摘要:目的: 探討益活清下法早期聯用用丙氨酰谷氨酰胺二肽治療重癥急性胰腺炎(severe acute pancreatitis, SAP)的療效。 方法 :依據納入和排除標準,選取我院中西醫結合科收治的SAP80例,按1︰1隨機分成早期組(40例)和晚期組(40例),早期組入院時便應用丙氨酰谷氨酰胺二肽治療;晚期組入院5 d后加用丙氨酰谷氨酰胺二肽治療。 結果 :兩組入院時Ranson評分、CT評分、APACHEⅡ評分無統計學差異(P ＞005),治療15 d后早期組APACHEⅡ評分(497±239分)明顯低于晚期組(863±357分)(P ＜001);兩組并發ARDS、腎功能衰竭、休克、肝功能不全、心功能衰竭、腦病及腸麻痹的發生率無統計學差異(P ＞005);早期組ARDS、腎功能衰竭、休克、肝功能不全、腦病及腸麻痹持續時間及住院病程短于晚期組(P＜005 );早期組感染率、手術中轉率及病死率低于晚期組(P＜005 )。 結論 :益活清下法早期應用丙氨酰谷氨酰胺二肽治療SAP,可縮短并發癥的持續時間及病程,降低病死率和手術中轉率。Abstract: Objective: To compare the effects of integrated basal treatment of Chaiqin Chengqi Decoction with alanylglutamine Dipeptide giving in different times for sever acute pancreatitis. Methods : The randomized parallel control was adopted. 80 patients of SAP were randomized to earlytreated group (40 cases were treated by AlaGln as soon as who entered hospital) and latetreated group (40 cases were treated by AlaGln after 5 days from who had entered hospital). The mortality, incidences of complication, operation and mortality,the duration of complication and the course of diseases, hospitalization were compared. Results : The mortality shown that in earlytreated group was lower than the latertreated group, there was statistically significantly difference. Ranson score, CT score, Acute Physiology and Chronic Heath EvaluationⅡscore (APACHEⅡ score) and the incidences of complications were no statistical differencein the two groups(P ＞005)in the early stage of hospitalization. But the APACHEⅡ score (497±239)in earlytreated group was lower than those in latetreated group(863±357)after 15 days(P ＜001 The duration of acute respiratory distress syndrome(ARDS ),renal failure, shock, hepatic failure, encephalopathy and enteroplegia were shorter in earlytreated group than those in latetreated group(P＜005 . The incidence of infection, operation and mortality were lower in earlytreated group than those in latetreated group(P＜005 . The course of diseases of earlytreated group was shorter than that of latetreated group (P＜005 . Conclusion : SAP treated by (CQCQD) and AlaGln in early stage can shorten the duration of complications and the hospitalization period, and reduce the incidences of infection, operation rates and mortality rate.
Objective To investigate the effect and potential mechanism of bone marrow mesenchymal stem cells (BMSCs) - derived extracellular vesicles (EVs) on lung tissue injury in mice with severe acute pancreatitis (SAP). Methods A total of 24 specific pathogen free grade male C57BL/6 mice and primary mouse lung microvascular endothelial cells (PMVECs) were selected. The mice were divided into sham group, SAP group, and BMSC group, with 8 mice in each group. The mouse primary PMVECs were divided into model group [sodium taurocholate (NaTC) group], BMSC-EV group, and control group. Extraction and characterization of healthy mouse BMSCs and their derived extracellular vesicles (BMSC-EVs) were conducted. A mouse model of SAP was established, and BMSC-EVs were injected into SAP mice by tail vein or intervened in PMVECs in vitro, to observe the pathological damage of pancreatic and lung tissues, the changes of serum amylase, lipase, and inflammatory factors [tumor necrosis factor α (TNF-α), interleukin-6 (IL-6)], the expression of inflammatory factors of lung tissues and PMVECs, and the endothelial cell barrier related proteins [E-cadherin, ZO-1, intercellular cell adhesion molecule-1 (ICAM-1)], and tight junctions between PMVECs to explore the effects of BMSC-EVs on pancreatic and lung tissues in SAP mice and PMVECs in vitro. Results BMSCs had the potential for osteogenic, chondrogenic, and lipogenic differentiation, and the EVs derived from them had a typical cup-shaped structure with a diameter of 60-100 nm. BMSC-EVs expressed the extracellular vesicle-positive proteins TSG101 and CD63 and did not express the negative protein Calnexin. Compared with the mice in the sham group, the SAP mice underwent significant pathological damage to the pancreas (P<0.05), and their serum amylase, lipase, inflammatory factor IL-6, and TNF-α levels were significantly up-regulated (P<0.05); whereas, BMSC-EVs markedly ameliorated the pancreatic tissue damage in the SAP mice (P<0.05), down-regulated the levels of peripheral serum amylase, lipase, IL-6 and TNF-α (P<0.05), and up-regulated the level of anti-inflammatory factor IL-10 (P<0.05). In addition to this, the SAP mice showed significant lung