胰蛋白酶原激活肽和白细胞介素-6在实验性急性胰腺炎中的意义

摘要

目的 探讨血浆胰蛋白酶原激活肽(TAP)和血清白细胞介素-6(IL-6)作为早期预测实验性急性胰腺炎病情严重程度指标的可行性.方法 雄性SD大鼠90只,随机分成5组.分别是3%牛磺胆酸钠逆行胆胰管注射组、5%牛磺胆酸钠逆行胆胰管注射组、3%牛磺胆酸钠逆行胆胰管注射后0.5h经股静脉注入乌司他丁组、0.9%生理盐水逆行胆胰管注射组和假手术组(只行开、关腹术).每组18只大鼠,每组再随机分成3组,分别于制模后3、6、24 h后取血处死,留取标本.观察血清淀粉酶、血浆TAP水平、血清IL-6水平变化,并在光镜下对胰腺病变进行双盲组织病理学评分.结果 制模后3和6 h血浆TAP水平5%牛磺胆酸钠逆行胆胰管注射组[(4.798±0.169)和(3.999±0.299)nmol/L]比3%牛磺胆酸钠逆行胆胰管注射组[(2.416±0.148)和(3.356±0.211)nmol/L]明显增高(P<0.01);制模后6 h,血清IL-6水平5%牛磺胆酸钠逆行胆胰管注射组(1339.51±56.43)pg/ml明显高于3%牛磺胆酸钠逆行胆胰管注射组(619.07±42.25)pg/ml(P<0.01).结论 在轻重不同的急性胰腺炎模型中,胰腺病理改变越严重,血浆TAP和血清IL-6峰值出现越早.血浆TAP水平可以作为早期精确预测急性胰腺炎模型胰腺病变严重程度的指标.%Objective To explore the feasibility of using plasma trypsinogen activation peptides (TAP) and serum interleukin-6 (IL-6) as early markers for predicting the severity of experimental acute pancreatitis. Methods Ninety male adult Sprague-Dawley rats were equally randomized into five groups: edema pancreatitis group, treated with retrograde ductal infusion of 3 ％ sodium taurocholate solution; necrosis pancreatitis group, treated with retrograde ductal infusion of 5％ sodium taurocholate solution; treatment pancrcatitis group, treated with retrograde ductal infusion of 3 ％ sodium taurocholate solution and ulinastatin intravenous infusion half an hour later; control pancreatitis group, treated with 0.9％ normal saline retrograde ductal infusion; and sham operation group, treated with sham operation. Rats in each group were equally randomized into three subgroups, which were killed by exsanguination 3, 6, or 24 hours after infusion, and blood specimens were obtained. Serum amylase, plasma TAP, and serum IL-6 were determined. The severity of pancreatitis was scored by two blinded pathologists under microscope. Results At 3 and 6 hours after infusion, plasma TAP concentration of necrosis pancreatitis group [ (4. 798 ± 0. 169 ) and ( 3. 999 ± 0. 299 ) nmol/L, respectively ] were significantly higher than those of edema pancreatitis group [ ( 2.416 ± 0. 148 ) and ( 3. 356 ± 0.211 ) nmol/L, respectively ] ( P ＜ 0.01 ); at 6 hours after infusion, serum IL-6 level of necrosis pancreatitis group [ (1339.51 ±56.43) pg/ml] was significantly higher than that of edema pancreatitis group [ (619.07 ± 42.25 ) pg/ml ] ( P ＜ 0.01 ). Conclusions In this acute pancreatitis model, the peak levels of plasma TAP and serum IL-6 may appear earlier in rats with severer disease. Serum TAP level may be used as a marker for the accurate early prediction of the severity of acute pancreatitis.