AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate r...AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate retrograde injection in Sprague-Dawley rats. APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after the induction of SAP. To verify the effect of APD on macrophages, PMs were isolated and cultured in an environment, with the peritoneal inflammatory environment simulated by the addition of peritoneal lavage in complete RPMI 1640 medium. Hematoxylin and eosin staining was performed. The levels of pancreatitis biomarkers amylase and lipase as well as the levels of inflammatory mediators in the blood and peritoneal lavage were determined. The polarization phenotypes of the PMs were identified by detecting the marker expression of M1/M2 macrophages via flow cytometry, qPCR and immunohistochemical staining. The protein expression in macrophages that had infiltrated the pancreas was determined by Western blot.RESULTS APD treatment significantly reduced the histopathological scores and levels of amylase, lipase, tumor necrosis factor-α and interleukin(IL)-1β, indicating that APD ameliorates the severity of SAP. Importantly, we found that APD treatment polarized PMs towards the M2 phenotype, as evidenced by the reduced number of M1 macrophages and the reduced levels of proinflammatory mediators, such as IL-1β and L-selectin, as well as the increased number of M2 macrophages and increased levels of anti-inflammatory mediators, such as IL-4 and IL-10. Furthermore, in an in vitro study wherein peritoneal lavage from the APD group was added to the cultured PMs to simulate the peritoneal inflammatory environment, PMs also exhibited a dominant M2 phenotype, resulting in a significantly lower level of inflammation. Finally, APD treatment increased the proportion of M2 macrophages and upregulated the expression of the anti-inflammatory protein Arg-1 in the pancreas of SAP model rats.CONCLUSION These findings suggest that APD treatment exerts antiinflammatory effects by regulating the M2 polarization of PMs, providing novel insights into the mechanism underlying its therapeutic effect.展开更多
BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).ME...BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.展开更多
目的：探讨不同时机腹腔灌洗治疗对重症急性胰腺炎并腹腔高压患者疗效的影响。方法68例确诊重症急性胰腺炎（SAP）并腹腔高压（IAH）患者根据发病至开始腹腔灌洗治疗的不同时机分成 A 组（发病≤24 h 灌洗组，n ＝20）、B 组（发病＞24 ...目的：探讨不同时机腹腔灌洗治疗对重症急性胰腺炎并腹腔高压患者疗效的影响。方法68例确诊重症急性胰腺炎（SAP）并腹腔高压（IAH）患者根据发病至开始腹腔灌洗治疗的不同时机分成 A 组（发病≤24 h 灌洗组，n ＝20）、B 组（发病＞24 h～≤48 h 内灌洗组，n ＝26）和 C 组（发病＞48 h～≤72 h 内灌洗组，n ＝22）。患者腹腔灌洗治疗前及治疗后1周进行急性生理学和慢性健康评分（APACHE-Ⅱ），记录患者灌洗治疗前及治疗第7天腹腔内压水平。结果3组经7 d 腹腔灌洗治疗后 APACHE-Ⅱ评分及腹腔内压水平较灌洗前均显著下降（P ＜0．01）；随着开始腹腔灌洗时间的延迟，经7 d 腹腔灌洗后的APACHE-Ⅱ评分及腹腔内压降低的程度在逐步减小（P ＜0．05），且A组腹腔内压下降程度较B组更为显著（P ＜0．05）。结论24 h 内开始腹腔灌洗是腹腔灌洗治疗重症急性胰腺炎并腹腔高压的最佳时机。展开更多
目的:观察前列地尔联合腹腔灌洗对高脂血症性重症胰腺炎(hyperlipidemia severe acute pancreatitis,HSAP)的治疗效果.方法:将27例HSAP患者随机分为对照组(13例)和治疗组(14例).对照组给予内科常规治疗,治疗组在对照组治疗方案基础上给...目的:观察前列地尔联合腹腔灌洗对高脂血症性重症胰腺炎(hyperlipidemia severe acute pancreatitis,HSAP)的治疗效果.方法:将27例HSAP患者随机分为对照组(13例)和治疗组(14例).对照组给予内科常规治疗,治疗组在对照组治疗方案基础上给予静脉滴注前列地尔及透析液腹腔灌洗治疗,14 d为1疗程.对两组疗效进行比较.结果:治疗组在临床症状/体征缓解时间(5.55 d±3.12 d vs 8.18 d±4.09 d,4.14 d±2.94 d v s 6.75 d±3.58 d)、血清甘油三酯(triacylglycerol,TG)好转时间(5.42 d±2.06 d vs 8.28 d±3.55 d)、首疗程总有效率(85.71%v s 6 1.5 4%)、并发症发生率(2 1.6%v s38.5%)、死亡率(7.14%vs 15.38%)、平均住院时间(23.84 d±7.54 d vs 31.98 d±12.18 d)及医疗总费用(34.56千元±13.44千元vs 41.29千元±18.81千元)等方面均优于对照组(P<0.05或P<0.01).结论:前列地尔联合透析液腹腔灌洗治疗HSAP疗效可靠、安全,可作为HSAP内科治疗的常规选择.展开更多
