Osman Z. KARAKUŞ, Oğuz ATEŞ, Nergis MURAT, Gülce HAKGÜDER, Mustafa OLGUNER, Bora SOLMAZ, ERDENER ÖZER, SEDEF GİDENER, Feza M. AKGÜR

Gastroşizisli civciv embriyolarında intraamniyotik mekonyumla oluşan barsak hasarında üriner tripsin inhibitörünün intestinal motiliteyi koruyucu etkisi

Amaç: Gastroşiziste barsak hasarı morbidite ve mortaliteyi önemli ölçüde etkiler. Morbiditenin en önemli nedeni barsak hasarı nedeniyle motilitenin yetersizliğine bağlı hastaların uzun süre parenteral beslenmelerinden kaynaklanan sepsis, kolestaz gibi ciddi sorunlardır. Üriner tripsin inhibitörü (ÜTİ)’nün gastroşiziste barsak hasarını engellediği gösterilmiştir. İntestinal motilite üzerindeki etkileri bilinmemektedir. Gastroşiziste ÜTİ’nin intestinal motilite üzerine etkilerini göstermek amacıyla bu çalışma planlanmıştır. Gereç ve yöntem: Bu çalışmada beş günlük civciv embriyoları kullanıldı. Kontrol grubunda yumurtalar hiç açılmadan izlendi. Sham grubunda sadece amniotik kese açıldı. Gastroşizis grubunda allantoik kese açılmadan amniyotik kese açılarak gastroşizis oluşturuldu. Mekonyum+gastroşizis grubunda, amnion sıvısına 1/400 konsantrasyonda mekonyum süspansiyonu eklendi. Tedavi gruplarında ise, sırasıyla 100, 200 ve 400 IÜ/ml ÜTİ + 1/400 mekonyum süspansiyonu gastroşizisli embryoların amniyon sıvısına eklendi. Embriyolar 18. günde çıkartılarak gastroşizisli barsak segmentleri Tyrode solüsyonunda organ banyosuna asılarak kümülatif olarak denenen asetilkolin (10-9- 10-4 M) ile oluşan kasılma yanıtları ölçüldü ve maksimum yanıt (Emax) 10-4 konsantrasyonda alındı. Barsaklar histopatolojik olarak incelenerek seroza kalınlıkları ölçüldü. Bulgular: Tüm gruplar Emax’taki yanıtlarına göre değerlendirildiğinde kontrol, sham ve 400 IÜ/ml ÜTİ grupları arasında anlamlı fark olmadığı görüldü. Gastroşizis mekonyum, 100 IÜ/ml ÜTİ ve 200 IÜ/ml ÜTİ grupları arasında da anlamlı fark saptanmadı. Bu gruplar ile 400 IÜ/ml ÜTİ grubu karşılaştırıldığında anlamlı fark saptandı (p< 0,01). barsak seroza kalınlıklarında gastroşizis mekonyum, 100 ve 200 İU/ml ÜTİ gruplarında artış saptanırken, 400 IÜ/ml ÜTİ grubunda normal saptandı. Sonuç: Gastroşiziste, intraamniotik 400 IÜ/ml ÜTİ, 1/400 konsantrasyonda mekonyum süspansiyonun yarattığı barsak hasarı ve motilite azlığını engellemektedir.

The protective effect of urinary tripsin inhibitor on intestinal motility in intestinal damage occuring with intraamniotic meconium of chick embryos with Gastrochisis

Objective: Intestinal damage (ID) is closely related to morbidity and mortality in gastroschisis. The reason of morbidity is hypomotility due to ID. Hypomotility causes serious problems such as sepsis and cholestasis following long time parenteral nutrition. Urinary trypsin inhibitor (UTI) has been shown to prevent intestinal damage in gastroschisis. However, the effect of UTI on intestinal motility is not known. An experimental study has planned to investigate the effects of UTI on intestinal motility in gastroschisis. Methods: Five-days-old fertilized chick embryos were used in this study. In control group, embryos was observed without opening the eggs. In Sham group only amniotic membrane was opened. In gastroschisis group, gastroschisis was created after amniotic membrane was opened. In the meconium + gastroschisis group, 1/400 meconium suspension was instilled into the amniotic cavity. In the treatment groups, 100, 200 and 400 IU/ml UTI plus 1/400 meconium suspension was instilled to amniotic cavity of the gastroschisis embryos, respectively. On the 18th gestational day, all embryos were extirpated and intestines were harvested then placed in Tyrode solution. Contraction responses in intestine were assessed by isolated tissue bath with cumulative doses of acetylcholine (10-9-10-4M). Serosal thicknesses of the intestines in each group were evaluated histopathologically. Results: When all the groups were evaluated according to their response to Emax., there was no significant difference between control, Sham, gastroschisis and 400 IU/ml UTI groups. Similarly there was no significant difference between meconium + gastroschisis group, 100 IU/ml and 200 IU/ml UTI groups. Significant difference was determined between these groups and 400 IU/ml UTI group (p<0,01). Indeed serosal thicknesses were increased in meconium + gastroschisis, 100 and 200 IU/ml UTI groups, it was normal in 400 IU/ml UTI group. Conclusion: Intraamniotic 400 IU/ml UTI prevents the ID and hypomotility induced by 1/400 concentration of meconium in gastroschisis.

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