地塞米松区域动脉灌注治疗重症急性胰腺炎的实验研究

Research of Continuous Regional Arterial Infusion of Dexamethasone Treatment for Severe Acute Pancreatitis

目的探讨持续区域动脉灌注(CRAI)地塞米松对重症急性胰腺炎(SAP)家兔血清炎性因子的影响及治疗效果。方法采用胰腺被膜下注射5%牛磺胆酸钠制备SAP家兔模型。采用随机数字表法将24只家兔随机分为假手术组、SAP组、静脉灌注地塞米松组及CRAI地塞米松组(每组6只)。造模成功后0.5、3、6、9及12h检测各组血清肿瘤坏死因子(TNF)-α、白介素(IL)-6、IL-10及淀粉酶(AMY)水平,并观察家兔胰腺病理变化和生存情况。结果与假手术组相比,SAP组家兔血清IL-6水平在造模成功后3h明显升高,在6h达到高峰,9h开始下降(均P<0.05);IL-10水平在6h时开始显著升高,且9h及12h时均持续升高(均P<0.001);TNF-α水平在0.5h已经显著升高,6h达到高峰,9h开始下降(均P<0.05);AMY在9h开始升高,至12h时仍持续升高(均P<0.05)。与SAP组相比,CRAI地塞米松组血清IL-6及IL-10水平在6、9及12h时均明显降低(P<0.001),静脉灌注地塞米松组3h以后的各时段血清IL-6水平降低,但仅在6h时差异具有统计学意义(P<0.05);CRAI地塞米松组TNF-α水平在3h就已经开始明显降低(P<0.001),此后各时段均明显持续降低(P<0.001),而静脉灌注地塞米松组血清TNF-α水平仅在6h显著降低(P<0.05);CRAI地塞米松组和静脉灌注地塞米松组血清AMY在12h时均显著降低(P<0.05)。与静脉灌注地塞米松组相比,CRAI地塞米松组血清IL-6和IL-10水平在6h(P<0.05)及12h(P<0.001)时明显降低;TNF-α水平在3、6、9及12h均明显降低(P<0.001);AMY变化差异无统计学意义(P>0.05)。CRAI地塞米松组胰腺组织损害明显改善,3d时动物死亡明显减少。结论 CRAI地塞米松能够减轻SAP家兔的全身炎症反应和胰腺局部的炎症反应,改善动物生存情况。

Objective To study the effects of continuous regional arterial infusion（CRAI） of dexamethasone on plasma inflammatory factors of severe acute pancreatitis（SAP） rabbits. Methods Twenty-four rabbits were randomly divided into sham operation group,SAP group,intravenous infusion of dexamethasone group and CRAI of dexamethasone group（each group 6 rabbits） by random number table.The serum tumor necrosis factor（TNF）-α,interleukin（IL）-6,IL-10,and amylase（AMY） levels in rabbits were tested at hour 0.5,3,6,9,and 12 after modeling succeed.The pathological changes of pancreas and the survival were observed on day 3 after modeling succeed. Results Compared with the sham operation group,the serum levels of IL-6 significantly increased at 3 h and reached the peak at 6 h,decreased at 9 h（all P〈0.05）;levels of IL-10 significantly increased at 6 h,continuously elevated at 9 h and 12 h（all P〈0.001）;levels of TNF-α significantly increased at 0.5 h（P〈0.001）,reached the peak at 6 h（P〈0.001） and decreased at 9 h（P〈0.05）;levels of AMY significantly increased at 9 h,continuously elevated at 12 h（all P〈0.05） in the SAP group.Compared with the SAP group,the serum levels of IL-6 and IL-10 in the CRAI of dexamethasone group all significantly decreased at 6 h,9 h,and 12 h（P〈0.001）;levels of IL-6 significantly decreased only at 6 h in the intravenous infusion of dexamethasone group;levels of TNF-α in the CRAI of dexamethasone group significantly decreased at 3 h,6 h,9 h,and 12 h（all P〈0.001）,which in the intravenous infusion of dexamethasone group significantly decreased only at 6 h（P〈0.05）;levels of AMY in the CRAI of dexamethasone group and intravenous infusion of dexamethasone group all significantly decreased at 12 h（P〈0.05）.Compared with the intravenous infusion of dexamethasone group,the serum levels of IL-6 and IL-10 in the CRAI of dexamethasone group all significantly decreased at 6 h（P〈0.05） and 12 h（P〈0.001）;levels of TNF-α all significantly decreased at 3 h,6 h,9 h,and 12 h（all P〈0.001）;levels of AMY were not significantly different（P〉0.05）.The pathological changes of pancreas in the CRAI of dexamethasone group were obvious,the death of rabbits reduced on day 3 after modeling succeed. Conclusion CRAI dexamethasone can effectively reduce the systemic inflammatory response and pancreatic inflammation,and reduce mortality.