Objective To investigate the efficiency of combining traditional Chinese medicine with western medicine in the treatment of severe acute pancreatitis (SAP). Methods The clinical results of sixty three cases of SAP of non-operative treatment with injection of Salia miltorrhizae composita, and oral or gastric tube feeding of decoction Qing-Yi-Tang were retrospectively studied. Results Thirty four cases were categorised as SAP Ⅰ grade, and 29 cases as SAP Ⅱ grade. A variety of complications occurred in 19 cases (30.16%), 3 patients died (4.76%), and 4 patients developing abscess of pancreas (6.35%) which had to be operated on.Conclusion The individualization principle on the basis of cause and clinical stage of the disease should be stressed in treating SAP. The patients who had complication needing to be operated on should be timely performed. There is a good efficiency in the treatment of SAP with the traditional Chinese medicine combining with western medicine.
【Abstract】Objective To investigate the role of early surgical intervention in the treatment of fulminant acute pancreatitis (FAP).Methods Eight cases of FAP admitted to our institution from September 2003 to December 2004 were reviewed retrospectively.Results Averagely 3 organs dysfunction was diagnosed on admission or in the course of treatment in this group. One patient treated non-operatively was dead. Of 7 cases with early surgical intervention, one was died of ACS and ARF, One female patient with 32 weeks pregnancy survived, but the fetus was dead before surgery. Five cases were complicated with intra-abscess, which were cured re-operatively. Conclusion Early operative intervention in the treatment of FAP could prevent MODS and improve the survival.
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.
Objective To investigate the changes of expression of zonula occludens-1(ZO-1) in rats with severe acute pancreatitis (SAP), and to study the relationship between the ZO-1 protein and microvascular injury in rats with SAP. Methods Forty-eight Wistar rats were randomly divided into sham-operation (SO) group and SAP group, each group enrolled 24 rats. Pancreas of rats in SO group were flipped only after laparotomies, but rats of SAP group were injected with 5% sodium taurocholate by retrograding cholangiopancreatography micro pump to produce the SAP model. At 6, 12, and 24 hours after operation, 8 rats were sacrificed to get abdominal aortic blood for testing the levels of peripheral blood amylase, trypsin, interleukin-8(IL-8), tumor necrosis factor-α(TNF-α), and ZO-1 protein. At the same time, pancreatic tissues were got to perform HE staining and immunohistochemical staining for observation of the pathological changes and the expression of ZO-1 protein respectively. Results Compared with SO group at the same time, the levels of peripheral blood amylase, trypsin, IL-8, TNF-α, and ZO-1 protein were all higher in SAP group (P < 0.05). The level of amylase in SAP-24 hours group was higher than those of 6 hours group and 12 hours group(P < 0.05), the levels of trypsin, IL-8, and ZO-1 protein in SAP group increased over time (P < 0.05), but levels of TNF-αin 3 time points of SAP group did not differ with each other significantly(P > 0.05). Results of regression showed that in the SAP group, the level of ZO-1 protein in serum was significantly positive correlated with pathological score of pancreatic tissue(b=0.96, P < 0.05), levels of serum amylase(b=0.87, P < 0.05), trypsin(b=0.72, P < 0.05), and serum IL-8 (b=0.69, P < 0.05), but was not significantly correlated with level of TNF-α(P > 0.05). HE staining results showed that damage of pancreatic tissues became worse over time in SAP group, and the pathological score of SAP-6 hours group was lower than those of 12 hours group and 24 hours group (P < 0.05). Immunohistochemical staining results showed that, in SAP group, with the extension of time, the number of ZO-1 protein granules in pancreatic acinar cells and capillary wall reduced, and expressed in capillaries discontinuously. Conclusion During the course of SAP, the concentration of serum ZO-1 protein increase, but its expression in the pancreatic tissue degrade, which is closely associated with microvascular injury and progression of pancreatic tissues.
