连续性血液净化治疗对重症急性胰腺炎患者内皮细胞通透性的影响

Effect of Continuous Blood Purification on Endothelial Permeability in Severe Acute Pancreatitis Patients

目的探讨连续性血液净化治疗对重症急性胰腺炎(severe acute pancreatitis,SAP)患者内皮细胞的作用。方法人脐静脉内皮细胞(Human Umbilical Vein Endothelial Cells,HUVEC)按实验分组分别用16例健康对照组血清,38例SAP患者连续性血液净化(Continuous Blood Purificantion,CBP)治疗前、治疗6 h、治疗20 h血清体外干预脐静脉内皮细胞5h。transwell小室观察内皮细胞通透性变化,激光共聚焦显微镜观察F-actin应力微丝的表达及分布。结果 SAP患者CBP治疗前内皮细胞通透性较健康对照组明显增高(P<0.01),CBP治疗6 h、治疗20 h后通透性均降低(P<0.05),但治疗20 h组与治疗6 h组相比,差异无显著性(P>0.05)。激光共聚焦结果显示,与健康对照组相比,CBP治疗前SAP患者内皮细胞F-actin应力微丝的数量及密度均明显增加,CBP治疗6 h后,F-actin应力微丝形成减少,治疗20 h后减少更加显著。结论重症急性胰腺炎患者内皮细胞通透性明显增加,CBP治疗可以显著降低SAP患者内皮细胞通透性,其机制可能与调节F-actin应力微丝形成与分布有关。

Objective To investigate the effect of continuous blood purification（CBP） on endothelial cells of patients with svere acute pancreatitis（SAP）. Methods Thirty-eight patients with SAP who received CBP and 16 healthy volunteers were involved in this study. This experi- ment was divided into 4 groups：healthy control.,pre-CBP group ,6-hour-CBP group and 20-hour-CBP group. Serum of healthy volunteers and the serum of patients with SAP at pre-CBP group ,6-hour-CBP group and 20-hour-CBP group were used to induced human umbilical vein Endotbelial cells （HUVEC） respectively in vitro for 5 h. Then, the changes of endothelial cell permeability were observed by Coaster Transwell system, and the expression and distribution of F-actin stress fibers were observed by laser scanning canfocal microscope. Results Compared with healthy volunteers, the endothelial cell permeability was significantly increased in pre-CBP group （p 〈 0. 05 ）, and was significantly decreased in 6-hour-CBP group and 20-hour-CBP group （P 〈 0. 05 ） ,however, there was no significant difference between 6-hour-CBP group and 20- hour-CBP group （ p 〉 0.05 ）. HUVECs in the pre-CBP group showed marked redistribution of the actin cytoskeleton with the increased formation of dense F-actin stress fibers both in number and density compared with healthy control. However, these changes were reduced in HUVECs from the 6-hour CBP and markedly reduced from 20-hour CBP groups. Conclusion The endothelial cell permeability was significantly increased in patients with SAP, after CBP treatment, endothelial hyperpermeability induced by serum from patients with SAP was reduced. The regulation of F-actin remodeling might be the mechanism.