急性出血性坏死性胰腺炎早期实验室诊断的研究

Early diagnosis of experimental acute hemorrhagic necrotizing pancreatitis

本实验以犬急性轻型和重型胰腺炎模型为对象，研究重症胰腺炎早期血清学变化。健康杂种犬１８只随机分三组。Ⅰ组为对照组，Ⅱ，Ⅲ组分别用１．５％，５％牛磺胆酸钠溶液加压注入犬的主胰管制成犬的轻型和重型胰腺炎模型，手术后１ｈ，４ｈ，７ｈ，１２ｈ取静脉血检测淀粉酶，脂肪酶，磷脂酶Ａ２（ＰＬＡ２）和正铁血红白蛋白（ＭＨＡ）的含量。结果发现重症组犬血ＰＬＡ２在术后４ｈ活性明显升高，为轻型组的１．８倍（Ｐ＜０．０１），对照组的４．７倍（Ｐ＜０．０１），且随病程的延长活性逐渐升高。ＭＨＡ的检测采用双光束二导波紫外分光光度法，血清不需任何处理，敏感性高，１μｍｏｌ／Ｌ以上的含量即可测出。本实验结果表明：重症组犬血ＭＨＡ含量在术后１ｈ即明显升高１７．１２±４．６１μｍｏｌ／Ｌ，为轻型的４．１倍（Ｐ＜０．０１），对照组的５．３倍（Ｐ＜０．０１），并且发现在术后１２ｈ时ＭＨＡ含量突然增高为轻型组的１１．７倍（Ｐ＜０．０１）对照组的３９．１倍（Ｐ＜０．０１）。重症组淀粉酶活性仅在１ｈ，４ｈ时与轻型组有显著性差异（Ｐ＜０．０５，Ｐ＜０．０１），而后随病程的延长其活性反而下降。脂肪酶活性升高的较早，术后１ｈ即与轻型组有显著性差别（Ｐ＜０．０?

The main problem in the diagnosis of acute pancreatitis is the early detection of the fulminant forms. So far there is no single laboratory test that affords an unequivocal measure of the severity of the disease. We have studied the serum amylase, lipase, phospholipase A2 and methemalbumin concentrations of 12 dogs with experimental edematous or hemorrhagic pancreatitis. The serum lipase, phospholipase A2 and methemalbumin concentrations were signiticantly higher in the dogs with hemorrhagic pancreatitis than in those with milder form of the disease. The significant elevation of lipase, phospholipase A2 and methemalbumin levels occured after one hour of operation. But the activities of lipase increase relatively slowly and the method for lipase activities is not sensitive.Serum methemalbumin levels were determined by secondderivative spectroscopy using a model 365 UV-vis double-beam spectrophotometer which has built-in derivative capability. The results suggest that the assaying of serum phospholipase and methemalbumin might be a valuable tool in the early diagnosis of AHNP.