histopathological damage (P<0.05), higher neutrophils and macrophages infiltration (P<0.05), higher levels of the inflammatory factors TGF-β and IL-6 (P<0.05), as well as reduced barrier protein E-cadherin, ZO-1 expression and elevated expression of ICAM-1 (P<0.05). BMSC-EVs significantly ameliorated lung histopathological injury, inflammatory cells infiltration, inflammatory factor levels, and expression of barrier proteins, and suppressed ICAM-1 expression (P<0.05). In the in vitro PMVECs experiments, it was found that intercellular tight junctions were broken in the NaTC group, and the levels of inflammatory factors TNF-α and IL-6 were significantly up-regulated (P<0.05), the protein expression of E-cadherin and ZO-1 was significantly down-regulated (P<0.05), and the expression of ICAM-1 was significantly up-regulated (P<0.05). BMSC-EVs significantly improved intercellular tight junctions in the NaTC group and inhibited the secretion of TNF-α and IL-6 (P<0.05), up-regulated the expression of the barrier proteins E-cadherin and ZO-1, and down-regulated the expression of ICAM-1 (P<0.05). Conclusion BMSC-derived EVs ameliorate lung tissue injury in SAP mice by restoring the lung endothelial cell barrier and inhibiting inflammatory cell infiltration.
ObjectiveTo investigate the therapeutic effect of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site in treatment of hyperlipidemic severe acute pancreatitis (HL-SAP).
MethodsThe clinical data of 34 patients with HL-SAP initially underwent B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site from January 2010 to June 2014 were retrospectively analyzed. According to the different of the onset to treatment time, 34 cases were divided into the≤24 h group and > 24 h group. The serum platelet activating factor (PAF) and triglyceride (TG) at the time of admission and after admission 1, 3, 5, 7, and 10 days were detected, and the hospitalization time, mortality, and the rate of conversion to open surgery were observed.
ResultsThe levels of PAF and TG in the both groups tended to gradually decrease with different degrees, were significantly lower than that the before treatment (P < 0.05), and the decline of PAF and TG in≤24 h group were more significant than > 24 h group. The hospitalization time, mortality, and the rate of conversion to open surgery in the≤24 h group were significantly lower than those of the > 24 h group (P < 0.05).
ConclusionThe early using of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site would have a beneficial impact on the management of HL-SAP and complications.
摘要:目的: 探討益活清下法治療重癥急性胰腺炎(severe acute pancreatitis, SAP)對血清單核趨化蛋白1及對器官功能不全的影響。 方法 : 依據納入和排除標準,選取SAP患者24例,按1︰1隨機分為治療組和對照組,在接受相同西醫治療的基礎上,治療組使用中藥“益活清下”法治療,對照組同時接受中藥安慰劑治療。測定患者第0、1、3、5、7天血清MCP1的濃度水平,比較各器官功能不全的發生率與持續時間。 結果 :兩組入院時Rason評分、CT評分、急性生理和慢性健康評價指標Ⅱ評分無統計學差異(〖WTBX〗P gt;005)。對照組第3天MCP1濃度水平明顯高于治療組,差異有統計學意義(〖WTBX〗P lt;005),對照組腸、肝功能不全的發生率高于治療組,持續時間長于治療組,但無統計學差異(〖WTBX〗P gt;005)。 結論 :益活清下法治療重癥急性胰腺炎,可降低患者血清MCP1的水平。Abstract: Objective: To investigated the impact of Yihuo Qingxia method on the serum monocyte chemoattractant protein1 of severe acute pancreatitis (SAP)and on the organs disfunction. Methods : Twentyfour SAP patients who admitted to hospital within 72h after onset were randomized into treatment group (n=12) and control group (n=12). The patients in the treatment group were treated by Yihuo Qingxia method, and the control group were administrated with placebo.The level of the serum mcp1 of the patients on the first,3rd,5th,7thday were measured, as well as the incidence and the duration of disfunction of the organs were compared.〖WTHZ〗Results :There were no statistical significance in admission Rason scores, CT scores, Acute physiology and chronic health evaltionⅡscores(APACHEⅡscores)(Pgt;005). The level of the serum Monocyte chemoattractant protein1 of the treatment group was lower than that of the placebo group generally(Plt;005).At the 3rd day after onset,the serum mcp1 level of the control group was significantly higher than that of the treament group(Plt;005).The incidence of the control group of the intestin disfunction and hepatic inadequacy was obviously higher than those of the treatment group,and the duration of the former was longer than that of the latter,but with no satistical significance. Conclusion :Yihuo Qingxia method can effectively cut down the level of the serum mcp1 of severe pancreatitis patients.
