手术治疗胆石症并发急性胰腺炎患者血清炎症和氧化应激介质的变化

Inflammatory and oxidative stress in patients with acute pancreatitis and underlying cholelithiasis after laparoscopic cholecystectomy

目的探讨胆石症并发急性胰腺炎(AP)患者在病情稳定后接受腹腔镜胆囊切除术(LC)治疗血清炎性和氧化应激介质的变化。方法 150例胆石症并发AP患者,在内科治疗病情稳定后,84例接受LC术,66例接受开腹胆囊切除术。采用ELISA法检测血清白介素-6(IL-6)、IL-10和C反应蛋白(CRP);采用ELISA法检测血清丙二醛(MDA)、氧化型低密度脂蛋白(ox-LDL)和对氧磷酶-1(PON-1);采用高效液相色谱法检测血清8-羟基鸟嘌呤(8-OHG)。结果术后第5天,LC组血清IL-6水平为(42.3±4.8)μg/L,显著低于开腹组的【(57.7±5.1)μg/L,P<0.05】,IL-10水平为(64.3±5.3)pg/ml,显著高于开腹组的【(51.2±4.2)pg/ml,P<0.05】,CRP水平为(15.8±5.7)μg/L,显著低于开腹组的【(38.4±6.8)μg/L,P<0.05】;MDA水平为(3.3±0.9)nmol/m L,显著低于开腹组的【(5.4±1.8)nmol/m L,P<0.05】,ox-LDL水平为(63.2±11.7)ng/ml,显著低于开腹组的【(72.3±11.0)ng/ml,P<0.05】,PON-1水平为(116.3±10.2)U/ml,显著高于开腹组的【(104.5±11.4)U/ml,P<0.05】,8-OHG水平为(0.5±0.2)ng/ml,与开腹组的(0.6±0.2)ng/ml比,无显著性相差(P>0.05)。结论对于胆石症并发AP患者,在内科控制AP病情后,及时行LC手术治疗,去除结石,可以减轻患者的氧化应激反应,安全可行。

Objective To investigate the inflammatory and oxidative stress in patients with acute pancreatitis(AP)and underlying cholelithiasis after laparoscopic cholecystectomy(LC).Methods A total of 150 patients with cholelithiasis complicated by AP were recruited in our hospital,and 84 cases were treated with LC and 66 cases received laparotomy after the AP was controlled.Serum interleukin-6(IL-6),IL-10,C-reactive protein(CRP),malondialdehyde(MDA),oxidized low density lipoprotein(ox-LDL)and paranoxonase(PON-1)were detected by ELISA,and serum 8-dihydro-8-oxoguanine(8-OHG)was detected by high-performance liquid chromatography.Results Five days after operation,serum IL-6 level in LC group was(42.3±4.8)μg/L,much lower than【(57.7±5.1)μg/L,P<0.05】in patients receiving laparotomy,serum IL-10 level was(64.3±5.3)pg/ml,much higher than【(51.2±4.2)pg/ml,P<0.05】in laparotomy group,serum CRP level was(15.8±5.7)μg/L,much lower than【(38.4±6.8)μg/L,P<0.05】in laparotomy group;serum MDA level was(3.3±0.9)nmol/mL,much lower than【(5.4±1.8)nmol/mL,P<0.05】in laparotomy group,serum ox-LDL level was(63.2±11.7)ng/ml,much lower than【(72.3±11.0)ng/ml,P<0.05】in laparotomy group,serum PON-1 level was(116.3±10.2)U/ml,much higher than【(104.5±11.4)U/ml,P<0.05】in laparotomy group,and serum 8-OHG level was(0.5±0.2)ng/ml,without significant difference as compared to(0.6±0.2)ng/ml(P>0.05)in laparotomy group.Conclusion The LC is practical in clinical practice in dealing with patients with AP and underlying cholelithiasis after AP is controlled,which might inhibit stress response in this settings.