中药清胰汤治大鼠重症急性胰腺炎时急性肺损伤的比较

Effect of Qingyitang on acute lung injury induced by severe acute pancreatitis in rats

目的:探讨中药(清胰汤)、糖皮质激素(地塞米松)、抗生素(凯复定)和生长抑素(善宁)在治疗重症急性胰腺炎(severe acute pancreatitis,SAP)时急性肺损伤(acute lung injury, ALI)的作用机制,为临床用药提供确切的理论依据. 方法:采用胰管逆行注射15 g/L去氧胆酸钠制成大鼠重症急性胰腺炎肺损伤模型.实验选用纯雄性健康Wistar大鼠共65只,质量220-250 g之间,随机分成6组:假手术对照组(SHAM,n=10);SAP模型组(SAP,n=20);SAP+善宁治疗组(SS,n=10);SAP+地塞米松治疗组(DEX,n=10); SAP+凯复定治疗组(KEF,n=10);SAP+清胰汤治疗组(QYT,n=10);分别于造模后24 h活杀,测定动脉血气, 血清淀粉酶的含量,血清内毒素及血清和肺组织匀浆中TNF,IL-6,MDA,SOD的含量,肺湿/干系数以及肺组织病理学改变. 结果:SAP模型组血清内毒素,血淀粉酶,血清及肺组织匀浆中TNF,IL-6,OFR均较假手术对照组(SHAM)明显升高(P<0.01).动脉血气显示肺损伤严重,肺湿/干比值较SHAM组明显升高,肺通透性明显升高,肺病理学形态改变加重.中药治疗组各检测指标均较模型组明显改善,其中LPS,TNF,IL-6下降显著.善宁治疗组在抑酶作用上优于其他治疗组.地塞米松治疗组对改善动脉血气,肺湿/干比率有明显作用. 结论:中药清胰汤,通过保护肠道屏障,减少了细菌移位,降低血清中内毒素水平,防止过氧化损伤,纠正机体致炎和抗炎系统失衡等多方面机制而对肺脏起到全面保护作用.地塞米松,善宁,凯复定在治疗ALI过程中均起到一定保护作用,通常在某个致病因素水平降低较中药显著,但并未降低整体死亡率,总体治疗效果较中药组差。

AIM: To compare the treatment of different Chinese medicines in rats with acute lung injury (ALI) induced by severe acute pancreatitis (SAP). METHODS: 15 g/L sodium deoxycholate was injected inversely into the common biliopancreatic duct in rat to make the model of ALJ during SAP. The rats were devided into 6 groups randomly: sham operated controls (n=10), SAP model (n =20), SAP+Sandostatin (n =10), SAP+ Dexamethasoni (n=10), SAP + Kefadim (n=10), and SAP +Qingyitang (n=10). All the rats were killed 24 hours after operation and treatment. The levels of TNF, IL-6, MDA, SOD, and NO in serum and pulmonary homogenate were measured. RESULTS: The levels of ET, TNF, IL-6, SOD, and MDA in serum and pulmonary homogenate in the model group were significantly higher than those of sham operated control group (P<0.01). The indexes of blood gas analysis showed obvious pathological changes in the model group and so did the pathological examination of lung tissue. The indexes of ALI-SAP + Qingyitang group were better than those of the model group (P<0.05). The effect of sandostatin on suppressing serum amylase was most significant. Dexamethasoni was effective on the amelioration of blood gas and W/T. CONCLUSION: ET, TNF, IL-6, and OFR play an important role in ALI caused by SAP. Qingyitang protects lung from injury in many aspects, preserving the gut barrier function, reducing or eliminate endotoxemia derived from the gut, and inhibiting the production and release of TNF, IL-6 and the translocation of bacteria. Dexamethasoni, sandostatin, kefadim have certain effect on reducing the levels of some indexes respectively, but those treatments can not improve the death rate. Qingyitang is superior to other methods.