Objective Exploring the correlation between intravesical pressure (IP) and diaphragm excursion (DE) in patients with severe acute pancreatitis (SAP) and acute respiratory distress syndrome (ARDS), and evaluating its predictive value for weaning outcomes. Methods A retrospective analysis was conducted on the clinical data of 144 SAP patients with ARDS admitted between 2020 and 2023. By collecting the outcome of weaning, collect data on gender, age, acute physiology and chronic health score II (APACHE II), oxygenation index, and IP and DE before weaning and extubation for all patients. Based on weaning outcomes, divide patients into successful and failed groups, and compare the differences in various indicators between the two groups; Use binary logistic regression to analyze whether IP and DE are risk factors affecting weaning in SAP patients with ARDS, and use Pearson correlation analysis to examine the correlation between IP and DE; Use receiver operating characteristic curve (ROC curve) to analyze the predictive value of IP and DE on weaning outcomes in SAP patients with ARDS. ResultsA total of 144 SAP patients with ARDS were included, of which 108 were successfully weaned and 36 were unsuccessful. There were no statistically significant differences in gender, age, and APACHE II scores between the successful and failed groups (males: 62.96% (68/108) compared to 69.44% (25/36), age (years): 41.91 ± 8.14 compared to 42.42 ± 6.22, APACHE II score (points): 18.28 ± 2.22 compared to 18.97 ± 1.83, P>0.05). The IP of the successful group was significantly lower than that of the failed group, and the DE was significantly higher than that of the failed group [IP (mmHg): 18.45 ± 3.76 compared to 23.92 ± 5.65, DE (mm): 16.18 ± 4.23 compared to 12.28 ± 4.44, all P<0.05]. All patients showed a significant negative correlation between IP and DE (r=–0.457, P<0.001). ROC curve analysis showed that the area under the curve (AUC) of IP predicting the withdrawal outcome of SAP patients with ARDS was 0.805, with a 95% confidence interval (95%CI) of 0.724-0.885 and P<0.001. When the cutoff value was 19.5 mmHg, the sensitivity was 91.57% and the specificity was 47.54%; The AUC for predicting the withdrawal outcome of SAP patients with ARDS by DE was 0.738, with a 95%CI of 0.641-0.834 and P<0.001. When the cutoff value was 11.5 points, the sensitivity was 84.82% and the specificity was 59.38%. Conclusions There is a significant negative correlation between IP and DE in SAP combined with ARDS patients, and both have certain predictive value for weaning outcomes.
Objective To explore the protective effect of rapamycin on brain tissues injury in severe acute pancreatitis (SAP) and its possible mechanism in experimental rats. Methods Ninety SPF males SD rats were randomly divided into 3 groups by random envelope opening method: sham operation group (SO group), SAP group, and rapamycin group (RAPA group), then the rats of each group were divided into 24 h, 36 h, and 48 h 3 subgroups by random number table method. Rats in each group underwent laparotomy, the model was prepared by retrograde injection of solutions into biliopancreatic duct, rat of the SO group was injected with 0.9% normal saline (2 mL/kg), rats of the SAP group and the RAPA group were injected with 5% sodium taurocholate solution (2 mL/kg), but rat of the RAPA group was injected with rapamycin (1 mg/kg) at 30 min before narcosis. All survival rats in each subgroup were killed at 24 h, 36 h, and 48 h respectively, then the pancreas and brain tissues of rats were collected, pancreas and brain tissues were stained by hematoxylin-eosin staining, brain tissues were stained by Luxol fast blue additionally, pathological changes of brain tissues were scored under light microscope. The protective effect of rapamycin on brain tissues injury was determined by comparing the differences in the degree of brain tissues among 3 groups. The phosphorylated mammaliantarget of rapamycin (p-mTOR) and phosphorylated ribosomal 40S small subunitS6 protein kinase (p-S6K1) expression levels in brain tissues were detected by Western blot. In addition, the correlations between the expression levels of p-mTOR and p-S6K1 in brain tissues and the degree of brain tissues injury were analyzed to further explore the possible mechanism of rapamycin’s protective effect on brain tissues injury in SAP. Results① At the point of 24 h, 36 h, and 48 h, the order of the relative expression levels of p-mTOR and p-S6K1 in brain tissues of three groups were all as follows: the SO group < the RAPA group < the SAP group (P<0.05). ② At the point of 24 h, 36 h, and 48 h, the order of brain histological score in three groups were all as follows: the SO group < the RAPA group < the SAP group (P<0.05). ③ The relative expression levels of p-mTOR and p-S6K1 in brain tissues were positively correlated with pathological scores of brain tissues (r=0.99, P<0.01; r=0.97, P<0.01). ConclusionRapamycin plays a protective role in pancreatic brain tissues injure by down-regulating the expression levels of p-mTOR and p-S6K1 in mTOR signaling pathway.
