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中华胰腺病杂志

中华胰腺病杂志

CSTPCD

Chinese Journal of Pancreatology
中国科协主管，中华医学会主办。本刊是我国第一本胰腺疾病方面的全国性专业学术期刊，是中国科技核心期刊。杂志具有学术性高、可读性强、实用性大的特点。辟有述评、专家论坛、论著、短篇论著、讲座、综述等栏目，内容涵盖内、外、病理、影像、肿瘤等各科。
  • 发文量：2862
  • 被引量：618
  • H指数：1
  • 开始收录时间：2001,1(1)
  • CNKI综合因子：0.401
  • 维普期刊影响因子： 0.566
  • 万方期刊影响因子：0.67
  • 创刊时间：2001
  • 国内刊号/CN：11-5667/R
    国际刊号/ISSN：1674-1935
  • 发行周期：双月刊
    邮发代号：4-689
  • 主管单位：中国科学技术协会
    主办单位：中华医学会
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  • 摘要：Objective To investigate the incidence of pleural effusion in acute panereatitis(AP)and the relation between pleural effusion and severity of AP.Methods The medical records of 766 patients with AP were analyzed retrospectively.The incidence of pleural effusion was documented and its relationship with age of onset,sex,Ranson score,CTSI,serum albumin and hospital day was analyzed.Results In the 766 AP patients,there were 129(16.8%)patients had pleural effusion.In 171 SAP patients,there were 91 (15.3%)patients had pleural effusion.In the 595 MAP patients,there were 129(16.8%)patients had pleural effusion.The difference in the incidence of pleural effusion between MAP and SAP patients was statistically significant(P＜0.05).The serum amylase,albumin,Ranson score,CTSI,and hospital day in patients with pleural effusion were(795±1013)U/L,(36±7)g/L,1.12±1.15,4.02±1.16 and(23.4±23.4)d,respectively;while the corresponding values in patients without pleural effusion were(592±856)U/L,(38±6)g/L,0.85±0.98,3.15±16.60 and(17.3±16.6)d,respectively.The difference in Ranson score,serum amylase,CTSI between the two groups was statistically significantly(P＜0.05 or＜0.01＝,the serum level of albumin in patients with pleural effusion was significantly lower than that in patients without pleural effusion(P＜0.01),the hospital day in patients with pleural effusion was significantly longer than that in patients without pleural effusion(P＜0.01).Pleural effusion of both sides was present in 92 patients,while pleural effusion of right side was present in 11 patients,pleural effusion of left side was present in 26 patients;the site of pleural effusion was not associated with the severity of AP,however,patients with pleural effusion of left side tended to have longer hospital day(P＜0.05).Conclusions Patients with pleural effusion during AP were more likely to be complicated with severe conditions,and the presence of pleural effusion may be a good marker for severity evaluation.%目的 分析急性胰腺炎(AP)患者胸腔积液的发生率,探讨胸腔积液与病情严重程度的关系.方法 回顾性分析766例AP患者胸腔积液的发生率及其与发病年龄、性别、Ranson评分、CT分级(CTSI)、血淀粉酶水平、白蛋白含量以及住院天数之间的关系.结果 766例AP患者中,129例(16.8%)发生胸腔积液.171例重症急性胰腺炎(SAP)中38例(22.2%)发生胸腔积液,595例轻症急性胰腺炎(MAP)中91例(15.3%)出现胸腔积液,SAP患者的胸腔积液发生率显著高于MAP患者(P＜0.05).发生胸腔积液患者的血淀粉酶水平、白蛋白含量、Ranson评分、CTSI及住院天数分别为(795±1013)U/L、(36±7)g/L、1.12±1.15、4.02±1.16和(23.4±23.4)d;无胸腔积液者分别为(592±856)U/L、(38±6)g/L、0.85±0.98、3.15±16.60和(17.3±16.6)d.胸腔积液患者的Ranson评分、血淀粉酶水平、CTSI均显著高于无胸腔积液者(P＜0.05或＜0.01);血清白蛋白含量显著低于无胸腔积液者(P＜0.01);住院天数明显长于无胸腔积液者(P＜0.01).双侧胸腔积液92例,右侧胸腔积液11例,左侧胸腔积液26例,胸腔积液部位与病情无关,但左侧胸腔积液者住院天数较长(P＜0.05).结论 AP患者发生胸腔积液者病情较重,胸腔积液可能是个较好的评估SAP的指标.
  • 摘要：@@ 随着消化内镜的普及和发展,特别是内镜下逆行胰胆管造影术(ERCP)和内镜超声(EUS)的应用,使得胰腺疾病的影像学诊断水平在US、CT、MRI等技术的基础上得到了提高.同时,ERCP和EUS相关介入技术的发展,使得获取胰液、胰腺细胞或组织标本成为可能,进行胰腺疾病的病理学、细胞学或分子生物学诊断得以实现.从而提高了胰腺疾病的诊断率和胰腺良恶性疾病的鉴别水平.
  • 摘要：目的 探讨重组肠三叶因子(rITF)对急性坏死性胰腺炎(ANP)大鼠肠黏膜的保护作用及其机制.方法 SD雄性大鼠60只,按随机数字表法分为对照组、ANP组、rITF组,每组20只.逆行胰胆管注射5%牛黄胆酸钠100μl/100 g体重制备ANP模型.rITF组制模前后尾静脉注射rITF 0.5mg/100 g体重,对照组及ANP组注射等量生理盐水,术后12、24 h分批处死大鼠.取血检测淀粉酶含量,取末端回肠组织观察病理学改变并予评分、免疫组化法检测肠黏膜NF-κB活性,RT-PCR法检测肠黏膜TNF-α mRNA、ICAM-1 mRNA的表达.结果 ANP组和rITF组血淀粉酶水平较同时点对照组均显著升高.ANP组肠黏膜损伤评分较同时点对照组高(P＜0.05);ANP 12 h组较rITF 12 h组高(P＜0.05),但24 h组间评分无明显差异.对照组、ANP组与rITF组12 h肠黏膜NF-κB阳性细胞数分别为(26±4)个、(55±8)个、(49±4)个;回肠组织TNF-α mRNA相对表达量分别为0.050±0.005、1.040±0.031和0.792±0.0256;回肠组织ICAM-1 mRNA相对表达量分别为0.045±0.010、0.795±0.037和0.400±0.031.ANP组上述各项指标值均较对照组显著增加(P＜0.05或P＜0.01),而rITF下组又较ANP组均显著减少(P＜0.05).结论 重组肠三叶因子对ANP大鼠肠黏膜具有保护作用,其机制可能通过抑制肠黏膜NF-κB活化,下调TNF-αmRNA、ICAM-1 mRNA表达.%Objective To investigate the effect of recombinant intestinal trefoil factor(rITF)on the intestinal mucosa of acute necrotizing pancreatitis(ANP)rats and explore the mechanism.Methods 60 male SD rats were randomly divided into control group(n=20),ANP group(n=20),rITF group(n=20).ANP was induced by retrograde injection of 5%sodium taurocholate(100μl/100 g)into biliopancreatic duct.Rats in rITF group were injected with rITF(0.5 mg/100 g)before and after ANP induction.The rats in ANP group and control group received same amount of normal sailne.Each group were sacrificed 12 h or 24 h later.respectively.Blood sample was taken to determine the serum level of amylase.Terminal ileum was resected to observe the pathologic changes;immunohistochemistry method was applied to detect the activity of NF-κB;the expression of TNF-α mRNA,ICAM-1 mRNA in intestinal mucosa was measured by RT-PCR.Results Intestinal injury score of ANP group was higher than that ofcontrol group(P＜0.05),intestinal injury score of ANP 12 h group was higher than that of rITF 12 h group(P＜0.05),but there was no significant difference between ANP 24 h group and rITF 24 h group.The number of positive NF-κB cells was 26±4,55±8,49±4,respectively;the relatively expression of TNF-α mRNA in terminal ileum was 0.050±0.005,1.040±0.031 and 0.792±0.0256,respectively;the relatively expression of ICAM-1 mBNA was 0.045±0.010,0.795±0.037 and 0.400±0.031,respectively,in control group,ANP group and rITF 12 h group.The corresponding values in the ANP group were significantly increased compared with those values in the control group (P＜0.05 or P＜0.01).Conclusions rITF may protect the intestinal mucosa.the mechanism may include inhibit NF-κB activation,down-regulate TiNF-α mBNA,ICAM-1 mRNA expression.
