重症急性胰腺炎肝血流动力学改变及活化蛋白C干预的影响

Effect of activated protein C on hemodynamic changes of liver in rats with severe acute pancreatitis.

目的通过CT灌注成像技术探讨SAP时肝脏的血流动力学表现,以及活化蛋白C（activated protein C,APC）对其的治疗作用。方法SD雄性大鼠分为对照组、ANP组、APC10μg/kg体重、50μg/kg体重治疗组。于制模后1h、6h、16h、24h行肝脏动态CT灌注成像检查,测定局部肝血流量（BF）、血容量（BV）、平均通过时间（MTT）、表面通透系数（PS）和肝动脉指数（HAF）,24h处死动物行肝脏和胰腺病理学检查。结果与对照组比较,ANP组BF、BV值降低,MTT值延长,PS增加,HAF值下降,以24h点最为显著（P〈0.01）。APC治疗组与ANP组比较,上述指标改善,以APC50μg/kg体重治疗组更明显（P〈0.01或0.05）,同时肝脏组织损伤分级及胰腺组织病理分值明显降低（P〈0.01）。结论ANP大鼠肝脏存在明显的血液低灌注状态,而APC的应用可改善异常的血流动力学。

Objective To evaluate the hemodynamic changes in the liver of rats with severe acute pancreatitis （SAP） by computed tomography （CT） perfusion imaging, and investigate the effect of activated protein C （APC） on homodynamic changes in rats with SAP. Methods Male SD rats were given intravenous injection of saline （SAP group） or APC （50 μg/kg, 10 μg/kg, respectively, treatment groups） just before induction of SAP. One group of rats underwent only sham operation （control group）. The blood flow （BF）, blood volume （BV）, mean transit time （MTT）, permeability surface （PS） and hepatic arterial fraction （HAF） of liver were measured by CT perfusion imaging at 1 h, 6 h, 16 h and 24 h after induction. The histological changes of liver and pancreas were evaluated when the rats were sacrificed after 24 h. Results The levels of BF and BV decreased, MTT was lengthened, the level of PS increased, the levels of HAF decreased in SAP group compared with control group, but which were opposite in APC treatment groups when compared to SAP group, the difference at 24 h in APC 50μg/kg treatment group was the most significant （P 〈 0.01）. The injuries of liver and pancreas improved in APC 50 μg/kg treatment group compared with SAP group （P 〈 0.01）. Conclusions During the course of ANP, the hemodynamic changes of hypoperfusion were present in liver of rats; therapy with APC could ameliorate blood microcirculation derangement and the hemodynamic abnormality.