经皮导管引流对重症急性胰腺炎大鼠胰腺损伤的影响  

Effect of percutaneous catheter drainage on pancreatic injury in rats with severe acute pancreatitis

作　　者：陈光宇[1,2] 戴睿武[2] 闫洪涛[2] 陈涛[2] 黎冬暄[2] 郑晓博[2] 汤礼军[2] 

机构地区：[1]第三军医大学研究生管理大队,重庆400038 [2]成都军区总医院全军普通外科中心,成都610083

出　　处：《第三军医大学学报》2013年第2期132-137,共6页Journal of Third Military Medical University

基　　金：四川省青年科技创新团队基金(2011JTD0010)~~

摘　　要：目的探讨经皮导管引流(percutaneous catheter drainage,PCD)对大鼠重症急性胰腺炎(severe acute pancre-atitis,SAP)胰腺损伤的影响及意义。方法 60只Wistar大鼠按随机数字表法分为假手术组(仅行开腹手术)、SAP组(逆行胰胆管注射牛磺胆酸钠诱导SAP大鼠模型)和PCD治疗组(在SAP组基础上行PCD治疗),每组20只,每组分6、24 h2个时相点,每时相点10只。分别于术后6、24 h取血清及腹水测定TNF-α、IL-1β及淀粉酶、蛋白酶水平,留取胰腺组织制作石蜡切片行光镜下病理检查、免疫组化检测Bcl-2、Bax在胰腺组织的表达以及采用TUNEL染色观察胰腺组织细胞的凋亡指数。结果注射牛磺胆酸钠后大鼠血清淀粉酶、TNF-α、IL-1β在造模后有显著升高(P<0.05),相同时相点的大鼠经PCD治疗后血清及腹水中炎症因子及腹水中蛋白酶含量即有明显下降(P<0.05),光镜病理检查提示PCD治疗组大鼠胰腺病理损伤较未治疗的SAP大鼠明显改善,TUNEL染色可见术后24 h PCD治疗组大鼠胰腺组织细胞凋亡指数较未治疗的SAP组高[(14.6±2.1)vs(2.7±1.5),P<0.05],免疫组化结果提示PCD治疗后Bcl-2表达下调[术后24 h:(10.81±2.16)vs(28.45±5.41),P<0.05]、Bax表达上调[术后24 h:(23.17±4.39)vs(9.64±1.85),P<0.05]。结论 PCD可减轻SAP大鼠胰腺损伤并缓解其病情,其可能机制与引流出富含炎症细胞因子及胰酶等有害物质的腹水从而抑制机体炎症反应促进胰腺组织细胞凋亡有关。Objective To determine the effect of percutaneous catheter drainage （PCD） on pancreatic injury of severe acute pancreatitis （SAP） rats and its significance. Methods Sixty Wistar rats were equally randomized into 3 groups, sham-operation group, SAP model group and PCD group. Acute hemorrhagic pancreatitis was induced in rats by injecting 5% sodium taurocholate （2 mL/h, 0.1 mL/100 g） into the common bilio- pancreatic duct. Rats in each group were then divided into 2 subgroups, which were killed in 6 and 24 h after operation （n = 10 ）. The levels of TNF-α, IL-1β, amylase, tryptase in the serum samples and ascites were measured in the 6th and 24th hour postoperatively. Apoptosis of the pancreatic cells were examined by TUNEL assay. The expression of Bcl-2 and Bax in the pancreatic tissue was detected by immunohistoehemistry, and pancreatic pathological changes were also observed. Results The serum levels of TNF-α, IL-1β and amylase were significantly higher in SAP group than sham-operation group （P 〈 0.05 ）. PCD treatment resulted in sig- nificant decreases in the serum and ascitic levels of inflammatory cytokines and amylase （P 〈 0. 05 ）. His- topathological results revealed that PCD treatment alleviated the pancreatic injury in the SAP rats. TUNEL staining indicated that the apoptosis index of pancreatic cells in the PCD rats were higher than that in the SAP model rats（24 h after operation： 14.6 ± 2.1 vs 2.7± 1.5,P 〈 0.05 ）. Immunohistoehemistry showed that the expression of Bcl-2 was decreased （24 h after operation ： 10.81 ± 2.16 vs 28.45 ± 5.41, P 〈 0.05 ） and that of Bax was increased（24 h after operation：23.17 ±4.39 vs 9.64± 1.85 ,P 〈0. 05） in the PCD rats compared with the SAP model rats. Conclusion PCD relieves SAP-induced pancreatic and systemic injury, probably by draining harmful ascites which contains inflammatory cytokine and trypsin, inhibiting inflammatory reaction and oromoting aoootosis of the pancreatic cells.

关 键 词：胰腺炎 急性坏死性 经皮导管引流 胰腺损伤 凋亡 大鼠 

分 类 号：R322.491[医药卫生—人体解剖和组织胚胎学] R576.05[医药卫生—基础医学]