  • 摘要：Objective To analyze the methylation status of MUC2 gene in pancreatic carcinoma cell lines and peripheral blood of pancreatic carcinoma patients,and to explore the role of MUC2 methylation in the early diagnosis of pancreatic carcinoma.Methods Human pancreatic cancer cell lines of SW1990,ASPC,PANC1,BxPC3,PaTu8988 and CFPAC1,and 40 peripheral blood samples of pancreatic carcinoma patients,15 cases of chronic pancreatitis,25 cases of normal controls were collected,and the methylation status of MUC2 gene was detected by methylation sensitive restriction endonuclease PCR.Results MUC2 methylation was not detected in PANC1,BxPC3,PaTu8988,but was detected in ASPC,CFPAC1,SW1990.Among the peripheral blood samples,the rate of methylation in pancreatic cancer was 40.O%(n=16),in chronic pancreatitis was 0%,in normal controls was 4.0%(n=1),and the difference among the three groups was statistically significant(P＜0.01).The methylation of MUC2 gene CpG islands for the diagnosis of pancreatic carcinoma had a sensitivity of 40%,specificity of 97.5%,accuracy of 68.8%,positive predictive value of 94.1%and negative predictive value of 61.9%.Conclusions The detection of MUC2 hypermethylation in peripheral blood samples may be an potential marker for early diagnosis of pancreatic carcinoma.%目的 检测MUC2基因在胰腺癌细胞株、胰腺癌患者外周血中的甲基化情况,探讨MUC2基因甲基化对胰腺癌早期诊断的价值.方法 收集长海医院消化内科实验室保存的人胰腺癌细胞系SW1990、ASPC、PANC1、BxPC3、PaTu8988、CFPAC1及40例胰腺癌、15例慢性胰腺炎患者和25例正常对照者外周血标本,应用甲基化敏感性限制性内切酶(methylation-sensitive restriction endonuelease,MS-RE)为基础的PCR法检测MUC2基因甲基化.结果 人胰腺癌细胞系PANC1、BxPC3、PaTu8988未发生MUC2基因甲基化;ASPC、CFPAC1、SW1990胰腺癌细胞系发生MUC2基因甲基化.外周血标本中,40例胰腺癌标本甲基化率为40.0%(16例),15例慢性胰腺炎无甲基化,25例正常对照甲基化率4.0%(1例).胰腺癌与慢性胰腺炎、正常对照之间的甲基化率有显著差异(P＜0.01).外周血标本MUC2基因启动子CpG岛甲基化检测诊断胰腺癌的敏感性为40%、特异性为97.5%、诊断准确性68.8%、阳性预测值94.1%、阴性预测值61.9%.结论 用甲基化限制性酶切PCR法对外周血进行MUC2基因启动子区高甲基化检测可望成为新的胰腺癌诊断的重要实验室辅助手段.
  • 摘要：Objective To investigate the diagnostic value of determination of the genotypes in codon 12 and 13 of K-ras oncogene in blood samples of patients with pancreatic carcinoma(PC).Methods Blood samples were obtained from 54 patients with pathologically confirmed PC,and 33 healthy controls.The DNAs were obtained in these samples.and then genotype of K-ras mutation was detected by using the PNA-clamping real-time quantitative PCR.Then the correlation between the K-ras genotypes of blood DNA and the clinical characteristics was analyzed.Results K-ras mutations were found in 74.1%(40/54)of patients with PC.There was no such mutation in control samples.The mutations of K-ras was associated with age,lymph node and vessel invasion.poorly differentiated tumor,CA19-9,while it was not associated with sex,tumor location,size of tumor,clinical staging and pathological type.Conclusions The one-step method was highly sensitive for detecting K-ras mutation in blood samples.Detection of circular blood cells harboring K-ras mutation suggested the tumor was highly invasive with poor prognosis.%目的 检测胰腺癌患者外周血K-rag基因第12、13密码子突变,探讨其对胰腺癌的诊断价值.方法 选取经病理证实的胰腺癌患者54例以及健康志愿者33例.抽取全部实验者外周血标本,抽提循环中的DNA,应用肽核酸钳制实时定量PCR法检测K-rag基因突变,并分析其与患者临床病理参数的相关性.结果 54名胰腺癌患者中,40例(74.1%)外周血标本可检测出K-ras基因第12或13密码子突变.33名健康志愿者外周血标本无一例检出K-ras基因突变.外周血中K-ras基因的突变与患者年龄、淋巴血管侵犯、肿瘤分化程度、肿瘤临床分期、CA19-9水平有关(P＜0.05),而与患者性别、肿瘤部位、肿瘤大小及病理类型无关.结论 肽核酸钳制实时定量PCR法检测外周血K-ras基因突变的敏感性高.外周血K-ras基因突变的检出提示肿瘤具有高侵袭性,可能预后不良.
