The serum activities of 3 cytokines (TNF,IL-1 and IL-6) were observed in 23 patients admitted within 4 days of onset of acute pancreatitis (AP). The results showed that the serum level of 3 cytokines raised in all of the AP patients, significant difference between TNF and IL-1 was abserved at admission and IL-6 did after one week of admission, suggesting that proper cytokine criteria are useful in predicting severity of the disease but the relationship between cytokines and MOF had not established.
【Abstract】Objective To summarize the effects of vasoactive mediators on local microvasculature in acute pancreatitis（AP）. Methods Literatures concerning metabolism, receptors, action mechanisms of vasoactive mediators and their effects in AP were reviewed. Results Bradykinin, endothelin, platelet activating factor and nitric oxide were important mediators in the development of microcirculatory disturbance in AP, however the results of experiments were inconsistent. Conclusion The roles which vasoactive mediators play in microcirculatory disturbance of AP are affected by many factors, and await further study.
Objective To assess the efficiency of Kansui root in the treatment of patients with severe acute pancreatitis. Methods Trials were identified by searching CNKI, VIP, CBM, PubMed, EMbase, and The Cochrane Library. Randomized controlled trials ( RCTs) and quasi-randomized controlled trials (quasi-RCT) were included. Two reviewers assessed the quality of each study and extracted data independently. Statistical analysis was performed by using RevMan 4.2.7. Results Finally, four trials involving 240 patients were included. All included trials were quasi-RCT. Meta-analysis showed that the Kansui group had the tendency of reducing early deaths [RR=0.45, 95%CI(0.23, 0.89)], shortening the course of treatment, reducing the incidence of hyperamylasemia, and reducing the mean hospitalization stay. Moreover, the duration of abdominal pain and distension were shortened, and conversion to operation rate and incidence of complications of SAP were reduced significantly compared with the control group. Conclusion There was not enough evidence to support the Kansui root’s effectiveness present since the included trials are of poor quality. Therefore, large-scale high-quality RCTs are needed.
目的:探讨合理的营养支持方式对重症急性胰腺炎(SAP)患者营养状况及预后的影响。方法:将60例SAP患者随机分为全胃肠外营养支持(对照组)和肠内与肠外相结合营养支持(实验组)两组,对比营养支持前后两组患者的血红蛋白、总蛋白、血清白蛋白、氮平衡、血脂等生化指标,每天观察相关并发症情况。结果:实验组血清白蛋白、总蛋白、血红蛋白、氮平衡方面明显优于对照组(Plt;0.05),且并发症少。结论:肠内与肠外结合的营养支持方式可以改善SAP患者的营养状况,对SAP患者治疗有积极的作用。
Objective To investigate the effects of ginkgo biloba extract （GBE） on expressions of IL-1β, IL-6,and TNF-α in the pancreas and brain tissues of rats with severe acute pancreatitis （SAP）, and further to explore the pathogenesis of SAP and the efficacy of GBE on brain injury. Methods Fifty-four Winstar rats were randomly divided into normal control group, model group, and treatment group, with 18 rats for each group. For rats in the normal control group, only conversion of pancreas was performed by abdomen opening , followed by wound closure immediately. For rats in the model group and treatment group, 5% sodium taurocholate hydrate were injected under pancreatic capsule to establish SAP model, and then GBE and normal saline were infected into intra-abdomen repeatedly every 8 hours, respectively. At 6 h, 12 h, and 24 h after the model establishment, experimental samples were extracted and serum amylase was detected. Pathogenic scoring for pancreas tissues was performed under light microscopy, and immunohistochemistry method was employed to detect the expression levels of IL-1β, IL-6, and TNF-α in pancreas and brain tissues. Results For the treatment group, both serum amylase and pancreas scoring were significantly lower than those of the model group （P＜0.01）. At 24 h after model establishment, the expressions of IL-1β, IL-6, and TNF-α of pancreas tissues in model group were significantly higher than those at 6 h and 12 h （P＜0.05 or P＜0.01）, but no significant differences wereobserved in treatment group （P＞0.05）. The expressions of IL-1β, IL-6, and TNF-α of brain tissues in model group were significantly higher than those at 6 h and 12 h （P＜0.05 or P＜0.01）, but in treatment group decreased （P＜0.05 or P＜0.01）. The expressions of IL-1β, IL-6, and TNF-α in the treatment group were significantly lower than those of the model group at same time （P＜0.01）. Conclusions During SAP, the expressions of IL-1β, IL-6 and TNF-α in pancreas and brain tissues increased obviously. GBE showed suppressing and scavenging effects on IL-1β, IL-6 and TNF-α in pancreas and brain tissues.
