肠道缺血再灌注在出血坏死性胰腺炎早期炎症反应中的作用  

Effects of intestinal ischemia reperfusion on the progression of inflammatory reaction of hemorrhagic necrosis pancreatitis

作　　者：刘林[1] 于骅[1] 钦琦[1] 张军港[1] 刘洋[1] 邓世昌[1] 赵刚[1] 王春友[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科,武汉430022

出　　处：《中华消化外科杂志》2011年第5期362-365,共4页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（30600594）

摘　　要：目的探讨肠道缺血再灌注（IIR）在出血坏死性胰腺炎（HNP）早期炎性反应中的作用。方法根据随机数字表法将80只大鼠分为4组，每组20只：假手术组（SO组），急性水肿型胰腺炎组（AEP组），急性水肿型胰腺炎合并肠道缺血再灌注组（AEP＋IIR组）和出血坏死性胰腺炎组（HNP组）。于建立模型后0、1、2、3、6h分别检测小肠系膜微循环红细胞流速（EV）、功能毛细血管密度（FCD）及白细胞黏附数（LA），并测定血清TNF-α及IL-6水平。多组比较采用方差分析，两两比较采用t检验。结果AEP组EV在1h明显下降，在3h升高，但仍显著低于SO组（t=9．60，P〈0．05）；而AEP＋IIR组及HNP组EV则持续下降，直至6h升高，但仍显著低于AEP组（t=6．03，6．12，P〈0．05）。AEP组FCD在3h时显著低于SO组（t=8．20，P〈0．05）；而AEP＋IIR组及HNP组FCD在3h后显著低于AEP组（t=35．60，23．80，P〈0．05）。AEP组IA在1h较sD组明显升高（t=75．00，P〈0．05），在3h达到峰值；而AEP＋IIR组及HNP组LA在1、2、3、6h均显著高于AEP组（t=23．00，29．50，53．00，38．70，23．10，48．20，39．20，47．50，P〈0．05）。与s0组比较，AEP组TNF-α在1h显著升高（t=77．00，P〈0．05），3h后逐渐下降，而AEP＋IIR组及HNP组TNF-α在2h后显著高于AEP组（t=23．50，18．10，P〈0．05）。AEP组IL-6水平在1、2、3、6h持续高于S0组（t=93．50，146．00，243．60，209．20，P〈0．05），而AEP＋IIR组及HNP组IL-6在1h与AEP组比较，差异无统计学意义（t=2．30，2．03，P〉0．05），但在2h后显著高于AEP组（t=35．63，29．80，P〈0．05）。结论IIR可进一步加重AEP早期炎性反应，提示IIR是HNP早期发生、发展的重要促进因素。Objective To investigate the effects of intestinal ischemia reperfusion （IIR） on the progression of inflammatory reaction in hemorrhagic necrosis pancreatitis （HNP）. Methods Eighty rats were randomly divided into sham operation （SO） group, acute edematous pancreatitis （AEP） group, AEP ＋ IIR group and HNP group according to the random number table. Erythrocyte velocity （EV）, functional capillary density （FCD） and leukocyte adherence （LA） were observed at 0, 1, 2, 3 and 6 hours after the models were completed. The serum levels of tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） were detected. All data were analyzed by using the analysis of variance or the t test. Results The level of EV in the AEP group significantly decreased at 1 hour, and got increased at 3 hours, while the level of EV in the AEP group was still significantly lower than that in the SO group （ t = 9. 60, P 〈 0.05 ）. The levels of EV in the AEP ＋ IIR group and HNP group constantly decreased, and increased at 6 hours, but were continually lower than that in the AEP group （ t = 6. 03, 6. 12, P 〈 0.05 ）. The level of FCD in the AEP group was significantly lower than that in the SO group at 3 hours （ t = 8.20, P 〈 0.05 ）. The levels of FCD in the AEP ＋ IIR group and HNP group were significantly lower than that in the AEP group at 3 hours （t = 35.60, 23.80, P 〈 0.05 ）. Compared with AEP group, the level of LA in the AEP group was significantly increased at 1 hour （ t = 75. 00, P 〈 0.05 ） and reached peak at 3 hours. The levels of LA in the AEP ＋ IIR group and HNP group were significantly higher than that in the AEP group at 1, 2, 3, 6 hours （t = 23.00, 29. 50, 53.00, 38.70, 23.10, 48.20, 39. 20, 47.50, P 〈 0.05）. Compared with SO group, the level of TNF-α in the AEP group significantly increased since 1 hour （ t = 77.00, P 〈 0.05 ）, and began to decrease at 3 hours ; the levels of TNF-α in the AEP ＋ IIR group and HNP group at 2 hours were significantly h

关 键 词：出血坏死性胰腺炎 急性水肿型胰腺炎 肠道缺血再灌注 

分 类 号：R576[医药卫生—消化系统]