ObjectiveTo investigate treatment of severe acute pancreatitis (SAP) concurrent peripancreatic walled-off necrosis.MethodsThe clinical data and treatment of a patient with SAP from the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The results of discussion of multidisciplinary team (MDT) were summarized.ResultsThe patient was admitted for the SAP with high fever, abdominal pain, and dyspnea for 2 weeks. The enhanced CT scan of the upper abdomen presented severe acute necrotizing pancreatitis with massive peripancreatic walled-off necrosis and pleural effusion. After the full discussion of SAP MDT, the percutaneous sinus tract necrosectomy (PSTN) was performed to relieved the symptom. After the two-stage PSTN treatment, the peripancreatic necrotic tissue was obviously reduced, the drainage was unobstructed, the clinical symptoms and biochemical indicators were obviously improved, and the patient was discharged on day 6 after the surgery.ConclusionsSAP is a critical situation with rapid progression and high mortality, and timing and approach of intervention for complications are very difficult to handle. PSTN could treat SAP with early appearance of infection or walled-off necrosis, which has advantages of less trauma, higher efficiency, and faster recovery as compared with traditional method and is of valuable in clinical practice.
ObjectiveTo explore the protective effect of rapamycin on pancreatic damage in severe acute pancreatitis (SAP) and further to explain its protective mechanism.MethodsNinety selected SPF males SD rats were randomly divided into 3 groups: sham-operated group (SO group), SAP group, and rapamycin group (RAPA group), with 30 rats in each group. Then each group of rats were randomly divided into 3 subgroups of 24 h, 36 h, and 48 h, 10 rats in each subgroup. Rats in each group underwent laparotomy, the model was prepared by retrograde injection of solutions into biliopancreatic duct, rats of the SO group were injected with 0.9% normal saline, rats of the SAP group and RAPA group were injected with 5% sodium taurocholate solution, but rats of the RAPA group were injected with rapamycin at 30 min before the injection of 5% sodium taurocholate. All the survival rats in corresponding subgroup were killed at 24 h,36 h, and 48 h after operation respectively, then serum and pancreas tissues of rats were collected, serum inflammatory factors content of IL-1β, IL-6, and TNF-α were detected by ELISA method, expression levels of p-mTOR and p-S6K1 in pancreas were detected by Western blot, pancreas tissues were stained by Hematoxylin-Eosin Staining and pathological changes of pancreas were scored under light microscope.Results① At the timepoint of 24 h, 36 h, and 48 h, the order of the expression levels of p-mTOR and p-S6K1 in pancreatic tissues of 3 groups were all as follows: SO group<RAPA group<SAP group, there were significant difference among any 2 groups (P<0.05). ② IL-1β: at the timepoint of 48 h, the order of the content of IL-1β in 3 groups were as follows: SO group<RAPA group<SAP group, there were significant differences among any 2 groups (P<0.05); IL-6: at the timepoint of 36 h and 48 h, the order of the content of IL-6 in3 groups were as follows: SO group<RAPA group<SAP group, there were significant differences among any 2 groups (P<0.05); TNF-α: at the timepoint of 48 h, the order of the content of TNF-α in 3 groups was as follows: SO/RAPA group<SAP group (P<0.05), but there was no significant difference between the SO group and RAPA group (P>0.05). ③ Pancreatic histological score: at the timepoint of 24 h, 36 h, and 48 h, the order of the pancreatic histological score in3 groups was all as follows: SO group<RAPA group <SAP group, there were significant differences among any 2 groups (P<0.05). ④ The expression levels of p-mTOR and p-S6K1 in pancreatic tissue were positively correlated with the pathological scores of pancreatic tissue (r=0.97, P<0.01; r=0.89, P<0.01).ConclusionRapamycin can reduce the degree of pancreatic damage in SAP and has protective effect on pancreatic tissue.