The purpose of this study was to determine the contribution of endotoxin (ET) in ocurrence and progression of acute pancreatitis (AP). The results indicated that correlation of ET changes with multiple organ damage in AP. The degree of ET elevation correlated well with the severty of AP. The level of plasma ET of severe AP patients was much higher than that of mild AP patients (Ｐ＜0.05). The chance of multiple organ damage got greater while the plasma ET level got higher. Moreover, the severety change of severe AP correlated with the change of plasma ET level. In other words, the ET level was reduced while the disease was recovering, elevated while it was becoming worse and maintained high level in dead cases. We think that plasma ET level can be used as a reference for differenciating mild AP with severe AP and a predictor for the prognosis of AP.
目的:探讨早期应用柴芩承气汤治疗重症急性胰腺炎(severe acute pancreatitis,SAP)伴多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的临床疗效。方法:88例符合病例选择标准并接受柴芩承气汤治疗的SAP伴MODS住院患者,按院外病程长短分为早期组(48 h内入院接受治疗,44例)和晚期组(48～72 h内入院接受治疗,44例),比较治疗过程中两组患者器官功能障碍持续时间、住院时间、感染率、中转手术率及病死率。结果:早期组急性呼吸窘迫综合征、肾功能衰竭、心功能衰竭、肝功能不全、脑病、凝血系统损害的持续时间低于晚期组(Plt;0.05);早期组住院时间、感染率、中转ICU率、中转手术率及病死率低于晚期组(Plt;0.05)。结论:早期应用柴芩承气汤治疗SAP伴MODS能减少器官损害持续时间,减轻器官损害,从而缩短病程,减少后期感染率及中转手术率,降低病死率。
To evaluatae the role of cathepsin B in the pathogenesis of acute pancreatitis. The experimental dogs were divided into three groups based on the severity. An acute edematous pancreatitis group (n＝11), an acute hemorrhagic necrotizing pancreatitis group (n＝12), and a control group (n＝7). Distribution of cathepsin B in pancreatic aciner cell was studied. Results: there was a redistribution of cathepsin B from the lysosomal fraction to the zymogen fraction. The results indicated that cathepsin B play a important role in the pathoagenesis of acute pancreatitis.
【Abstract】Objective To study the liver injury and effects of aescin on liver in rats with acute pancreatitis. Methods The rats were divided into 3 groups (control group, AP group and aescin group). The serum alanine aminotransferase （ALT）, serum lactate dehydrogenase (LDH), hepatic cellular energy charge (EC) and adenosine triphosphate (ATP) were detected. The pathologic changes in pancreas and liver were also observed. Results The serum levels of ALT and LDH in aescin group were significantly lower than those of the AP group. The EC and ATP levels were significantly higher in aescin group than that of the AP group. Conclusion Introvenous injection of aescin can alleviate the liver injury in rats with acute pancreatitis.
【Abstract】Objective To study the influence of early hemofiltration on plasma concentrations of proinflammatory cytokines TNF-α and IL-1β and their transcription levels in severe acute pancreatitis (SAP) pigs. Methods The model of SAP was induced by retrograde injection of artificial bile into pancreatic duct in pigs. Animals were divided randomly into two groups: SAP hemofiltration treatment group (HF group, n=8) and SAP no hemofiltration treatment group (NHF group, n=8). TNF-α and IL-1β plasma concentrations were measured by ELISA. Their transcription levels in the tissues of pancreas, liver and lung were assayed by semi-quantitative reverse transcription polymerase chain reaction. Results After hemofiltration treatment, the plasma concentrations of TNF-α and IL-1β increased gradually but were lower than those of NHF group at the same time spot 〔at 6 h after hemofiltration treatment, (618±276) pg/ml vs (1 375±334) pg/ml and (445±141) pg/ml vs (965±265) pg/ml, P＜0.01〕. At 6 h after hemofiltration treatment, the transcription levels of TNF-α and IL-1β in tissues of pancreas, liver and lung were lower than in NHF group (57.8±8.9 vs 85.7±17.4, 48.0±8.1 vs 78.1±10.2, 46.2±9.6 vs 82.4±10.5; 55.9±9.0 vs 82.2±15.7, 40.6±9.2 vs 60.0±10.6, 35.7±9.8 vs 58.1±9.3, P＜0.01). Conclusion Early hemofiltration can reduce TNF-α and IL-1β plasma concentrations and transcription levels in SAP pigs.