  • 摘要：Objective To evaluate the efficacy,safety and the possible mechanism of shenfu injection (SFI)in the treatment of severe acute pancreatitis(SAP).Methods A total of fifty-eiSht patients with SAP admitted to Research Institute of General Surgery of Nanjing Military Command from June 2006 to September 2008 were randomized into the conventional group(n=28)and SFI group(n=30).Patients in SFI group were treated by plus SFI(50 ml per day for 7 days)on routine treatment.The time to pain ease,bowel sound recovery times,body temperature recovery time were observed;APACHE Ⅱ score,Binder point was calculated;serum amylase,TNF-α and IL-1β were measured.The complication rate,operation rate,mortality were analyzed.Results The duration of abdominal pain,recovery of bowel sound,body temperature,and mean hospital stay days in SFI group were 95.3±2.8)d,(5.1±1.7)d,(7.1±2.4)d and(32.4±6.4)d;7 days later the APACHE Ⅱ score,Binder point was 8.63±1.33 and 6.50±1.66.respectively;the serum levels of amylase,TNF-α,and IL-1β were(1152±576)U/L,(48.7±16.4)nsa and(199.3±53.3)ng/ml,respectively.12 episodes of severe complication occurred,operation rate was 3.33%(4/30)and the mortality rate was 0%.All the parameters were statistically significantly lower than those in the conventional group(P＜0.05 or P＜0.01).There was no adverse event related to SFI.Conclusions SFI was safe and effective for SAP,and the mechanism may be related to inhibit over-release of inflammatory medium and cytokines,and improve microcirculation.%目的 探讨参附注射液治疗重症急性胰腺炎(SAP)的有效性、安全性及可能的机制.方法 收集2006年6月至2008年9月南京军区普通外科研究所58例SAP患者,按完全随机法分为常规治疗组28例和参附注射液组30例.参附注射液组在常规治疗基础上加用参附注射液50ml静脉滴注,每日1次,连用7 d.观察两组患者腹痛缓解时间、肠鸣音恢复时间和体温恢复时间;记录APACHEⅡ评分和Binder并发症积分;检测血清淀粉酶、IL-1β和TNF-α水平;统计并发症发生率、中转手术率、病死率和住院天数;观测两组与治疗相关的不良反应.结果 参附注射液组腹痛缓解时间、肠鸣音与体温恢复正常时间、平均住院天数分别为(5.3±2.8)d、(5.1±1.7)d、(7.1±2.4)d和(32.4±6.4)d;治疗后7 d的APACHEⅡ评分、Binder并发症积分分别为8.63±1.33和6.50±1.66;治疗7 d的血淀粉酶、IL-1β和TNF-α水平分别为(1152±576)U/L、(48.7±16.4)ng/ml和(199.3±53.3)ng/ml.均显著低于常规治疗组(P＜0.05或＜0.01).严重并发症发生12例次,中转手术率13.33%(4/30例),病死率0,无注射参附注射液相关不良反应.结论 参附注射液治疗SAP安全、有效,其作用机制可能与抑制炎症介质和细胞因子的过度释放、改善微循环障碍有关.
  • 摘要：Objective To investigate the role of endoscopic sphincterotomy(EST)and endoscopic nasobiliary drainage(ENBD)in the treatment of non-biliary severe acute pancreatitis(SAP).Methods 73 patients were randomly divided into the endoscopic treatment group(35 cases)and control group(38 cases).The patients in control group received non-surgical treatment.EST plus ENBD were performed in patients in the endoscopic treatment group 72h within hospitalization.Serum levels of amylase before EST and 1d,3 d,7 d after EST were measured;the ease of pain and recovery of bowel function were documented;the mortality rate,complication rate,surgery rote and hospital stay were also observed.Results The successful cannulation rate in the EST group was 94.3%(33/35),and there was no procedure related complication.Serum levels of amylase before EST and 1d,3 d,7 d after EST were(1376±131)U/L,(675±49)U/L,(238±49)U/L,(75±13)U/L,the serum levels of amylase before EST and 1d after EST in the EST group were not significantly different from those in the control group,but the corresponding values at 3 d,7 d were significantly lower than those in the control group(P＜0.01).The apparent effective rate and total effective rate of pain relief was 37.1%and 48.6%.which was significantly higher than those in the control group (26.3%and 28.9%,P＜0.05).There was no mortality in both groups.The complication rate in the EST group within 30 d was 14.3%,which was signiilcanfly higher than that in the control group(44.7%,P＜0.01).The gurgery rate in EST group was 2.86%,which was significantly lower than that in the control group (21.1%,P＜0.05).The hospital stay in EST group was(27.6±4.0)d,which was significantly shorter than that in the control group[(41.7±5.9)d,P＜0.05].Conclusions EST and ENBD treatment for non-biliary SAP was superior to non-surgical treatment within 72 h of symptom onset with excellent safety and feasibility profile.%目的 探讨经内镜十二指肠乳头括约肌切开术(EST)和鼻胆管引流术(ENBD)在非胆源性重症急性胰腺炎(SAP)治疗中的作用.方法 73例非胆源性SAP患者按随机法分为内镜治疗组(35例)和对照组(38例).对照组采用内科非手术治疗;内镜治疗组在入院后72 h内行EST和ENBD.检测治疗前及治疗后24 h、3 d、7 d血清淀粉酶;观察入院后腹痛缓解、肠功能恢复情况;记录两组患者病死率、并发症发生率、中转手术率、住院天数.结果 内镜治疗组插管成功率94.3%(33/35),无相关操作并发症;治疗前及治疗后24 h、3 d、7 d血清淀粉酶水平分别为(1376±131)U/L、(675±49)U/L、(238±49)U/L、(75±13)U/L,治疗前和治疗后24 h与对照组无显著差异,治疗后3 d、7 d均较对照组显著降低(P＜0.01).内镜治疗组患者腹痛缓解显效率48.6%,有效率37.1%,显著高于对照组的26.3%和28.9%(P＜0.05).两组患者均无病死.发病30 d内内镜治疗组并发症发生率为14.3%,中转手术率为2.86%,显著低于对照组的44.7%和21.1%(P＜0.01和P＜0.05).内镜治疗组平均住院(27.6±4.0)d,比对照组的(41.7±5.9)d显著缩短(P＜0.05).结论 发病72 h以内采用EST和ENBD治疗非胆源性SAP效果明显优于内科非手术治疗,且安全、可行.
  • 摘要：@@ 胰十二指肠切除术(whipple术)是治疗壶腹部周围恶性肿瘤的首选方法.多个研究表明,术前总胆红素水平是影响whipple术后并发症的独立危险因素[1-2],本文比较不同年代在本中心行whipple手术治疗患者术前血清总胆红素浓度对术后并发症影响,探讨在手术技术和围手术期监护较过去都有很大提高的现在,术前血胆红素浓度是否仍然是影响whipple术后并发症的独立危险因素.
  • 摘要：@@ 肿瘤由异质性的肿瘤细胞组成,其中包含一个在肿瘤发生、发展、侵袭转移和耐药中起关键作用的亚群--肿瘤干细胞[1].近年根据肿瘤干细胞理论分选到了胰腺癌干细胞(CD24+ CD44+ ESA+)[2],而且从胰腺癌细胞系PANC1中分离的CDD24+ CD44+ 细胞具有高致瘤性[3].本实验探讨从胰腺癌细胞系PANC1中富集CD24+ CD44+细胞的方法,为进一步研究这种细胞的生物学特性提供足量的细胞.
  • 摘要：Objective To investigate whether expression of XAF1 mediated by edenovirus vector AdS/F35 could induce apoptosis in pancreatic cancer cell line BxPC-3 and its possible mechanisms.Methods Preconstructed recombinant Ad5/F35-XAF1 virus and negative control Ad5/F35-Null was tranfected into BxPC3:the expression of XAF1 mRNA and protein before and after tranfection was,analyzed by semi-quantitative RT-PCR and Western blot.The expressions of proteins including Caspase-3,PARP,Caspase-8 and bcl-2 were detected by Western blots.Cell apoptosis was assessed by Annexin-v/PI and TUNEL staining.Results After Ad5/F35-XAF1 tranfection,XAF1 mRNA and protein expression significantly increased,and the difference was statistically significant when compared with control group and Ad5/F35-Null group(P＜0.05).The apoptosis rate was(19.90±3.09)%and(9.29±2.13)%,which was significantly different(P＜0.01)from those in the Ad5/F35-Null group[(6.72±0.7)6%,(2.73±0.51)%]or in the control group[(7.22±1.53)%,(1.56±0.47)%].The expression of Caspase-3,PARP and Caspase-8 significantly increased,but the expression of bcl-2 decreased.Conclusions XAF1 plays a major role in the apoptosis of pancreatic cancer that acts thriugh the activation of death receptor pathway and mitochondrial pathway of apoptosis.%目的 探讨Ad5/F35腺病毒介导的XAF1基因诱导胰腺癌细胞BxPC3凋亡及其可能的作用机制.方法 将前期构建的重组腺病毒Ad5/F35-XAF1感染胰腺癌细胞BxPc3.采用半定量RTPCR、蛋白质印迹检测法检测感染前后BxPC3细胞XAF1 mRNA和蛋白表达的变化;运用Annexin-V/PI和TUNEL法检测细胞的凋亡率;免疫蛋白印迹法检测细胞Caspase-3、PARP、Caspase-8和Bcl-2蛋白的表达.结果 Ad5/F35-XAF1感染后,BxPC3细胞的XAF1 mRNA和蛋白表达明显增高,与空白组和Ad5/F35-Null对照组比较,差异显著(P＜0.05);两种方法 检测的细胞凋亡率分别为(19.90±3.09)%、(9.29±2.13)%,较Ad5/F35-Null组的(6.72±0.76)%、(2.73±0.51)%和空白组的(7.22±1.53)%、(1.56±0.47)%均有显著差异(P＜0.01);Caspase-3、PARP、Caspase-8蛋白表达显著增强,Bcl-2表达降低.结论 Ad5F35-XAF1重组腺病毒感染胰腺癌细胞BxPC-3能明显诱导细胞的凋亡,其机制可能是激活死亡受体途径和线粒体途径.
