急性重症胰腺炎相关肺损伤的病理生理改变及相关机制研究  

Pathophysiologic changes and correlated mechanisms of pancreatitis-associated lung injury

作　　者：燕晓雯[1] 李维勤[1] 王浩[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京大学医学院临床医院(南京军区南京总医院)普通外科研究所ICU,210002

出　　处：《中国急救医学》2006年第9期675-677,共3页Chinese Journal of Critical Care Medicine

基　　金：江苏省社会发展基金资助项目(No.BS2000051)

摘　　要：目的研究急性重症胰腺炎相关肺损伤(PALI)的病理生理改变及相关机制。方法实验猪随机分为对照组和PALI组。PALI组动物通过向胰管内注射牛黄胆酸钠和胰蛋白酶诱导急性重症胰腺炎(SAP),对照组动物仅行腹部手术而不诱导SAP。检测所有猪术前及术后各时间点的血流动力学指数、PaO2、血浆细胞因子浓度以及外周血单核细胞NF-κB活性,并计算肺血管阻力指数(PVR I),评定肺组织损伤病理学评分。结果①对照组和PALI组猪48 h生存率分别为100%和12.5%(P<0.01),中位生存时间分别为72 h和41 h(P<0.01);②PALI组体温在SAP早期显著高于对照组(P<0.01),12 h达到峰值,然后迅速显著下降,后期显著低于对照组(P<0.01);③PVR I在SAP早期代偿性下降,后期循环衰竭时显著升高(P<0.01);PaO2在SAP诱导后呈进行性下降,显著低于对照组(P<0.01);④PALI组猪肺组织出现弥漫性肺泡损伤,总病理评分达(15±2.45)分;⑤PALI组血浆细胞因子浓度显著高于对照组(P<0.01);⑥外周血单核细胞NF-κB活性在SAP诱导后6 h开始升高,12 h达到峰值,24 h明显减弱。结论SAP猪存在严重肺功能障碍和组织损害,存活率较低。其机制可能与强烈的体温变化、血浆细胞因子浓度和外周血单核细胞NF-κB活性的过度增加有关。Object To investigate the pathophysiologic changes and correlated mechanisms of pancreatitis - associated lung injury （PALI）. Method The experimental pigs were grouped into control group and PALl group. Pigs in PALl group had severe acute pancreatitis （SAP） induced by intraductal injection of sodium taurocholate and trypsin, while only abdominal operations were administrated to pigs in control group. Body temperature, haernodynamics index, arterial oxygen tension （ PaO2 ） , serum cytokine concentrations and activated NF - κB levels of peripheral blood mononuclear cells were measured intermittently. After the animals died, the degree of microscopic lung injury was judged and scored. Result ①Survival rate in 48 h of pigs in control group and PALl group were 100% and 12, 5% （ P 〈 0.01 ）, and the median survival time were 72 h and 41 h （ P 〈 0.01 ）, respectively. ②Body temperature of PALl pigs was significantly higher at the early phase, and lower at the late phase of SAP than control pigs （P 〈0.01 ）. ③ Pulmonary vascular resistance index showed compensated decrease at the early phase of SAP, while significantly increased in failure phase （ P 〈0, 01 ）. PaO2 decreased progressively in SAP and was significantly lower than in control pigs （ P 〈0.01 ）. ④Diffuse alveo- lar damage appeared in lung of PALI pigs. The total pathological score was 15± 2.45. ⑤Serum cytokines concentrations of PALl pigs were significantly higher than control pigs （ P 〈 0.01 ）. ⑥Activated NF - κB levels of peripheral blood mononuclear cells in PALl pigs increased at 6 h, reached peak value at 12 h, and weakened at 24 h. Conclusion There are sever pulmonary functional impairment and tissue damage in SAP pigs, The mechanisms maybe related with intense change of body temperature and excessive expression of serum cytokines and activated NF - κB in peripheral blood mononuclear cells.

关 键 词：急性重症胰腺炎 肺损伤 细胞因子 NF-ΚB 

分 类 号：R576[医药卫生—消化系统]