ObjectiveTo investigate the protective effect of exogenous insulin on relative adrenal insufficiency (RAI) in rats with severe acute pancreatitis (SAP).MethodsEighty SPF SD rats were randomly divided into 5 groups (n=16): sham operation (SO) group, SAP group, low-dose insulin intervention (low-dose) group (0.05 U/100 g body weight), medium-dose insulin intervention (medium-dose) group (0.1 U/100 g body weight), and high-dose insulin intervention (high-dose) group (0.2 U/100 g body weight). The five groups were randomly divided into two subgroups: cosyntropin stimulation test (CST) subgroup and non-CST subgroup. SAP model was established by retrograde injection of 5% sodium taurocholate into biliopancreatic duct. The rats were sacrificed 3 hours after the establishment of SAP model. The levels of amylase (AMY), alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea (Ur) and creatinine (Cr) were detected by automatic biochemical analyzer. The serum levels of tumor necrosis factor-α (TNF-α) and corticosterone (Cor) were detected by ELISA kit. The pathological changes of pancreas and adrenal gland were observed under light microscope. The lipid content of adrenal gland was observed by oil red O staining.ResultsCompared with the SO group, the serum levels of Amy, ALT, AST, Ur, Cr, TNF-α and Cor in the SAP group were significantly increased (P<0.05), typical pathological damages occurred in pancreas and adrenal gland, and pathological scores were significantly increased (P<0.05). Compared with the SAP group, the levels of AMY, ALT, AST, Ur, Cr, TNF-α and Cor in the low-dose group were not significantly changed (P>0.05); the levels of AMY, ALT, AST, Ur, Cr and TNF-α in the medium-dose group and the high-dose group were significantly decreased (P<0.05), and Cor levels were significantly increased (P<0.05). Compared with the low-dose group, AMY, ALT, AST, Cr, TNF-α in the medium-dose group and the high-dose group were significantly decreased (P<0.05), Cor level were significantly increased (P<0.05), Ur level had no significant change. There were no significant difference in AMY, ALT, AST, Ur, Cr, TNF-α and Cor levels between the medium-dose group and the high-dose group (P>0.05). After CST intervention, there were no significant change in serum Cor levels in the SAP group and the low-dose group (P>0.05), but the serum Cor levels in the SO group, the medium-dose group and the high-dose group were significantly increased (P<0.05).ConclusionAppropriate dose of exogenous insulin can improve SAP related adrenal injury and RAI, but the specific mechanism still needs further study.
ObjectiveTo explore the protective effects of abdominal paracentesis drainage (APD) on pancreatitis-associated liver injury in the early phase of severe acute pancreatitis (SAP). MethodsOne hundred and fourteen consecutive patients with SAP, admitted to the General Hospital of Western Theater Command from January 2015 to January 2021, were included in this retrospective study. The patients were divided into the APD group (n=61) and the non-APD group (n=53) based on whether they underwent APD treatment within 72 h of admission. The variables including baseline data, liverfunction tests, inflammation indexes, severity scores and other variables of the two groups were statistically analyzed. ResultsThe hospital mortality in the APD group was lower than that in the non-APD group (8.2% vs. 22.6%, P=0.031). These severity scores (including APACHE Ⅱ score, Ranson score and modified Marshall score) and inflammation indexes (including C-reactive protein, interleukin-6, interleukin-1 and tumor necrosis factor-α) in the APD group were all lower than those in the non-APD group (P＜0.05). In terms of liver function related indexes, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and direct bilirubin (DBIL) after treatment in both two groups were significantly lower than those before treatment (P＜0.05). The levels of ALT, AST, TBIL and DBIL after treatment in the APD group were lower than those in the non-APD group (P＜0.05), and the levels of prealbumin and albumin after treatment in the APD group were higher than those in the non-APD group (P＜0.05), but there were no significant differences in the levels of alkaline phosphatase, GGT and 5′ -nucleotidase after treatment in the two group (P＞0.05). ConclusionFor SAP patients with ascitic fluid, application of APD can attenuate liver injury and improve liver function in the early stage of SAP.