  • 12.消息
  • 摘要：目的 建立无血清悬浮培养分离人胰腺癌细胞系PANC1干细胞球的方法.方法 采用无血清悬浮法培养PANC1细胞,显微镜下观察干细胞球形成率;流式细胞仪检测细胞CD133表达和细胞周期;以含10%FBS培养基诱导干细胞球细胞分化,荧光显微镜下观察细胞形态及CK18的表达;干细胞球细胞接种NOD/SCID小鼠皮下,观察其成瘤能力.结果 在无血清悬浮培养条件下存活的PANC1细胞形成干细胞球,体外连续传代培养20代始终保持4%0～5%0的干细胞球形成率.干细胞球细胞CD133表达率(5.91±0.7)%,G0/G1期细胞占(80.99±2.60)%,与原代PANC1细胞的(1.44±0.52)%和(69.01±5.03)%相差显著(P＜0.05).将于细胞球细胞置含血清培养基中培养.细胞逐渐恢复原代细胞形态,并表达上皮标志蛋白CK18,2×103的干细胞即在NOD/SCID小鼠皮下成瘤.结论 无血清悬浮法培养PANC1细胞可分离出肿瘤干细胞,其具有自我更新、多向分化和成瘤能力.%Objective To establish the method of suspension culture for stem cells from human pancreatic cancer cell line PANC1.Methods PANC1 cells were cultured in serum-free medium under floating-culture system.Tumor cell spheres were observed by optical microscope.Expression of CD133 and cell cycle were detected by flow cytometry.Cancer stem cells were induced to differentiate with 10%FBS,and expression of CK18,was evaluated with immunofluorescence microscope.Spheres cells were injected into the subcutaneous space of NOD/SCID rat and tumor formation was monitored weekly.Results PANC1 cells could form the stem cells spheres,and the rate of sphere formation was stable between 4%0 and 5%0 after 20 passages in vitro.The expression of CD133(5.91±0.7%)and proportion of G0/G1 phase cell(80.99±2.60%)was significantly increased in spheres cells compared with parental PANC1 cells(1.44±0.52%and 69.01±5.03%),and the difference was statistically significant(P＜0.05).When these spheres cells were cultured in media with serum,these cells gradually returned to the status of parental cells and expressed CK18,2×103 sphere cells injection could initiate tumor fornmtion in NOD/SCID rat.Conclusions Tumor spheres stem cellscould be generated under serum-free floating-culture system.The sphere cells possessed the capacities of self renew,difierentiation,and tumorigenic potential.
  • 摘要：@@ 异位胰腺为少见的先天性发育异常,临床表现常缺乏特异性,诊断困难.近年来,由于内镜及内镜超声技术发展,其检出率有增加趋势.本文回顾21例经病理证实的异位胰腺患者资料,分析其临床特征、内镜表现及其与病理结果的关系,旨在提高临床医师对该病的认识.
  • 摘要：@@ 患者男,16岁,因"腹痛、腹胀8月,再发半月"入院.8月前患者无明显诱因出现中上腹持续性胀痛,恶心呕吐胃内容物,当地医院查尿淀粉酶780 U/L,血淀粉酶、血常规正常,腹部彩超未见异常,诊断急性胰腺炎(AP),予抗炎、抑酶、抑酸等处理腹痛好转,仍腹胀.半月来上述症状再发,伴有腹泻,解墨绿色水样便4～6次/d,无黏液脓血,MRI示少量胸腹水,血常规、血淀粉酶正常,尿淀粉酶1300 U/L,按AP治疗后无效转入我院.
  • 摘要：Objective To investigate stem cell factor(SCF)expression in activated pancreatic stellate cell(PSC)and the effect of SCF on adhesion between PSC and mast cell(MC).Methods PSC of SD rat was separated and activated by pancreatic tissue culture;the expression of SCF mRNA and protein was detected bv RT-PCR and immunachemistry.SCF was blocked with different dose of anti-SCF antibody,the rate of adhesion between PSC and MC was determined by thiomn blue stain and β-hexasaminidase assay.PSC was stimulated by 10 μg/ml mitomycin-C and was co-cultured with MC,then the growth of MC was observed at 2,3,5 day,respectively.Results Activated PSC expressed SCF mRNA and protein,the number of adhered MC in the control,1mg/ml and 10 mg/ml antibody groups was 48±10,28±8,and 23±9,respectively;the difference between antibody and control group was statistically significant(P＜0.05).One day after PSC and MC was co-cultured without serum.there were MC adhesion;3 days later the rate of adhesion increased;5 days later the adhesion appeared bulk-like and lots of colonies were present,while PSC basically disappeared.Conclusions Activated PSC may synthesize,express SCF and induced adhesion and growth of MC.%目的 观察干细胞因子(SCF)在活化胰腺星状细胞(PSC)中的表达以及在PSC与肥大细胞黏附中的作用.方法 采用SD大鼠胰腺组织块培养分离活化PSC,应用RT-PCR免疫细胞化学染色法检测PSC的SCF mRNA和蛋白的表达;经不同剂量的抗SCF抗体中和PSC表面SCF,采用β-氨基已糖苷酶测定观察肥大细胞与PSC之间的黏附;PSC经10μg/ml丝裂霉素C处理后为饲养层细胞,与肥大细胞共培养,硫堇兰染色观察培养后2、3、5 d的肥大细胞生长情况.结果 活化的PSC表达SCFmRNA和蛋白.对照组、1mg/ml和10 mg/ml抗体处理组黏附的肥大细胞量分别为每视野(48±10)个、(28±8)个和(23±9)个,抗体组较对照组明显减少(P＜0.05).1 mg/ml和10 mg/ml抗体组的肥大细胞黏附率分别为(53±3)%和(45±5)%.PSC和肥大细胞在无血清条件下共培养1 d后,PSC有肥大细胞黏附;共培养3 d后黏附的数量增加;5 d后呈堆积状,有较多集落形成,PSC基本消失.结论 活化的PSC可合成分泌SCF,引起肥大细胞的黏附和生长.
