生长抑素和生长激素联用对兔重症急性胰腺炎肠黏膜屏障损伤的保护作用

The protective effect of somatostatin combined with growth hormone in treatment of intestinal mucosal barrier injury in rabbits with severe acute pancreatitis

目的 观察生长抑素（SS）和生长激素（GH）联合应用对重症急性胰腺炎（SAP）兔肠黏膜屏障损伤的保护作用,探讨其对治疗SAP的意义.方法 72只新西兰大白兔平均分为3组,SAP模型组（SAP组）、SS治疗组（SS组）以及SS和GH联合治疗组（SS＋GH组）.经胰管开口逆行注入5%牛磺胆酸钠溶液诱导兔SAP模型,造模后3组均每日予5%葡萄糖氯化钠（GNS）治疗,SS组造模后按3.5μg·kg-1·h-1持续48 h泵入SS治疗,SS＋GH组造模后第1、24 h在持续泵入SS的基础上,按0.15 IU/kg皮下注射GH治疗.观察各组动物造模后第6、12、24、48小时血清淀粉酶、肿瘤坏死因子（TNF）-α,血浆二胺氧化酶水平的变化,观察兔胰腺和肠黏膜的病理学变化及存活率.采用SPSS 16.0统计软件进行分析,组间比较采用单因素方差分析.结果 SS＋GH组兔血清TNF-α和血浆二胺氧化酶水平较SAP组和SS组均明显降低,造模后24 h[分别为（2.43±0.14）pg/ml和（4.61±0.45）U/L]和48 h[分别为（2.08±0.23）pg/rl和（3.75±0.47）U/L]较SS组[24 h分别为（2.80±0.30）pg/ml和（8.74±1.77）U/L,48 h分别为（2.45±0.12）pg/m1和（5.02±0.95）U/L]显著降低,差异均有统计学意义（P＜0.05）.SS＋GH组较SAP组和SS组兔肠黏膜炎性反应减轻,肠黏膜的完整性增加,胰腺组织炎性反应减轻,存活率提高,但血清淀粉酶在各时间点与SS组相比差异均无统计学意义.结论 SS和GH联合应用可增强兔肠黏膜屏障功能,改善SAP预后.

Objective To investigate the protective effect of somatostatin （SS）combined with growth hormone （GH） in treatment of intestinal mucosal barrier injury in rabbits with severe acute pancreatitis （SAP）, as well as its clinical significance. Methods Seventy-two rabbits were equally assigned into model group （SAP group）, SS treated group （SS group） and SS combined with GH treated group （SS ＋ GH group）. SAP models were induced by retro-injection of 5% sodium taurocholate into the pancreatic duct. After modeling, all rabbits were given 5 % glucose saline daily.The rabbits in SS group and SS＋GH group were continuously Given SS （3.5μg·kg-1·h-1）for 48 hours. Besides, the rabbits in SS＋GH group were subcutaneously injected with 0.15 IU/kg of GH at the 1st and the 24th hours after modeling. The levels of serum amylase, serum tumor necrosis factor-α （TNF-α） and plasma diamine oxidase were measured at the 6th, 12th, 24th and 48th hours after modeling. The pathological changes of pancreatic tissue and ileal mucosa were observed. Survival rate was calculated. Data were analyzed using SPSS 16.0 software. The univariate analysis was used to compare the difference among groups. Results In SS＋GH group, the levels of serum TNF-α and plasma diamine oxidase were （2. 43 ± 0. 14） pg/ml and （4. 61 ± 0. 45） U/L at the 24th hour respectively, and were （2.08±0.23） pg/ml and （3.75±0.47） U/L at the 48th hour, respectively,which were lower than those in SAP group and SS group [（2.80 0.30） pg/ml and （8.74 ± 1.77）U/L, respectively, at the 24th hour; （2. 45±0.12） pg/ml and （5. 02±0.95） U/L, respectively, at the 48th hour）]with significant difference （P＜0.05）. The inflammation in pancreas and ileal mucosa was alleviated, and the integrity of bowel mucosa was improved. Survival rate of SS＋GH group was significantly higher than SAP group and SS group. There was no significant difference in level of serum amylase between SS＋GH group and SS group. Conclusion The combination of SS with GH may enhance the function of intestinal mucosa barrier and improve the prognosis of SAP in rabbits.