肿瘤坏死因子对急性坏死性胰腺炎肠道屏障的影响及生长抑素的作用  

Effects of TNFα on gut barrier and protective effects of somatostatin in acute necrosis

作　　者：张平平[1] 杜金郎[1] 王金龙[1] 

机构地区：[1]呼和浩特市内蒙古医学院第一附属医院,010015

出　　处：《消化外科》2002年第5期318-320,共3页Journal of Digestive Surgery

摘　　要：目的 探讨肿瘤坏死因子（TNFα）在急性坏死性胰腺炎（ANP）肠道损伤中的作用及生长抑素对其肠道的保护作用。方法 制成大ANP模型,分为假手术组、ANP组及生长抑素治疗组。分别于术后6、12、24、48h测定血浆TNFα、内毒素、淀粉酶,并观察胰腺和回肠粘膜病理学及电镜超微结构及肠道细菌移位情况。结果ANP组血浆TNFα、内毒素、淀粉酶水平显著高于假手术组和治疗组,且以发病后12、24h最为明显（P<0.01-0.05）,血中细菌和肠系膜淋巴结（MLN）细菌移位率均为100％;肠粘膜上皮坏死脱落、血管扩张充血,固有膜中度水肿伴有炎性细胞浸润,电镜观察肠粘膜微绒毛长短不一、排列不整齐,脱落严重。生长抑素（SS）治疗组血浆 TNFα、内毒素、淀粉酶水平显著高于假手术组,也以发病后12、24h最为明显（P<0.01-0.05）,血中细菌和MLN细菌移位率为60％,光镜及电镜下肠粘膜也有明显病损,但程度较ANP组明显减轻。结论TNFα是导致ANP时肠道屏障损伤的重要因素,生长抑素能减轻ANP时肠道屏障的损伤。Objective To investigate the effects of tumor necrosis factor-α(TNFα) on gut injury and protective effects of somatostatin on gut in acute necrotizing pancreatitis (ANP). Methods Seventeen dogs were randomly divided into control group( n = 5), ANP group ( n = 7) and somatostatin treating group(SS) ( n = 7) . After ANP model induced in dogs, plasma levels of TNFα, endotoxin and amylase were measured at 6 h, 12 h, 24 h, 48 h after operation. Pathological changes and ultrastrueture of mucosa and pancrease and bacterial translocation of gut were observed. Results Plasma levels of TNFα, endotoxin and amylase were significantly higher in ANP group than in control and treating group, especially at 12 h, 24 h ( P < 0.01 - 0.05). The translocation rate of bacterial in blood and MLN were 100% . The epithelial villi of the mucosa was damaged. The vessel was expanded and hyperemia. Moderate edema emerged at mueosa lamina propria with inflammatory cells infiltrating. The microvilli was not equal in length, disodered, reduced and badly damaged. Plasma levels of TNFa, endotoxin and amylase were significantly higher in SS treating group than in control group, especially at 12 h, 24 h ( P < 0.01 - 0.05). The bacterial translocation rate of blood and MLN was 60% . The gut mucosa was also damaged. The extent of reduction of microvilli was lighter in SS group than in ANP group. Conclusions TNFa is an improtant factor causing the damage of gut barrier. The somatostatin can reduce the release of TNFa and other cytokins, lighten the gut injury and inhibit gut endotoxin and bacteria] translocation.

关 键 词：胰腺炎 并发症 肠粘膜 病理学 肿瘤坏死因子 内毒素 肠道细菌移位 

分 类 号：R657.51[医药卫生—外科学]