  • 摘要：Objective To investigate the expression of Bcl-2,survivin and pancreatic cancer stem cells markers Oct-4 and ABCG2 in pancreatic cancer cells resistance to chemoradiotherapy.and explore its mechanism.Methods Concurrent ehemoradiotherapy was used to obtain pancreatic cancer cells resistant to chemoradiotherapy,the pancreatic cancer cells without chemoradiotherapy treatment were used as control.Western-blot was applied to detect the expression of Bcl-2,survivin,Oct-4,ABCG2.Results The expression of Bcl-2 was 0.7955±0.0326,0.5718±0.0212,0.6137±0.0382 and 0.8733±0.0461,respectively;the expression of survivin protein was 0.8207±0.0490,0.6973±0.0211,0.7967±0.0346 and 0.8013±0.0398,respectively;the expression of Oct-4 protein was 0.8728±0.0177,0.7861±0.0139,0.4794±0.0932 and 0.4216±0.1043,respectively;the expression of ABCG2 protein was 0.7810±0.1370,0.4957±0.1126,0.6102±0.1358 and 0.4670±0.1274,respectively.in resistant pancreatic cancer cells of SW1990,BxPC3,pc3,jf305 cell line.The corresponding values in the control group were 0.4723±0.018,0.2954±0.0103.0.3587±0.0201 and 0.2718±0.0136;0.4717±0.0274,0.3587±0.0113,0.3891±0.0147 and 0.3326±0.0124;0.6053±0.0142,0.4236±0.0086.0.2385±0.0671 and 0.1985±0.0582;0.3156±0.0582.0.2360±0.0423,0.2813±0.0512 and 0.1808±0.a0370.The expression of all the four proteins significantly increased after ehemoradiotherapy(P＜0.05).Conclusions Pancreatic cancer cells resistant to chemoradiotherapy may contain cancer stem cells.%目的 观察放化疗抵抗的胰腺癌细胞的Bcl-2、survivin及干细胞标志物Oct-4、ABCG2蛋白表达的变化,探讨这部分肿瘤细胞耐受放化疗的原因.方法 采用同步放化疗干预人胰腺癌细胞系SW1990、BxPC3、pc3、jr305,获得放化疗抵抗的胰腺癌细胞,以不行放化疗处理的细胞作为对照.采用Western blotting检测它们的Bcl-2、survivin、Oct-4和ABCG2蛋白的表达变化.结果 放化疗抵抗的SW1990、BxPC3、pc3、jt305胰腺癌细胞Bcl-2蛋白表达量分别为0.7955±0.0326、0.5718±0.0212、0.6137±0.0382和0.8733±0.0461;survivin蛋白表达量分别为0.8207±0.0490、0.6973±0.021 1、0.7967±0.0346和0.8013±0.0398;Oct-4蛋白表达量分别为0.8728±0.0177、0.7861±0.0139、0.4794±0.0932和0.4216±0.1043;ABCG2蛋白表达量分别为0.7810±0.1370、0.4957±0.1126、0.6102±0.1358和0.4670±0.1274.对照组相应细胞系的4种蛋白表达量分别为0.4723±0.018、0.2954±0.0103、0.3587±0.0201和0.2718±0.0136;0.4717±0.0274、0.3587±0.0113、0.3891±0.0147和0.3326±0.0124;0.6053±0.0142、0.4236±0.0086、0.2385±0.0671和0.1985±0.0582;0.3156±0.0582、0.2360±0.0423、0.2813±0.0512和0.1808±0.0370.放化疗后胰腺癌细胞的4种蛋白表达量均显著增加(P＜0.05).结论 放化疗抵抗的胰腺癌细胞中可能富含肿瘤干细胞.
  • 摘要：Objective To establish a stable orthotopic transplantation nude mouse model of the human pancreatic cancer and to explore the role of monitoring tumor growth with noninvesive MRI.Methods The tumors cells suspension made by the subcutaneous injection of human pancreatic cancer cell lines PANC1 were used as the source of tissue for orthotopic implantation of tissue.and transplanted into the pancreas of 20 BALB/C-nu nude mice.After implantation,the successful rate,tumor formation time,tumor growth speed,tumor shape and the change of signal of the tumor were monitored and recorded noninvasively by MRI.At the end of the 7th week,all the specimens were examined by pathological methods.Results Thirty-five percent (7/20)mice with implantation of primary human PANC1 adenocarcinoma cells were detected to have orthotopic implanted tumors by MRI after 15 days,and all the 20 nude mice developed pancreatic tumor within 27 days after operations,and the successful rate was 100%.Compared with adjacent normal tissue,the T1 WI imaging of 90%(18/20)of all the tumors showed uniformly hypo-intense signal,10%(2/20)showed iso-intense signal,the T2W 75%(15/20)showed uniformly hyper-intense signal.The tumor size 2,3,4,5,6,7 weeks after implantation was(912.6±2.4)mm3,(94.3±11.2)mm3,(175.9±82.5)mm3,(395.8±126.6)mm3,(1290.2±167.2)mm3,(1583.4±87.4)mm3,respectively.Pathologic examination confirmed poody differentiated pancreatic adenocatcinoma and it remained the primary tumor's biolosic features.Conclusions The orthotopic transplantation nude mouse model was in accordance with the feature of human pancreatic cancer and was easy for noninvasive monitoring,which provided an effective and stable in vivo experimental system.%目的 建立一种稳定的人胰腺癌裸小鼠原位移植瘤模型,并探讨无创的磁共振(MRI)对其监测的应用价值.方法 人胰腺癌细胞株PANC1体外常规传代后建立裸鼠皮下种植瘤模型,将皮下种植瘤制成细胞悬液,植入20只BALB/C-nn裸鼠的胰腺包膜下构建人胰腺癌原位移植模型;通过MRI检查监测模型的成瘤率、成瘤时间、肿瘤生长速度、肿瘤形态、信号变化等特征,于第7周末取肿瘤组织行病理学检查.结果 接种后15 d,7只(35%)荷瘤鼠在MRI上显示成瘤,至接种后27 d,成瘤率为100%.肿瘤信号与邻近组织相比,90%(18/20)病灶T1WI呈均匀稍低信号,10%(2/20)呈等信号;75%(15/20)在T2WI呈均匀高信号.移植后2、3、4、5、6、7周经MRI测量的移植瘤体积分别为(12.6±2.4)mm3、(94.3±11.2)mm3、(175.9±82.5)mm3、(395.8±126.6)mm3、(1290.2±167.2)mm3、(1583.4±87.4)mm3.病理学检查确诊为胰腺低分化腺癌,并保持原发瘤的生物学特征.结论 人胰腺癌细胞株PANC1移植瘤制成的细胞悬液种植裸小鼠胰腺包膜下制备胰腺癌模型符合人胰腺癌的特征,且易于无创监测,为临床研究提供了一个有效、稳定的体内实验体系.
  • 摘要：@@ 糖尿病(diabetes mellitus,DM)是一种严重威胁人类健康和生命的高发性的代谢性疾病.临床分为1型(T1DM)、2型(T2DM)、特殊型、妊娠糖尿病4种类型.目前常用的糖尿病治疗方法包括胰岛素注射、胰岛素泵、全胰腺移植和胰岛移植.虽然注射外源性胰岛素可以有效控制血糖,但无法改善血糖的生理性代谢和根本解决DM并发症的问题.而全胰腺移植和胰岛移植均可使受者获得接近生理状态的胰岛素分泌.
