肝在重症急性胰腺炎发病过程中的作用

The role of liver in the process of severe acute pancreatitis

目的 :探讨肝在重症急性胰腺炎发病过程中的作用。 方法 :比较对照组、门腔静脉分流 (PC)组、急性出血坏死性胰腺炎 (ANP)组及PC后立即制作ANP(PC +ANP)组大鼠生存时间、血浆和腹水中内毒素、血清和腹水中白细胞介素 6 (IL 6 )及血浆血小板α 颗粒膜蛋白 (GMP 14 0 )水平 ,并对各组动物肺组织进行病理检查。用ANP大鼠腹水经下腔静脉给PC及不分流组进行注射 ,测定血清IL 6水平 ,并与用等渗盐水的对照组进行比较。 结果 :PC后立即制作ANP组生存时间明显减少 ,其血浆内毒素、血清IL 6及血浆GMP 14 0水平明显高于其他各组(P <0 .0 1) ,且其肺组织病变严重。腹水中内毒素、IL 6水平均高于血浆中内毒素、血清IL 6。腹水注射组和PC后腹水注射组血清IL 6水平明显高于对照组和ANP组 ,而前二组之间无明显差异。 结论 :肝在重症急性胰腺炎发病早期对机体起保护作用 ,对ANP腹水进入体循环引起的炎症反应无明显作用。

Objectives: To explore the role of liver in the process of severe acute pancreatitis. Methods:Comparing the survival time, the endotoxin level of plasma and ascites , the IL-6 level of serum and ascites, the platelet granule membrane protein-140 (GMP-140) level of plasma and the histology change of lung between control group, portocaval shunting group(PC), acute necrotic pancreatitis (ANP) group and acute necrotic pancreatitis immediately after portocaval shunt(PC+ANP) group of rats. Measuring the serum IL-6 of control group, portocaval shunt control group (injecting normal saline through caval vein, PCJ), ascites injecting group (AJ) and ascites injecting portocaval shunt group (PC+AJ). Results: The survival time of PC+ANP group was much shorter than those of the other groups, and its plasma endotoxin , serum IL-6 and plasma GMP-140 levels were higher than those of the other groups (P<0.01). The histology change of lung in PC+ANP group was more severe than those of the other groups. The endotoxin and IL-6 levels of ascites were higher than those of plasma and serum (P<0.01). The levels of serum IL-6 in AJ group and PC+AJ group were more than those of control group, PCJ group and ANP group (P<0.05), and there was no obviously difference between AJ group and PC+AJ group. Conclusions: Liver plays a protective role in the early stage of ANP.Liver has no obvious effect on inflammatory response by the ascites of ANP already entering into the systematic circulation.