L-精氨酸对胰腺炎相关性腹水诱导肾损伤的保护作用

The protective effect of L-arginine on the renal injury induced by pancreatitis associated ascitic fluid

目的通过观察胰腺炎相关性腹水（PAAF）对正常肾脏的影响及L-精氨酸（L-arg）对其的作用，探讨重症急性胰腺炎时急性肾损伤的发病机制。方法60只SD大鼠制成重症急性胰腺炎（SAP）模型并收集其腹水备用；60只SD大鼠制成消化道穿孔性腹膜炎（DPP）模型并收集其腹水（DAF）备用；将两组腹水分别注射至正常大鼠腹腔内诱导肾损伤以此建立PAAF组及DAF组；并观察L-精氨酸的作用。观察各组术后12h的肾功能、血淀粉酶及病理学变化，同时检测肾细胞凋亡及诱生型一氧化氮合酶（iNOS）的表达情况。结果血清BUN、Cr，PAAF组〉DAF组〉L-arg组〉NS组；Amyl，DAF组〉PAAF组〉L-arg组〉NS组；但均低于SAP组；而血清NO及组织中iNOS的表达，NS组〈PAAF组〈DAF组〈SAP组〈L—arg组；肾细胞凋亡率及病理学改变，SAP组〉PAAF组〉DAF组〉L-arg组〉NS组。结论PAAF可以诱导正常大鼠的肾细胞凋亡引起肾损伤，且该作用可以被小剂量的L—arg阻断。

Objective To explore the mechanism of acute renal injury in severe acute pancreatitis （SAP） by observing the effect of pancreatitis associated ascitic fluid （PAAF） on the normal kidney and the effect of L-arginine on it. Methods SAP models were established in 60 rats and PAAF was collected. Perforative peritonitis （PP） models were created in other 60 rats and the perforative peritonitis associated ascitic fluid （PPAF） was collected. Seventy two SD rats were randomly divided into 4 groups：NS group, DAF group, PAAF group and L-arg group. Serum concentrations of amylase, urea nitrogen, creatinine clearance rate and nitric oxide were determined at 12th h post-operation. The renal cell apoptosis rate and inducible nitric oxide synthase activity were examined. Histological observation was performed. Resuits The BUN, Cr levels and the renal cell apoptosis rate in DAF group were higher than in L-arg group, but lower than in PAAF group,which was identical with renal pathological changes. The amylase levels in PAAF group were higher than in L-arg group ,but lower than in DAF group. The amylase level was lowest in NS group, but highest in SAP group. The content of nitric oxide and the activity of inducible nitric oxide synthase in DAF group were higher than in PAAF group,but lower than in L-Arg group,and lowest in SAP group. Conclusion The renal cell apoptosis and injury could be induced by pancreatitis associated ascitic fluid and it could be blocked by low doses of L-arzinine.