  • 摘要：Objective To investigate the effect and safety of duct-to-mucosa anastomosis technique for pancreaticoduodenectomy(PD).Methods The clinical data,including pancreatic fistula and other complications,of 189 patients underwent PD with end-to-side pancreaticojejunostomy at our institution from Jan 2001 to Jan 2009 were analyzed retrospectively.The definition of pancreatic fistula was threefold increase over the serum amylase level 7 days after operation,and draining volume was more than 50 ml per day.Results Totally 177 Whipple procedures were performed,while 12 pylorus-preserving pancreateduodenectomy procedures were performed.Five patients developed pancreatic fistula with a incidence of 2.65%(5/189).In which 3 were mild Cases,who fully recovered after conservative management,and the other 2 cages were cured by surgical intervention.Other complications included 9 cases of wound infection(4.76%,9/189),11 cases of empty dysfunction(5.82%,11/189),5 Cases of delayed hemorrhage(2.65%,5/189),and 4 cases of intra-abdominal infection(2.12%,4/189),and 2 patients died due to severe intra-abdominal infection and acute pulmonary infarction.Conclusions Duet-to-mucesa anastomosis technique resembles physiological state with low incidence of pancreatic fistula and delayed anastomosis hemorrhage.It may be used for different kinds of anastomosis for pancreatic stump.%目的 探讨胰十二指肠切除术中应用胰管一黏膜端侧吻合法的效果及安全性.方法 回顾性分析2001年1月至2009年1月应用胰管-黏膜端侧吻合法的189例胰十二指肠切除术患者的胰瘘及其他并发症发生率.胰漏的诊断标准为:手术后7 d腹腔引流液淀粉酶测定值大于血中淀粉酶水平3倍以上,每日引流量＞50 ml.结果 行常规胰十二指肠切除术(Whipple)177例,保留幽门胰十二指肠切除术(PPPD)12例.本组5例发生胰瘘,发生率为2.65%(5/189).其中3例为轻度胰瘘,经保守治疗痊愈,另2例经再次手术痊愈.其他并发症包括切口感染9例(4.76%,9/189)、胃排空障碍11例(5.82%,11/189)、腹腔或胃肠吻合口出血5例(2.65%,5/189)和腹腔感染4例(2.12%,4/189).2例分别死于术后腹腔严重感染和急性肺梗死.结论 胰管-黏膜端侧胰肠吻合法较接近生理状态,胰瘘及残端出血的发生率较低,适合各种胰腺残端的吻合术.
  • 摘要：Objective To assess the cost-utility and medical economics of surgjcal treatment for SAP.Methods A retrospective study of SAP patients admitted from January to December 2003 to Ruijin Hospital was carried out.The cost of treatment was obtained from financial department and patients questionnaire;health-related quality of life was assessed by using the SF-36 brief questionnaire and the results were compared with normal population and were converted into rQALY,then utility scores were obtained so as to conduct CUA (cost-utility analysis)and related factors were analyzed.Results 98 patients with SAP were discharged,85 were discharged healthy;of them,59 patients had complete records were followed up,2 died during follow up,with a mortality of 3.4%,one patients could not finish the questionnaire and 6 did not respond,finally 50 finished the questionnaire;the total cost in hospital was 9899095 yuan,per capita 101011 yuan;the corrected post-discharge cost was 681737 yuan;the total cost was 10580832 yuan.The cost of medication was the highest,which accounted for 56%of all the cost.The means and deviations for each of eight scales(PF,RP,RE,BP,VT,MH,SF,GH)scores of SF-36 in SAP patients were 83.00±14.64,61.5.0±42.32,68.67±36.52,79.98±14.90,68.80±18.94,72.40±14.75,75.00±17.53,64.70±18.28.compared with normal population,gained 1929.05 QALYs;the cost-utility analysis was 5485 yuan per QALY.The patient's age,length of stay,chronic co-morbidity was associated with the cost of treatment.Conclusions SAP treatment in surgery department was justified in medical economics.Medication contributed to the most part of total costs.The related factors of cost included age,length of stay and chronic co-morbidity.%目的 对重症急性胰腺(SAP)外科治疗进行成本.效用分析及卫生经济学评价.方法 收集2003年1月至2003年12月瑞金医院住院的SAP患者,通过患者帐单及调查问卷获得相关治疗成本;应用SF-36量表评价其健康相关生命质量,与普通人群比较,转换成rQALY,计算QALYs,从而获得其效用;进行成本-效用分析,计算成本-效用比,同时分析相关影响因素.结果 98例患者,院内病死13例,出院85例.病历资料完整的59例获得随访,随访获知病死2例,院外病死率3.4%,不能完成问卷1例,无应答6例.收回有效SF-36问卷50份.98例患者住院总费用为989.91万元,人均10.10万元;校正后的后续治疗总费用为68.17万元.总成本为1058.08万元,其中西药费成本最高,占56%.SF-36的8个维度PF、RP、RE、BP、VT、MH、SF和GH的得分分别为83.00±14.64、61.50±42.32、68.67±36.52、79.98±14.90、68.80±18.94、72.40±14.75、75.00±17.53、64.70±18.28;与普通人群同年龄同性别比较,共获得1929.05个QALY,成本效用分析(CUA)=5485元/QALY.年龄、住院时间、有无慢性并发症与治疗成本相关.结论 SAP外科治疗从卫生经济学角度行成本.效用分析是值得的;药品费用构成成本的主要方面;影响其成本的主要因素有年龄、住院时间、有无慢性并发症.
  • 摘要：Objective To investigate the expressions of CXCR4,MMP-2 and VEGF in pancreatic carcinoma and the relationship with biological behavior of pancreatic carcinoma.Methods Immunohistochemical PV6000 technique was used to detect the expression of CXCR4,MMP-2 and VEGF in 47 cases of pancreatic carcinoma tissues,and the relationship between the expressions and pathologic parameters,and the relationship among the expressions of the 3 proteins were analysed.Results The expression rates of CXCR-4,MMP-2 and VEGF were 72.3%,66.O%and 61.7%in pancreatic carcinoma tissues,and all these proteins were correlated with metastasis,clinical staging and prognosis(X2=5.84～12.69;P＜0.05).The expression of CXCR-4,MMP-2 and VEGF was not correlated with sex,age,tumor size and differentiation(X2=0.03～4.27;P＞0.05).There was a positive relationship between the expression of CXCR-4 and MMP-2 or VEGF in pancreatic carcinoma(r=0.587,0.521;P＜0.01).Conclusions CXCR-4 could up-regulate the expression of MMP-2 and VEGF in pancreatic carcinoma,and they may contribute to metastasis and invasion of pancreatic carcinoma.%目的 探讨CXCR-4、MMP-2、VEGF在胰腺癌中的表达及其与胰腺癌生物学行为的关系.方法 采用免疫组化PV6000法检测47例胰腺癌组织中CXCR-4、MMP-2及VEGF的表达,分析它们与肿瘤病理参数的关系以及3种蛋白表达之间的关系.结果 47例胰腺癌组织中CXCR-4、MMP-2及VEGF的阳性表达率分别为72.3%、66.0%和61.7%,三者均与胰腺癌的转移、临床分期和预后有关(x2=5.84～12.69,P＜0.05),而与患者性别、年龄、肿瘤大小和组织学分化无关(X2=0.03～4.27,P＞0.05).胰腺癌组织中CXCR-4的表达与MMP-2和VEGF的表达均呈正相关(r=0.587、0.521,P＜0.01).结论 CXCR-4通过上调MMP-2及VEGF的表达,共同参与胰腺癌的浸润和转移.
