重症急性胰腺炎患者血浆内皮素-1、一氧化氮的动态变化及前列地尔的干预作用

Changes in plasma ET-1 and NO in patients with severe acute pancreatitis and effect of alprostadil on ET-1 and NO

目的:观察重症急性胰腺炎(severe acute pancreatitis,SAP)患者血浆内皮素-1(endothelin-1,ET-1)、一氧化氮(nitric oxide,NO)的动态变化及前列地尔对其表达的影响.方法:60例SAP患者,随机分成两组,每组30例,对照组在一般治疗的基础上单用生长抑素治疗,联合组为生长抑素联合前列地尔治疗.在入院即刻、发病12、24、48、72 h、1 wk分别检测两组患者血浆ET-1及NO浓度,并计算ET-1/NO值.结果:两组患者血浆ET-1及NO水平均呈先升高再下降的趋势,12 h时达到高峰后逐渐下降,72 h时仍维持在高水平,1 wk后下降至低于入院即刻水平.入院即刻至发病24 h时两组E T-1及N O水平变化趋势类似(E T-1:入院即刻:97.7 ng/L±14.9 ng/L vs 98.8 ng/L±15.6n g/L;12 h:157.4 n g/L±14.4 n g/L v s 160.3ng/L±15.8 ng/L;24 h:146.0 ng/L±18.8 ng/L v s 146.4 n g/L±19.2 n g/L;N O:入院即刻:29.0μmol/L±4.4μmol/L vs 29.7μmol/L±6.0μmol/L;12 h:40.2μmol/L±3.9μmol/L vs41.2μmol/L±5.5μmol/L;24 h:39.7μmol/L±4.7μmol/L vs 39.7μmol/L±4.6μmol/L;均P>0.05),48 h后ET-1水平联合组下降较对照组更明显(48 h:134.1 ng/L±18.5 ng/L vs 128.3 ng/L±17.8 ng/L;72 h:99.5 ng/L±16.6 n g/L v s 109.8 n g/L±17.3 n g/L;1 w k:71.4 n g/L±12.1 n g/L v s 78.8 n g/L±13.3ng/L;均P<0.05),而NO水平48 h后对照组较联合组下降更明显(48 h:30.1μmol/L±4.9μmol/L vs 33.8μmol/L±4.1μmol/L;72 h:22.2μmol/L±4.8μmol/L vs 28.0μmol/L±4.2μmol/L;1 wk:17.0μmol/L±3.7μmol/L vs 20.2μmol/L±3.4μmol/L;均P<0.05).结论:ET-1、NO是介导SAP微循环障碍的重要因素,前列地尔能改善胰腺微循环,可能是通过影响ET-1、NO的表达起作用.

AIM： To detect the changes in plasma endothelin-1 （ET-1） and nitric oxide （NO） in patients with severe acute pancreatitis and to observe the effect of alprostadil on ET-1 and NO levels. METHODS： Sixty patients with SAP were randomly divided into two groups： a control group （n -- 30） or a combination group （n = 30）. The control group received intravenous infusion of somatostatin on the basis of conventional therapy, and the combination group received intravenous infusion of alprostadil and somatostatin on the basis of conventional therapy. Plasma levels of ET-1 and NO were measured at admission, 12 h, 48 h, 72 h, and 1 week after onset, and ET-1/NO ratio was calculated. RESULTS： Plasma levels of ET-1 and NO initially increased, peaked at 12 h, were still maintained at high levels at 72 h, and then declined at 1 week below the levels at admission. The trend of changes of ET-1 and NO were similar between the two groups from admission to 24 h （ET-1 at admission： 97.7 ng/L ± 14.9 ng/L vs 98.8 ng/L ± 15.6 ng/L; 12 h： 157.4 ng/L ± 14.4 ng/L vs 160.3 ng/L ± 15.8 ng/L; 24 h： 146.0 ng/L ± 18.8 ng/L vs 146.4 ng/L ± 19.2 ng/L; NO at admission： 29.0 μmol/L ± 4.4 μmol/L vs 29.7μmol/L ± 6.0 μmol/ L; 12 h： 40.2 μmol/L ± 3.9 μmol/L vs 41.2 μmol/L ± 5.5μmol/L; 24 h： 39.7 μmol/L ± 4.7 μmol/L vs 39.7 μmol/L ± 4.6μmol/L; P 〉 0.05 for all）. The levels of ET-1 decreased more significantly from 48 h to 1 week in the combination group （48 h： 134.1 ng/L ± 18.5 ng/L vs 128.3 ng/L ± 17.8 ng/L; 72 h： 99.5 ng/L ± 16.6 ng/L vs 109.8 ng/L ± 17.3 ng/L; I wk： 71.4 ng/L ± 12.1 ng/L vs 78.8 ng/L ± 13.3 ng/L; P 〈 0.05 for all）, while the levels of NO decreased more significantly in the control group （48 h： 30.1μmol/L ± 4.9 μmol/L vs 33.8μmol/L ± 4.1μmol/L; 72 h： 22.2μmol/L ± 4.8 μmol/L vs 28.0 μmol/L ± 4.2 μmol/L; 1 wk： 17.0μmol/L ± 3.7μmol/L vs 20.2μmol/L ± 3.4μmol/L; P 〈 0.05 for all）. CONCLUSION： ET-1 and NO are important factors mediating microcirculation disturbance in SAP. Alprostadil can ameliorate pancreatic microcirculation possibly by altering ET-1 and NO expression.