基金the National Natural Science Foundation of China,No.81772001,No.8177071311 and No.81502696the National Clinical Key Subject of China,No.41792113+1 种基金the Technology Plan Program of Sichuan Province,No.2015SZ0229,No.2018JY0041 and No.18YYJC0442the Science and Technology Development Plan of Sichuan Province,No.2016YJ0023
文摘AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate retrograde injection in Sprague-Dawley rats. APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after the induction of SAP. To verify the effect of APD on macrophages, PMs were isolated and cultured in an environment, with the peritoneal inflammatory environment simulated by the addition of peritoneal lavage in complete RPMI 1640 medium. Hematoxylin and eosin staining was performed. The levels of pancreatitis biomarkers amylase and lipase as well as the levels of inflammatory mediators in the blood and peritoneal lavage were determined. The polarization phenotypes of the PMs were identified by detecting the marker expression of M1/M2 macrophages via flow cytometry, qPCR and immunohistochemical staining. The protein expression in macrophages that had infiltrated the pancreas was determined by Western blot.RESULTS APD treatment significantly reduced the histopathological scores and levels of amylase, lipase, tumor necrosis factor-α and interleukin(IL)-1β, indicating that APD ameliorates the severity of SAP. Importantly, we found that APD treatment polarized PMs towards the M2 phenotype, as evidenced by the reduced number of M1 macrophages and the reduced levels of proinflammatory mediators, such as IL-1β and L-selectin, as well as the increased number of M2 macrophages and increased levels of anti-inflammatory mediators, such as IL-4 and IL-10. Furthermore, in an in vitro study wherein peritoneal lavage from the APD group was added to the cultured PMs to simulate the peritoneal inflammatory environment, PMs also exhibited a dominant M2 phenotype, resulting in a significantly lower level of inflammation. Finally, APD treatment increased the proportion of M2 macrophages and upregulated the expression of the anti-inflammatory protein Arg-1 in the pancreas of SAP model rats.CONCLUSION These findings suggest that APD treatment exerts antiinflammatory effects by regulating the M2 polarization of PMs, providing novel insights into the mechanism underlying its therapeutic effect.
文摘BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.
文摘目的：探讨不同时机腹腔灌洗治疗对重症急性胰腺炎并腹腔高压患者疗效的影响。方法68例确诊重症急性胰腺炎（SAP）并腹腔高压（IAH）患者根据发病至开始腹腔灌洗治疗的不同时机分成 A 组（发病≤24 h 灌洗组，n ＝20）、B 组（发病＞24 h～≤48 h 内灌洗组，n ＝26）和 C 组（发病＞48 h～≤72 h 内灌洗组，n ＝22）。患者腹腔灌洗治疗前及治疗后1周进行急性生理学和慢性健康评分（APACHE-Ⅱ），记录患者灌洗治疗前及治疗第7天腹腔内压水平。结果3组经7 d 腹腔灌洗治疗后 APACHE-Ⅱ评分及腹腔内压水平较灌洗前均显著下降（P ＜0．01）；随着开始腹腔灌洗时间的延迟，经7 d 腹腔灌洗后的APACHE-Ⅱ评分及腹腔内压降低的程度在逐步减小（P ＜0．05），且A组腹腔内压下降程度较B组更为显著（P ＜0．05）。结论24 h 内开始腹腔灌洗是腹腔灌洗治疗重症急性胰腺炎并腹腔高压的最佳时机。
文摘目的:观察前列地尔联合腹腔灌洗对高脂血症性重症胰腺炎(hyperlipidemia severe acute pancreatitis,HSAP)的治疗效果.方法:将27例HSAP患者随机分为对照组(13例)和治疗组(14例).对照组给予内科常规治疗,治疗组在对照组治疗方案基础上给予静脉滴注前列地尔及透析液腹腔灌洗治疗,14 d为1疗程.对两组疗效进行比较.结果:治疗组在临床症状/体征缓解时间(5.55 d±3.12 d vs 8.18 d±4.09 d,4.14 d±2.94 d v s 6.75 d±3.58 d)、血清甘油三酯(triacylglycerol,TG)好转时间(5.42 d±2.06 d vs 8.28 d±3.55 d)、首疗程总有效率(85.71%v s 6 1.5 4%)、并发症发生率(2 1.6%v s38.5%)、死亡率(7.14%vs 15.38%)、平均住院时间(23.84 d±7.54 d vs 31.98 d±12.18 d)及医疗总费用(34.56千元±13.44千元vs 41.29千元±18.81千元)等方面均优于对照组(P<0.05或P<0.01).结论:前列地尔联合透析液腹腔灌洗治疗HSAP疗效可靠、安全,可作为HSAP内科治疗的常规选择.