  • 摘要：目的 前瞻性评估US、MSCT、EUS和MRI 4种影像学方法 在胰腺癌胰胆管梗阻程度定量评估中的价值.方法 应用US、MSCT、EUS和MRI 4种方法 对连续收治的68例胰腺癌患者分别于术前测量其肝外胆管、胰管直径,评估其梗阻扩张程度,并与手术标本测量结果 进行相关性分析.结果 US、MSCT、MRI、EUS测量的肝外胆管直径分别为(16.60±6.33)mm、(18.90±6.74)mm、(18.80±5.88)mm和(17.26±4.83)mm,手术标本测量的直径为(18.39±6.05)mm.4种检查方法 测量值与手术标本测量值的相关性分别为r=0.3839,P=0.1055;r=0.71 13,P=0.0011;r=0.3759,P=0.0465; r=0.3376,P=0.2872.Kappa值分别为0.6285、0.7115、0.6661和0.7490.测量的胰管直径分别为(15.90±3.41)mm、(6.83±3.70)mm、(6.77±3.22)mm和(5.58±2.65)mm,手术标本测量的直径为(5.97±2.60)mm.4种检查方法 测量值与手术标本测量值的相关性分别为r=0.3584,P=0.2895;r=0.6148,P＜0.0001;r=0.7373,P＜0.0001; r=1.0746,P＜0.0001.Kappa值分别为4.159、9.094、9.001和4.050,均具较好一致性.结论 对肝外胆管、胰管梗阻的评估可首选US作为初筛,选择MRI或MSCT进行量化评估,必要时结合EUS,可较准确预测胆管、胰管梗阻程度.%Objective To prospectively evaluate the value of US,MSCT,EUS and MRI in the quantitative evaluation of the extent of pancreaticobiliary duct obstruction in pancreatic cancer.Methods Consecutive 68 patients with pancreatic carcinoma underwent US,MSCT,EUS and MRI before surgery.The diameter of extrahepatic bile duct and pancreatic duet were measured,and correlation analysis was performed with surgical specimens.Results Diameters of extrahepatic bile duct scaled by US.MSCT,EUS and MRI were(16.60±6.33)mm,(18.90±6.74)mm,(18.80±5.88)nun and(17.26±4.83)mm,and diameter measured from surgical specimens was(18.39±6.05)mm;the correlation among the four imaging examinations and the surgical evaluation were r=0.3839,P=0.1055;r=0.7113,P=0.0011; r=0.3759,P=0.0465;r=0.3376,P=0.2872,respectively. Kappa Values were 0.6285,0.7115,0.6661 and 0.7490,respectively.The diameter of pancreatic duct was(15.90±3.41)mm,(6.83 4-3.70)mm,(6.77±3.22)mm and(5.58±2.65)mm,and diameter measured from surgical specimens was(5.97±2.60)mm,the correlation among the four imaging examinations and the surgical evaluation were r=0.3584,P=0.2895;r=0.6148,P＜0.0001; r=0.7373,P＜0.0001;r=1.0746,P＜0.0001.Kappa values were 4.159,9.094,9.001 and 4.050.All of these parameters were in coherence with surgical findings.Condusions US could be used as the initial method in the assessment of extrahepatic and pancreatic duct obstruction.MRI and MSCT,combined with EUS if necessary,could be used to quantitatively evaluate the extent of pancreaticobiliary obstruction.
  • 摘要：目的 探讨胰腺癌疼痛的发病率及其临床特征.方法 回顾性分析广州医学院附属广州市第一人民医院和中山大学附属第二医院1999年至2007年收治的415例胰腺癌病例资料,探讨癌痛发生率、临床特征及其与肿瘤部位、临床分期的关系.结果 胰腺癌疼痛发生率为65.1%(270/415),60.5%(251/415)的患者以疼痛为首发症状,Ⅰ级疼痛占42.2%(114/270),Ⅱ级疼痛44.1%(119/270),Ⅲ级疼痛13.7%(37/270).以上腹部疼痛多见,多表现为持续性或阵发性隐痛、胀痛.胰体尾癌患者的疼痛发生率为80.7%,全胰癌患者为71.4%,胰头癌患者为58.2%,胰体尾癌与胰头癌患者的疼痛发生率相差显著(P＜0.05));Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期胰腺癌患者的疼痛发生率分别为28.6%、58.1%、66.2%和78.6%,相差非常显著(P＜0.01);中、重度疼痛在Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者中所占比例分别为18.8%、44.4%、53.1%和68.2%,相差也非常显著(P＜0.01).结论 进展期胰腺癌的癌痛非常常见,发生率及严重程度随肿瘤进展而加重.%Objective To investigate the prevalence and the clinical features of pancreatic cancer pain in a Chinese patient population.Methods The study was carried out in 415 cages of pancreatic cancer which were admitted to the First Municipal people's Hospital of Guangzhou Medical college and the Second Affiliated Hospital of Sun Yat-sen University from 1999 to 2007.The prevalence,clinical features of pancreatic cancer pain and its correlations with the cancer site and the clinical staging were analyzed.Results Of the 415 patients.the prevalence of pain wag 65.1%and 60.5%of all the patients presented pain as the initial symptom;the incidence of pain in pancreatic body/tail cancer patients was 80.7%.while it was 71.4%in total pancreatic cancer patients.and the incidence was 58.2%in pancreatic head cancer patients;the incidence between pancreatic body/tail cancer and pancreatic head cancer patients was statistically different (P＜0.05).The incidence of pain in patients with stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ was 28.6%,58.1%,66.2%and 78.6%.and the difference was statistically significant(P＜0.01).The incidence of moderate to severe degree of pain in patients with stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ was 18.8%,44.4%,53.1%and 68.2%,and the differenee was statistically significant(P＜0.01).Conclusions Pain was very common in patients with advanced pancreatic cancer.The incidence and severity of pain increased with the progression of pancreatic cancer.
  • 摘要：@@ Oddi括约肌具有控制胆汁和胰液排放及阻止肠液反流的重要功能,其协调性的收缩和舒张受神经、体液的调控.Oddi括约肌的功能发生紊乱会影响胆汁及胰液的排放甚至出现反流而引起胆胰疾病.近年来,有关Oddi括约肌功能紊乱(sphincter of Oddi dysfunction,SOD)与胆胰疾病相关性的研究日趋增多.本文就SOD与胰腺疾病的发生做一综述.
  • 摘要：@@ 重症急性胰腺炎(SAP)的早期可发生多器官功能障碍[1-2],后期发生感染性并发症[3-4],两者导致高病死率.作为基层医院,入院时对SAP早期进行病死预测,从而决定是否转院和加强治疗非常重要.但传统的评分方法组成复杂.所以寻求评估早期病死的因素非常重要.
