结肠清洁联合善宁治疗重症急性胰腺炎时促炎因子的变化

Change of pro-inflammatory cytokines in experimental severe acute pancreatitis treated by enema and Sandostatin.

目的探讨结肠清洁联合善宁治疗犬急性坏死性胰腺炎（ANP）时促炎因子的变化。方法健康杂种犬16只，随机分为4组：（1）假手术组（A组，n=4）；（2）ANP组（B组，n=4）；（3）善宁治疗组（C组，n=4）；（4）善宁＋结肠清洁联合治疗组（D组，n=4）。采用胰管内注入5％牛磺胆酸钠（1ml／kg体重）和胰蛋白酶（每毫升含8000～10000BAEE）混合液的方法诱导犬ANP，以0．9％氯化钠注射液取代5％牛磺胆酸钠混合液即为假手术组。每只犬均在术前30min、术后8h、26h、50h、74h各取股静脉血2ml，测定TNF-α、IL-β、IL-6、IL-8的动态变化，术后12h、24h、48h、72h测定血清淀粉酶，术后74h处死犬。结果血清淀粉酶的变化符合ANP。组间比较显示，术后促炎因子水平联合治疗组明显低于善宁治疗组和ANP组（P〈0．05），善宁治疗组明显低于ANP组，ANP组和善宁治疗组均明显高于假手术组（P〈0．05）。结论结肠清洁联合善宁治疗ANP对促炎因子清除明显。

Objective To explore a combined treatment of colonic therapy with Sandostatin for severe acute pancreatitis and observe dynamic changes of pro-inflammatory cytokines in an animal model. Methods Sixteen healthy mongrel dogs were randomly divided into normal control group（n -= 4）, severe acute pancreatitis group（n=4）, Sandostatin therapy group（n = 4）, and Sandostatin plus colonic therapy group（combined therapy group, n = 4）. Severe acute pancreatitis was induced in dogs by pancreatic duct infusion of a mixture of 5% sodium taurocholate （1 ml/kg） and trypsin（8 000 10 000 BAEE in every milliliter）. The mixture of sodium taurocholate was replaced by by 0.9% sodium chloride in normal control group. 2 ml blood was drawn from the femoral vein 30 min before operation, and 8, 26, 50 and 74 h after operation. Dynamic changes of tumor necrosis factor-α（TNF-α）, interleukin 1β（IL-1β）, interleukin-6（IL-6） and interleukin-8（IL-8） were tested. Serum amylase levels were observed at 12, 24, 48 and 72 h. The dogs were killed at 74 h after operation. Results Changes of serum amylase level were consistent with SAP. Inter-group comparison showed that plasma proinflammatory cytokine level was significantly lower in combined therapy group than in Sandostatin therapy group and SAP group after operation, and that plasma pro-inflammatory cytokine level was significantly lower in Sandostatin therapy group than in SAP group, and significantly higher in Sandostatin therapy group and SAP group than in normal control group （P 〈 0. 05）. Conclusions Colonic therapy combined with Sandostatin has a significant effect of clearing pro-inflammatory cytokines.