促发水肿型胰腺炎向坏死型胰腺炎转变的机理研究  

An Experimental Study on the Mechanism of Conversion of Acute Edematous Pancreatitis to Hemorrhagic-necroti-zing Pancreatitis.

作　　者：蒲青凡[1] 严律南[1] 金立人[1] 刘占培[1] 谭建三[2] 左凤琼 吴兆峰 

机构地区：[1]华西医科大学附属第一医院普外科 [2]华西医科大学公共卫生学院 [3]华西医科大学基础医学院,610001

出　　处：《外科理论与实践》1998年第2期111-114,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:借助于一种新的大鼠模型,研究急性水肿性胰腺炎(AEP)向出血坏死性胰腺炎(AHNP)转变的机理.方法:Sprague-Dawley大鼠52只,随机分为三组:Ⅰ组,假手术组;Ⅱ组,采用胰管结扎及静脉推注蛙皮素(100μg/kg)、促胰液素(10μg/kg)以诱发AEP;Ⅲ组,在AEP模型的基础上静注10%高分子右旋糖酐(分子量110000)500mg/kg诱发AHNP.各组分别于造模型后3、gh行组织学及电镜等检查.结果:AEP和AHNP组大鼠血清淀粉酶浓度均明显增高;AHNP组胰腺细胞质膜Ca^(2+)-ATPase活性明显降低.AHNP组3h及9h时腹水量明显多于AEP组,胰实质出血或/和坏死明显,并有胰腺组织细胞内钙沉积、小静脉扩张、红细胞沉积、粒细胞聚集等现象.电镜观察显示:AEP组有大小不等的酶原颗粒聚集于细胞内.AHNP组见毛细血管内皮细胞坏死、剥脱,基膜不完整.结论:静注大剂量Dextran-110在AEP模型基础上通过引起胰微血管损害而促发AHNP.Objective: To elucidate the mechanism of conversion of acute edematous pancreatitis (AEP) to hemorrhagic-necrotizing pancreatitis (AHNP), by means of a new rat model. Methods: Fifty-two Spra-gue-Dawley rats were randomized into 3 experimental groups: Group I , Sham-operation control; Group I , AEP was induced by pancreatic duct ligation and exocrine stimulation; Group III, AHNP was produced on the basis of the AEP model by adding an intravenous injection of a large dose of Dextran (110, 500mg/kg). Light and electron microscopic examinations were performed 3h and 9h after induction. Results: The serum amylase concentration increased significantly in Groups II and III, while the pancreatic cell plasma membrane Ca2+-ATPase activity decreased significantly in Group III. Further more, the quantity of ascitic fluid found in Group III was greater than that discovered in Group II. 9h after the induction of AHNP, hemorrhage, parenchymal necrosis and calcium deposits in acinar cells were observed in the pancreas.Venous dilation, congestion and accumulation of granulocytes in veins were observed only in Group III. Ultrastructural examination demonstrated accumulation of zymogen granules in the acinar cells in Group II. The separation of endothelial cells from the capillary basal membrane and the destruction of the latter were observed only in Group III. Conclusion: These results suggest that ischemia caused by the intravenous injection of a bolus of Dextran-110 is porbably a contributing factor in the conversion of AEP to AHNP.

关 键 词：胰腺炎 动物模型 水肿型 坏死型 

分 类 号：R657.510.2[医药卫生—外科学]