胰酶自身消化在大鼠急性出血坏死性胰腺炎病程中的作用

Role of autodigestion of pancreatic enzymes in acute hemorrhagic necrotizing pancreatitis in rats

目的：探讨急性出血坏死性胰腺炎（ＡＨＮＰ）病程中胰酶自身消化对胰腺病变的作用程度及胰酶活性与胰腺病变之间的关系。方法：以３％牛磺胆酸钠经胆胰管逆行注射制成大鼠ＡＨＮＰ。观察血清、十二指肠液、胰腺组织胰酶活性变化及胰腺组织学改变。结果：在ＡＨＮＰ６ｈ出现严重的胰腺出血坏死，血清胰酶活性显著升高（Ｐ＜０．０１），十二指肠液、胰腺组织胰酶活性显著降低（Ｐ＜０．０１），１２ｈ后３种胰酶活性呈进行性降低，胰腺组织学改变则进行性加重。结论：胰酶自身消化是ＡＨＮＰ早期胰腺病变的主要原因，血清、十二指肠液及胰腺组织中淀粉酶（ＡＭＳ）、脂肪酶（ＬＰＡ）、磷脂酶Ａ２（ＰＬＡ２）活性各呈一致的变化趋势，十二指肠液胰酶活性变化能够反映胰腺的病变程度。

Objective: To explore the effects of autodigestion of pancreatic enzymes on pancreatic lesions during acute hemorrhagic necrotizing pancreatitis (AHNP) and the relationship between the pancreatic enzymes and pancreatic lesions. Methods: After the model of AHNP was established with retrograde injection of 3% sodium taurocholate into biliopancreatic duct in rats, the activities of pancreatic enzymes in the serum, duodenal juice and pancreas were determined and the histological changes of the pancreas observed. Results: At the 6th hour after AHNP, severe hemorrhage and necrosis were seen in the pancreas and the activities of the pancreatic enzymes in the serum were significantly increased (P<0.01) but those in the duodenal juice and pancreas significantly decreased (P<0.01). At the 12th hour after AHNP, the activities in all the three samples were progressively decreased and the histological lesions in the pancreas developed continuously. Conclusion: The autodigestion of pancreatic enzymes is the main cause for the early pancreatic lesions and the changes of the activities of AMS, LPA and PLA 2 are unanimous in the serum, duodenal juice and pancreas. The changes of the pancreatic enzymes in duodenal juice can reflect the severity of pancreatic lesions.