients were 240% of those in non TBI severe patients,similar to those in patients with burn body surface area of 20% to 40%.In acute stage,TBI patients present a high energy metabolism state.With the high differentiated metabolism and immune function changes,the excessive protein decomposition occurs,such as lack of adequate nutrition intake to support patients' acute bullying recovery and later rehabilitation needs,which will directly affect the prognosis.Clinically,nutritional support for TBI patients is mostly dependent on enteral nutrition.After TBI,gastrointestinal dysfunction will seriously affect the gastrointestinal tract's nutrition intake and improve the treatment level of gastrointestinal dysfunction after TBI,so as to improve the cure rate of TBI,which has important clinical significance.However,little is known about the changes and mechanisms of gastroenteric dynamics after TBI.Ghrelin is one of the brain gut peptides involved in the regulation of gastrointestinal motility,and has a variety of roles.Does Ghrelin have an improved effect on gastrointestinal dysfunction after TBI? How is the mechanism? Can you as one of the TBI after the treatment of gastrointestinal dysfunction,therefore,are as follows:(1)the establishment of TBI animal model of gastrointestinal dysfunction,gastrointestinal changes observed after TBI;(2)to observe the intervention with Ghrelin TBI after gastrointestinal dysfunction;(3)the effect of Ghrelin on the mechanism of gastrointestinal dysfunction after TBI.Method:(1)healthy adult male SD rats,TBI rat model,general observation,pathology and detection of gastrointestinal motility,evaluate the success of model making;(2)were randomly divided into sham operation group(Sham),trauma group(TBI),Ghrelin group(group Ghrelin,Ghrelin)after the injury to 30 min by rat tail intravenous injection of Ghrelin 20ug/kg,respectively,gastric motility detection: detection,gastric emptying rate,intragastric pressure,intestinal propulsive rate of fecal water content percentage and gastric contents percentage of body weight,cut the stomach,from the ileocecal 15 cm small intestine,caecum(Department of proximal ileum length was about 3 cm,3 cm distal colon ca.3 cm),gastrointestinal mucosal micro changes were observed under light microscope and electron microscope;(2)and sham operation group(Sham),trauma group(TBI)and group Ghrelin(Ghrelin)72h cerebral cortex The multichannel protein chip was used to screen the protein expression level and find the differential protein.Results:The rat model of gastrointestinal dysfunction after TBI was successfully established and verified by histopathology and function.The experiment showed that gastrointestinal dysfunction existed after TBI in rats.(1)form the basis of determination of changes of nerve function defect score of each nerve function volume showed that: TBI group and Ghrelin 6h group of neural function defect score was significantly higher than Sham group,there was significant difference(P < 0.01);and there was no difference between group TBI and group Ghrelin 6h neural function defect score(P > 0.05).TBI group and Ghrelin group 24 h,48h,72 h,neural function defect scores were significantly higher than that in Sham group,there was significant difference(P < 0.01);group TBI 24 h,48h 72 h,neurological deficit score was significantly higher than that in Ghrelin group,there was significant difference(P < 0.01);(2)rats results: the observation of gastrointestinal intestinal specimens of rats in Sham group were pink,TBI group of gastric dilatation,wall thinning,pale or dark red,small bowel dilatation,dark gray color,even with a large number of blood stasis,intestinal mucus,visible intestinal flatulence,only a small amount of discharge,even if the preoperative fasting for 24 h at each time still have large amounts of residual food in the stomach.In group Ghrelin 6 h,the residual food in the stomach was not significantly different from that in the TBI group,but the residual amount after 24 h decreased significantly.The percentage of fecal water content showed that the fecal water content of 24 h,48h and 72 h in group Sham was higher than that in group TBI and Ghrelin,and there was a significant difference(P < 0.01).The water content of feces of 24 h,48h and 72 h in Ghrelin group was also higher than that in group C.There was a significant difference(P < 0.01).Rat gastric contents of body weight accounted for the percentage of comparison results showed that: TBI group,24 h 48h,72 h of gastric contents account for the weight percentage was higher than that of Sham group and Ghrelin group,there was significant difference(P < 0.01);and there was no difference between group Sham and group Ghrelin 24 h,48h,72 h of gastric contents account for the weight percentage(P > 0.05).(3)after TBI,the main cells in the gastric gland were seen by 72 h electron microscope,and the surface of the cells had scattered and short microvilli.A large number of rough endoplasmic reticulum in the cytoplasm were found in the cytoplasm.The arrangement of the endoplasmic reticulum was not very regular.The mitochondria were locally swollen and the medullary corpuscles were found.A large number of endocrine granules were seen in the cytoplasm.Mitochondria were distributed and swollen,mitochondria cristae became shorter and fewer,and there were myeloid bodies in them.In group Ghrelin,the changes of 72 h gastric mucosa under electron microscope were better than those in TBI group.(4)the results of multichannel protein chip: the protein expression level was detected by protein chip in the cortical tissue of each group by 72 h.Compared with Sham,there were 14 differences in protein expression in group TBI.After Ghrelin,the expression of b FGF protein decreased significantly.Conclusion:This study confirms that there is gastrointestinal dysfunction after TBI.Ghrelin can effectively improve the gastrointestinal mucosal microstructure and gastrointestinal motility after TBI.It is preliminarily proved that the mechanism of Ghrelin improving gastrointestinal motility after TBI is brain protection.