  • 摘要：目的 探讨应用脂蛋白脂酶基因(LPL)缺陷的杂合子小鼠作为制备高脂血症相关性急性胰腺炎的动物模型的可行性.方法 野生型及LPL杂合子小鼠均分为实验组和对照组,每组又分为12、24 h 2个时点.实验组腹腔注射雨蛙肽(50 μg/kg体重)7次,每次间隔1 h.对照组同法注射等量生理盐水.检测各组小鼠血浆三酰甘油(TG)、淀粉酶水平,观察胰腺形态学改变并评分.结果 LPL杂合子小鼠对照组血TG为(3.55±0.27)mmol/L,显著高于野生型小鼠对照组的(0.94±0.18)mmol/L(P＜0.05).杂合子小鼠实验组12 h的血TG、淀粉酶水平分别为(3.55±0.27)mmol/L和(3685±484)U/L,均显著高于野生型小鼠实验组12 h的(0.92±0.11)mmol/L和(2501±410)U/L(P＜0.05).杂合子小鼠实验组12 h的胰腺水肿、坏死、出血和炎细胞浸润的分值分别为3.94±0.21、3.94±0.21、1.84±0.25和1.84±0.25,均显著高于野生型小鼠实验组12 h的3.06±0.01、2.52±0.51、0.46±0.22和0.58±0.38(P＜0.05).结论 LPL杂合子小鼠血TG中度升高且稳定,在雨蛙肽诱导下产生严重的急性胰腺炎,是研究高脂血症相关性急性胰腺炎发病机制的一种理想的动物模型.%Objective To establish an experimental animal model of hypertriglyceridemic(HTG)panereatitis by using special lipoprotein lipase(LPL)deficient HTG heterozygous mice.Methods LPL deficient HTG heterozygous mice and wild type mice were divided into experiment group and control group,then each group was subdivided into 12 h,24 h subgroup.Acute pancreatitis(AP)was induced by caerulein intra-abdominal injection for 7 times(50μg/kg)at the interval of 1 h;the mice in the control group received same amount of normal ssline.The serum level of TG,amylase was determined,and morphologic changes were scored.Results The serum level of TG in LPL deficient HTG heterozygous mice was(3.55±0.27)mmol/L,which was significantly higher than that of wild type mice[(0.94±0.18)mmol/L,P＜0.05].The serum level of TG and amylase in heterozygous mice at 12 h was(3.55±0.27)mmol/L and(3685±484)U/L,which was significantly higher than those in wild type mice[(0.92±0.11)mmol/L and(2501±410)U/L,P＜0.05].The pancreatic tissue edema,necrosis,bleeding and inflammatory cell infiltration score was 3.94 ±0.21,3.94±0.21,1.84±0.25 and 1.84±0.25 in heterozygous mice,which was significantly higher than that of wild type mice(3.06±0.01,2.52±0.51,0.46±0.22 and 0.58±0.38,P＜0.05).Conclusions The serum level of TG was moderately and stably elevated in heterozygous mice.The mice developed more severe panereatitis after caemlein induction.which was an ideal experimental model for study of mechanism of HTG pancreatitis.
  • 摘要：@@ 腹腔镜下置管腹腔灌洗引流术(laparoscopic peritoneallavage and drainge,LPLD)以微创手段达到胰腺清创灌洗引流的治疗目的,开创了重症急性胰腺炎(SAP)治疗的新途径[1],并已取得了阶段性的疗效.但腹腔镜手术时腹腔内高压的CO2对病变胰腺局部及全身微循环的影响,目前尚缺乏系统的研究资料.本实验观察CO2对急性坏死性胰腺炎(ANP)大鼠胰腺局部及全身微循环状况的相关炎性因子内皮素(ET)、一氧化氮(NO)、血栓素A2(TXA2)、前列腺素I2(PGI2)的影响,为临床工作提供参考.
  • 摘要：Objective To investigate the etiology and clinical characteristics of acute pancreatitis complicated with hyperlipidemia.Methods 497 patients admitted from Jan.2002 to Dec.2007 were screened,60 patients who fulfiHed the inclusion criteria were enrolled,and these patients were divided into two groups according to the level of serum triglyeeride and disease severity respectively.Patients whose serum level of triglyeeride>11.3 mmoVL were defined as severe hyperlipidemia group.while those patients whose serum level of triglyceride between 5.65～11.3 mmol/L with milky serliiH were defined as mild hyperlipidemia group.Patients were classified into mild acute pancreatitis(MAP) and Severe acute pancreatitis(SAP) groups according to the disease severity.The etiology and clinical characteristics in all patients were investigated. Results There were 13 patients in severe hyperlipidemia group,47 patients in mild hyperlipidemia group.5 patients(38.5%)in Severe hyperlipidemia group had history of acute pancreatitis,which wag significantly higher than that of mild hyperlipidemia group(10.6%,P<0.05).The etiology was mainly biliary diseases in the mild hyperlipidemia group,and mainly hyperlipidemia in the severe hyperlipidemia group.The levels of total cholesterol and triglyceride was(8.17±2.76)mmol/L and(13.47±4.12)mmol/L,which were significantly higher than(4.97±1.67)mmol/L and(4.09±2.18)mmol/L of mild hyperlipidemia group(P< 0.01).The Serum amylase,gluc08e,TG,Tc and duration of relief of abdominal pain were(1396±2233) U/L.(14.17±8.37)mmol/L,(7.69±6.56)mol/L,(5.39±3.58)mmol/L and(6.30±3.27)d, respectively,in SAP group;and the corresponding values were(831±1348)U/L,(8.28±3.89)mmol/L, (5.55±3.92)moVL,(5.64±1.79)mol/L and(4.29±2.62)d in MAP group;only the values ofglucose and duration of relief of abdominal pain were statistically different(P<0.05).Conclusions The recurrence rate of acute panereatitis was hisher in patients with severe hyperlipdemia;the severity of hyperlipdemia Was closely associated with the development of acute pancreatitis,but not the severity of acute pancreatitis.%目的 探讨急性胰腺炎(AP)合并高脂血症患者的病因及临床特点.方法 收集2002年1月至2007年12月收治的AP患者497例,纳入符合标准的60例.以三酰甘油(TG)>11.3 mmol/L或者TG在5.65～11.3 mmol/L之间,但血清呈乳状者为标准分为重度高脂血症组和轻度高脂血症组,另按病情严重程度分为轻症急性胰腺炎组(MAP)和重症急性胰腺炎组(SAP),分别观察其病因及临床特点.结果 重度高脂血症组13例,轻度高脂血症组47例.重度组5例(38.5%)有AP发作史,显著高于轻度组的10.6%(P<0.05);重度组病因以高脂血症为主,轻度组以胆源性为主.重度组血清总胆固醇(TC)为(8.17±2.76)mmol/L,TG为(13.47±4.12)mmol/L,显著高于轻度组的(4.97±1.67)mmol/L和(4.09±2.18)mmol/L(P<0.01).另一方面,SAP组血淀粉酶、血糖、TG、TC及腹痛缓解时间分别为(1396±2233)U/L、(14.17±8.37)mmol/L、(7.69 ±6.56)mmol/L、(5.39±3.58)mmol/L和(6.30±3.27)d,MAP组分别为(831±1348)U/L、(8.28±3.89)mmol/L、(5.55±3.92)mmol/L、(5.64±1.79)mmol/L和(4.29±2.62)d,两组比较,仅血糖水平和腹痛缓解时间具有显著差异(P<0.05).结论 重度高脂血症者AP的复发率高,高血脂程度与AP的发生关系密切,但与病情严重程度无关.

    中华胰腺病杂志的期刊信息

    • 曾用名：胰腺病学;中华胰腺病学杂志
    • 创刊时间：2001
    • 地区：CN
    • 语言：中文
    • 热门主题：中华医学会
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