中药清胰汤治疗急性坏死性胰腺炎的实验研究

An Experimental Study on Curative Effect of Chinese Medicine Qing Yi Tang in Acute Necrotizing Pancreatitis

目的 :观察中药清胰汤对急性坏死性胰腺炎 (ANP)治疗效果。方法 :杂种犬 2 3只 ,分3组 :对照组 (7只 )、ANP组 (8只)和中药组 (8只 ,术后每天经胃管灌服清胰汤 2 0ml/kg,连用 7天 )。测定血中淀粉酶 (AMY)、内毒素 (LPS) ,作脏器细菌培养、病理检查和肠粘膜菌群分析。结果 :ANP组胰、肠病理损害严重 ,肠粘膜大肠杆菌数量增加 ,双歧杆菌和乳杆菌减少 ,肠道微生态紊乱 ,脏器细菌移位率 1 0 0 % ,AMY和LPS明显升高。中药组与ANP组比较 ,上述变化明显减轻 ,脏器细菌移位率下降 5 0 % ,血AMY和LPS水平下降 2～ 3倍。结论 :清胰汤可明显减轻ANP的病理和病理生理损害 ,调整菌群失调 ,保护肠屏障功能 ,对防治ANP后肠道细菌移位和肠源性感染具有重要作用。

Objective: To observe the curative effect of the traditional Chinese medicine (TCM) Qing Yi Tang (QYT) in acute necrotizing pancreatitis (ANP). Methods: Twenty three dogs were randomly divided into 3 groups. In control group (n=7), animals underwent laparotomy only. In ANP group (n=8), acute necrotizing pancreatitis was induced by injection of 0.5 ml/kg 5% sodium taurocholate with 3000u/kg trypsin into the pancreatic duct. While in TCM group (n=8) were fed everyday with QYT after onset of ANP. All animals were sacrificed 7 days later and organs were gathered and cultured. Mucosal and luminal floras of the intestine were analysed. Pancreas and ileal mucosa were examined histologically and ultra microscopically, the levels of lipopolysaccharide (LPS) and amylase in blood were determined. Results: In TCM groups, histologic and ultra structural damages in pancreas and ileal mucosa were much milder as compared with those of ANP group. In ANP group, there was a significant increase of E. coli and bacterocoids, and a significant decrease of bifidobacteria, lactobacilli and enterococci in the intestinal mucosa, while in TCM groups, these changes were alleviated significantly (P<0 05 or P<0 01). As compared with ANP group, the bacterial translocation (BT) rate was reduced from 100% to 50%, and the counts of translocated bacteria were decreased 10～40 times, the levels of LPS and amylase reduced 2 to 3 times. Conclusion: TCM recipe QYT showed their protective effects on gut barrier function by alleviating the damage of intestinal mucosa and microecologic disturbance following acute pancreatitis. As a result, the chances of BT and enterogenic infection declined. These preparation might be promising in the prophylaxis and treatment of infection complicating ANP.