肝细胞生长因子对小鼠轻症急性胰腺炎影响的实验研究

背景:及时、有效地控制轻症急性胰腺炎可防止其向重症急性胰腺炎演变,因而具有重要的临床价值。近年来,肝细胞生长因子(HGF)能否减轻啮齿动物的急性胰腺炎正日益受到关注。目的:观察外源性HGF能否减轻小鼠轻症急性胰腺炎,并探讨其作用机制。方法:以雨蛙肽腹腔注射诱发小鼠轻症急性胰腺炎,在制模前和制模中予各组小鼠皮下注射不同浓度的重组人HGF(rhHGF),部分小鼠同时皮下注射抗rhHGF单抗。根据血清淀粉酶、脂肪酶水平、胰腺组织学炎症评分和胰腺超微结构的变化评估炎症程度,并测定胰腺匀浆中花生四烯酸代谢产物血栓素(TX)B2和6鄄酮(keto)鄄前列腺素(PG)F1α的水平。结果:与单纯炎症组相比,给予4μg/kg或20μg/kgrhHGF小鼠的血清淀粉酶、脂肪酶水平和胰腺组织学炎症评分显著降低,胰腺匀浆中TXB2水平显著降低,6鄄keto鄄PGF1α水平显著增高,但4μg/kg与20μg/kgrhHGF的疗效无显著差异。给予rhHGF的同时给予抗rhHGF单抗,小鼠的上述各项参数与单纯炎症组无显著差异。结论:外源性HGF能减轻雨蛙肽诱导的小鼠轻症急性胰腺炎,其机制可能与对花生四烯酸代谢的影响有关。抗HGF单抗能抵消HGF的生物学作用。

中药封包联合西医常规治疗急性胰腺炎的临床研究

目的:观察中药封包联合西医常规治疗对急性胰腺炎胃肠功能及血清胰酶水平恢复的临床疗效。方法:将80例急性胰腺炎患者按照1∶1的比例分为两组,每组40例。对照组采用西医常规治疗;治疗组在对照组基础上加用中药封包(醋乳香、醋没药、北刘寄奴、威灵仙、赤芍、黄芩、黄连、蒲公英、连翘、芒硝)治疗,每次20 min,每日2次。两组均以14 d为1个疗程,治疗1个疗程后判定疗效。结果:治疗组痊愈23例,显效12例,有效2例,无效3例,有效率为92.5%;对照组痊愈14例,显效7例,有效10例,无效9例,有效率为77.5%。两组对比,差别有统计学意义(P<0.05)。治疗后,治疗组胃肠道功能及血清胰酶水平恢复正常的时间均较对照组显著缩短(P<0.01)。结论:中药封包联合西医常规治疗急性胰腺炎具有较好临床疗效,可促进患者胃肠道功能和血清胰酶水平的恢复,提高急性胰腺炎的治愈率。

糖尿病患者的“另类杀手”——暴发性1型糖尿病

暴发性1型糖尿病是日本学者Imagawa等在2000年提出的1型糖尿病新亚型，该起病更加急骤，且伴有胰腺外分泌异常，如血清胰酶增高。国内特发性1型糖尿病中，暴发性1型糖尿病的患病比例约为2．8％。该亚型糖尿病呈超急性酮症或酮症酸中毒起病，是代谢内分泌疾病中的急危重症，如未及时诊断和治疗，患者会在短期内死亡。因此，有必要对糖尿病患者的“另类杀手”——暴发性1型糖尿病进行认识和了解。

Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient

Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons.Sometimes too much reliance is put on investigations that can lead to a misdiagnosis.This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase,which led to an assumed diagnosis of pancreatitis.She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis,with no evidence of pancreatitis.Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

Breviscapine attenuates acute pancreatitis by inhibiting expression of PKCα and NF-κB in pancreas

AIM:To study the effect of breviscapine (Bre) on activity of protein kinase Cα (PKCα) and nuclear factor (NF)-κB in pancreas,and the mechanism of Bre attenuating acute pancreatitis (AP). METHODS:One hundred and eight rats were randomly divided into acute necrotizing pancreatitis (ANP) group,Bre group (ANP + Bre group) and sham operation (SO) group,36 rats in each group. ANP model was induced by a retrograde injection of 4% sodium deoxycholate into the bilio-pancreatic duct. Fifteen minutes after the ANP model was induced,the rats in Bre group were intraperitoneally injected with Bre (0.4 mg/100 g body weight or 0.1 mL/100 g body weight). Survival time and mortality of rats were calculated. Serum amylase and malondialdehyde levels were measured,volume of ascites was recorded and morphology of pancreas and lung was evaluated at 1,5 and 10 h,after the ANP model was induced,respectively. Expressions of PKCα and subunit p65 of NF-κB in pancreas were detected by immunohistochemistry and Western blotting. RESULTS:The life span of rats was longer and the mortality was lower in Bre group than in ANP group 13.51 ± 5.46 vs 25.36 ± 8.11 (P < 0.05). The amylase and MDA levels as well as the volume of ascites were lower and the pathological changes in pancreas and lung were less in Bre group than ANP group (P < 0.05),indicating that the pancreatitis is less severe in Bre group than ANP group. The activation of PKCα and NF-κB p65 in pancreas was induced rapidly and reached their peak at 1 h or 5 h after ANP,but their activity in Bre group was significantly inhibited. CONCLUSION:Bre exerts its therapeutic effect on AP by inhibiting the activation of PKCα and NF-κB p65 in pancreas.

Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure

AIM: To clarify the relationship between the change of serum amylase level and post-ERCP pancreatitis. METHODS: Between January 1999 and December 2002, 1291 ERCP-related procedures were performed. Serum amylase concentrations were measured before the procedure and 3, 6, and 24 h afterward. The frequency and severity of post-ERCP pancreatitis and the relationship between these phenomena and the change in amylase level were estimated. RESULTS: Post-ERCP pancreatitis occurred in 47 patients (3.6%). Pancreatitis occurred in 1% of patients with normal amylase levels 3 h after ERCP, and in 1%, 5%, 20%, 31% and 39% of patients with amylase levels elevated 1-2 times, 2-3 times, 3-5 times, 5-10 times and over 10 times the upper normal limit at 3 h after ERCP, respectively (level < 2 times vs ≥ 2 times, P < 0.001). Of the 143 patients with levels higher than the normal limit at 3 h after ERCP followed by elevation at 6 h, pancreatitis occurred in 26%. In contrast, pancreatitis occurred in 9% of 45 patients with a level higher than two times the normal limit at 3 h after ERCP followed by a decrease at 6 h (26% vs 9%, P < 0.05). CONCLUSION: Post-ERCP pancreatitis is frequently associated with an increase in serum amylase level greater than twice the normal limit at 3 h after ERCP with an elevation at 6 h. A decrease in amylase level at 6 h after ERCP suggests the unlikelihood of development of post-ERCP pancreatitis.

重症急性胰腺炎的治疗策略

急性胰腺炎是多种病因导致的胰酶在胰腺内被激活后所引起的胰腺组织自身消化的急性化学性炎症。临床以急性上腹痛、恶心、呕吐、发热和血清胰酶增高等为特点。病变程度轻重不等，轻者以胰腺水肿为主，临床多见，病情常呈自限性，预后良好，又称为轻症急性胰腺炎。少数患者病情严重，胰腺出血坏死，常继发感染、腹膜炎和休克等多种并发症，病死率高，称为重症急性胰腺炎。大多数急性胰腺炎属于轻型急性胰腺炎，经3—5d恰当治疗后常可治愈，而对于高度怀疑或确诊为重症胰腺炎者则应及早采取综合治疗措施。目前，对于重症急性胰腺炎临床通常采用的治疗策略如下。

Synergetic Effect of Yihuo Qingyi Decoction (益活凊胰汤) and Recombinant Staphylokinase in Treatment of Severe Acute Pancreatitis of Rats

Objective: To investigate the effect of recombinant staphylokinase (r-Sak) and the Chinese medicine Yihuo Qingyi Decoction (益活凊胰汤 Herbal decoction for severe acute pancreatitis) in the treatment of the severe acute pancreatitis (SAP) in rats, and to observe the synergistic effect of the two. Methods: One hundred and sixty-two adult male SD rats with the body mass of 250–280 g were randomly divided into the following 5 groups: sham operation group (n=18), control group (n=36), Yihuo Qingyi Decoction treatment group (n=36), r-Sak treatment group (n=36), and Yihuo Qingyi Decoction plus r-Sak treatment group (n=36). The SAP ratmodel was prepared by retrograde injection of 5% sodium taurocholate into the cholangiopancreatic duct. Two days before modeling, Yihuo Qingyi Decoction was intragastrically administrated, and r-Sak was intraperitoneally injected. The survival rate within 18 h after modeling was determined. The pancreatic blood flow, the weight of ascites, and the serum amylase and lipase were investigated at 6 h, 12 h, and 18kh after modeling, and the pancreatic tissue was examined under light microscopy to see its pathological change. Results: The 18 h survival count of group A,B,C,D and E rats was 9,2,6,7 and 8 respectively. After r-Sak and Yihuo Qingyi Decoction intervention, the serum amylase and lipase and the weight of ascites were significantly decreased, especially in group E.18 h after modeling, the level of the serum amylase and lipase and the weight of ascites in group E was 1 100±118 U·L-1,1 000±150 U·L-1 and 13.40±1.80 g respectively, obviously lower than that of group B (P<0.05).After SAP was induced, the pancreatic blood flow showed a tendency to decrease, but the decrease extent in the treatment groups was smaller than that in the control group.18h after modeling, the pancreatic blood flow in group B and group E was 30.16±8.96 mL·100 g-1·min-1,and 129.10±42.58 mL·100 g-1·min-1 respectively, there was significant difference (P<0.05). The pathological change of the pancreatic tissue was alleviated in the treatment groups. Conclusion: Both r-Sak and Yihuo Qingyi Decoction play a beneficial role in the treatment of rat SAP and there is a synergistic effect between the two.