急性出血坏死性胰腺炎大鼠肾上腺病理及功能的变化  

Significance of pathologic and functional changes in acute hemorrhage necrotizing pancreatitis-associated-adrenal insufficiency in rat models

作　　者：狄茂军[1,2] 惠远见[2] 王卫星[1] 付应峰[2] 余佳[1] 邓文宏[1] 

机构地区：[1]武汉大学人民医院普通外科,430060 [2]湖北医药学院附属太和医院普通外科

出　　处：《中华实验外科杂志》2012年第6期1124-1126,共3页Chinese Journal of Experimental Surgery

基　　金：基金项目：国家自然科学基金资助项目（81070368）;中央高校基本科研业务费专项资金资助项目（4104003）;湖北省卫生厅基金资助项目（JX4818）

摘　　要：目的建立急性出血坏死性胰腺炎（AHNP）大鼠肾上腺损伤的病理评分标准，观察肾上腺病理损伤和血清皮质酮的变化。方法将106只大鼠分为假手术组（S0组）和胰腺炎组（AHNP组）。设立0、1、3、6、12、24h时间点，其中AHNP12h组11只，24h组15只，其他各时间点均为8只。用5％牛磺胆酸钠溶液（0．1ml／100g）逆行胰胆管注射法造模，测定血清淀粉酶、皮质酮水平，观察胰腺和肾上腺病理表现，并进行评分。结果AHNP组大鼠血清淀粉酶和胰腺病理评分进行性升高，血清皮质酮在1h达高峰，为1252．7ug／L，维持至3h，为1214．1ug／L，然后迅速下降，至12、24h低于SO组同期皮质酮水平（P〉0．05）。肾上腺病理评分逐渐升高，在1～3h之间病理改变最快，由2．08分升至5．26分，3h后病理损伤减慢，12h（7．14分）与24h（7．53分）病理评分差异无统计学意义（P〉0．05）。结论在皮质酮水平处于高峰时，肾上腺皮质病理改变加重最快，此时对肾上腺进行保护治疗，可能是防治胰腺炎相关肾上腺功能不全的关键期。Objective To establish the histopathologic scoring criteria of adrenal injury, observe the significance of pathologic and functional changes of adrenal glands in acute hemorrhage necrotizing panereatitis. Methods 106 rats were divided into sham operation group （SO group） and pancreatitis group （ AHNP group）. The models were induced by retrograde injection of 5% sodium taurucholate into the major pancreatic duct. Rats were killed at 0, 1, 3, 6, 12 and 24 h after operation, serum amylase and corticosterone levels were measured, and pathologic changes of pancreas and adrenal glands were observed under the microscopy, with assessing by scoring criteria respectively. Results Serum amylase levels and pancreatic pathologic scores were increased progressively after induction of pancreatitis. Serum corticosterone level was increased to 1252.7 ug/L at 1 h in AHNP group, and remained 1214. 1 ug/L at 3 h, then rapidly decreased, which was lower than that in SO group by 12 and 24 h （ P 〉 0. 05 ）. Adrenal pathologic scores were gradually increased in AHNP group, to the full extent from 2. 08 at 1 h to 5.26 at 3 h. The scores were increased slowly after 3 h, and the scoring difference was not significant between 12 h （7. 14） and 24 h （7. 53 ） （P 〉 0. 05 ）. Conclusion Adrenal cortex is injured rapidly when cortieosterone level is at the peak in AHNP group. Appropriate treatment timely may be the key to the cure of adrenal insufficiency.

关 键 词：急性出血坏死性胰腺炎 肾上腺功能不全 皮质酮 

分 类 号：R657.51[医药卫生—外科学]