【Abstract】Objective To investigate the protective effect of improving the pancreatic ischemia and calcium channel blockers on preventing the progression of acute pancreatitis. Methods Twenty-four patients with mild acute pancreatitis were randomly divided into two groups： control group and treated group. Within the first 72 hours from the onset of AP, routine conservative managements were performed in control group, improving the pancreatic ischemia and preventing Ca2+ overload were performed in treated group for two weeks. The hemorrheological parameters were measured at 1,4,7,14 days after adimission, simultanously, serum TNFα, IL-1β, C-reactive protein and plasma TXB2, 6-keto-PGF1α levels were determined with ELISA methods. Results The hemorrheological changes were improved in treated group, serum TNFα, IL-1β, C-reactive protein and plasma TXB2, 6-keto-PGF1α levels were significantly decreased each time point in treated group as compared with control group. Conclusion Improving the pancreatic ischemia and calcium channel blockers have protective effect through reducing the generation of cytokines and inflammatory mediators on preventing the progression of acute pancreatitis.
Objective To investigate the relationship between early fluid management and the conversion rate to surgery in patients with sever acute pancreatitis( SAP) .Methods The patients with SAP admitted in ICU in West China Hospital from July 2005 to June 2010 were retrospectively analyzed. They were divided into four groups according to the quartile of the accumulated fluid balance in the first three days after admission in ICU( lt; 25% , 25% ～50% , 50% ～75% , and gt; 75% , respectively) . The major demographic data, clinical characteristics, mortality, and conversion rate to surgery were evaluated respectively. Results 208 patients were enrolled. For each quartile, the conversion rate to surgery decreased at first, and then increased along with the increase of the accumulated fluid balance. Significant difference existed between the second quartile with the lowest conversion rate to surgery and other three quartiles ( P lt; 0. 05) . Differences were also found in mortality and the score of acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) on 24th and 48th hour between the first three quartiles and the last quartile with the highest mortality and APACHⅡ score( P lt;0. 05) . However, sex ratio, age, Ranson criteria, and the score of sequential organ failure assessment( SOFA) did not have significant differences among each quartile( P gt; 0. 05) . Conclusion Fluid management in early stage can influence conversion rate to surgery and mortality in patients with SAP.
Objective To investigate therapeutic effects of continous regional arterial infusion with verapamil on preventing the progression of acute pancreatitis. Methods Forty-five patients with mild acute pancreatitis were randomly divided into three groups: conventional treatment group, intravenous treatment group and arterial infusion group. After admission, conventional treatments were performed in conventional treatment group. Reasonable fluid and verapamil were intravenously injected to the patients in intravenous treatment group, and fluid treatments and continous regional arterial infusion with verapamil were performed in arterial infusion group for 1－2 weeks. The levels of serum TNF-α, IL-1β, ICAM-1 and P-selectin were determined on the 1st, 4th and 7th day after treatment, respectively. Results On the 4th and 7th day after treatment, the levels of serum TNF-α and P-selectin significantly decreased in arterial infusion group compared with the other two groups （P＜0.05）, while the level of serum IL-1β significantly decreased in arterial infusion group and intravenous treatment group compared with the conventional treatment group （P＜0.05）. The level of serum ICAM-1 significantly decreased in arterial infusion group compared with the conventional treatment group （P＜0.05）.Conclusion Continous regional arterial infusion with verapamil could reduce the production of inflammatory cytokines and inhibit the up-regulation of adhesion molecules ICAM-1 and P-selectin, and prevent the progression of acute pancreatitis ultimately.
To evaluate the effects of different pressure and duration of autologous bile perfusion into dog’s pancreatic duct on the severity of induced acute pancreatitis. Thirty mongrel dogs were divided into five groups, with each group consisting of six dogs. Histological changes of pancreas were observed. Results: Histological changes of pancreas were correlated with the pressure and duration of autologous bile perfusion into pancreatic duct. It was easier to produce acute hemorrhagic necrotizing pancreatitis in the groups with a higher pressure and a longer duration of perfusion than in the groups with a lower pressure and a shorter duration. The results indicated that there was a significant effect of higher pressure and longer duration bile perfusion into pancreatic duct on the severity of induced acute pancreatitis.
ObjectiveTo comparatively analyze the image features of tumorous acute pancreatitis (T-AP) and non-tumorous acute pancreatitis (NT-AP). MethodsSixteen cases of histopathologically proven pancreatic tumors inducing acute pancreatitis and 30 cases of non-tumorous acute pancreatitis were collected, and studied their CT and MRI features. ResultsThere were 16 cases (100%) with focal nodules or masses in T-AP group and none in NT-AP group. The average innerdiameter of main pancreatic ducts in T-AP group was (9.6±6.8) mm, in which 14 cases (87.5%) were dilated. And the average innerdiameter of main pancreatic ducts in NT-AP group was (2.9±0.9) mm, in which 7 cases (23.3%) were dilated. The cases of sinistral portal hypertension (SPH), accompanying cholelithiasis and lymphadenosis between the two groups were 10 (62.5%), 3 (18.8%), 14 (87.5%), and 1 (3.4%), 25 (83.3%), 30 (100%), respectively. The occurrence of manifestation of focal nodules or masses, dilated main pancreatic ducts, SPH, and accompanying cholelithiasis were significantly different (P=0.000) between T-AP and NT-AP groups. While, the differences in enhancement pattern and the occurrence of lymphadenosis between the two groups were not significant (P > 0.05). ConclusionThe image features of T-AP are various. The application of CT and MRI could provide effective diagnostic guidelines for patients with T-AP.