髓过氧化物酶在腹腔灌洗治疗重症急性胰腺炎急性肺损伤中的作用

Role of myeloperoxidase in the treatment of acute lung injury associated with severe acute pancreatitis by peritoneal lavage

目的探讨髓过氧化物酶(MPO)在腹腔灌洗治疗重症急性胰腺炎(SAP)急性肺损伤中的作用。方法成年Wistar大鼠60只,随机分为4组:①阴性对照组(C组):开腹后仅翻动胰腺;②SAP组(S组):采用3.5﹪牛磺胆酸钠胰胆管逆行注射制成SAP模型;③腹腔灌洗组(W组):复制SAP模型成功后于胰腺被膜外放置灌洗管,于下腹部留置引流管,0.9%生理盐水行腹腔持续灌洗;④腹腔注射组(E组):取S组大鼠胰腺匀浆及腹水,于正常大鼠腹腔内注射。于造模后3、6和12h分批处死大鼠,采下腔静脉血2ml行淀粉酶测定;取左肺下叶组织行MPO检测;对胰腺及肺组织进行病理评分。结果 S组及E组肺泡间质水肿、出血,并有中性粒细胞、巨噬细胞浸润。在不同时间点,S组、W组和E组血清胰淀粉酶、肺MPO均高于C组(P<0.01),W组升高的程度小于S组。结论 SAP相关性腹水可以导致急性肺损伤,肺组织中MPO表达升高,提示其参与了急性肺损伤的发生过程,其原因可能与相关性腹水激活了粒细胞有关。早期腹腔灌洗将SAP相关性腹水进行稀释并引出体外,减少了腹膜巨噬细胞的活化,下调了MPO水平,减轻了肺损伤的程度,具有较好的治疗作用。

Objective To investigate the role of myeloperoxidase （MPO） in the treatment of acute lungs injury associated with severe acute pancreatitis （SAP） by peritoneal lavage. Methods Sixty adult wistar rats were randomly divided into four groups （n =15）：negative control group （group C）,SAP group （group S）,peritoneal lavage group （group W）,and peritoneal injection group （group E）. Rats in group C received laparotomy only. In group S,3.5% sodium taurocholate was injected retrogradely into biliopancreatic duct to establish SAPmodel. Thereafter pancreatic homogenate and ascites from group S were injected into abdominal cavity of rats in group E. Rats in group W were given continuous peritoneal lavage with 0.9% physiological saline through the drainage tube of hypogastric zone after SAP model replicating. All the rats were killed at 3,6 and 12 h after SAP model established respectively. The vena cava inferior blood was obtained for amylase determination. The tissue of left lower lobe was taken for MPO detection,and pathology of pancreas and lungs was scored. Results Pulmonary interstitial edema,hemorrhage and infiltration of neutrophilic granulocyte and macrophage were observed in the group S and E. At different time points,the levels of blood amylase and MPO in the group S and E were significantly higher than the group C （P〈0.01）,and the increased degree in group W were milder than the group S. Conclusions Acute lungs injury can be induced by SAP associated ascetic fluid. The MOP expression is elevated,indicating its important role in the process of acute lungs injury,and that may be related to activation of granulocyte by ascetic fluid. Early peritoneal lavage can dilute and elicit ascetic fluid from abdominal cavity,decrease activation of peritoneal macrophages,down-regulate MOP level,reduce lung injury,and thereby achieve a better therapeutic effect.