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.
ObjectiveTo investigate predictive value of a new blood biochemical scoring system (CPWAG scoring system) on severity and mortality of acute pancreatitis (AP).MethodsThe AP patients who met the inclusion and exclusion criteria in our hospital from January 2017 to June 2019 were collected, then were divided into severe acute pancreatitis (SAP) group and non-SAP group according to the latest Atlanta classification. The differences of clinical characteristics and related blood biochemical indicators between the SAP group and the non-SAP group were compared. Univariate logistic regression analysis was used to screen blood biochemical risk indicators related to SAP. The receiver operating characteristic (ROC) curve was used to obtain the best cut-off value corresponding to the maximum Youden index of statistical significant risk factors and was assigned as 0 or 1 point according to different situations. At the same time, the pleural effusion of the BISAP score was included and assigned as 0 (yes) or 1 (no) point, then the CPWAG score was obtained by adding the point of the above indexes.The areas under the ROC curve (AUC) of the CPWAG, BISAP, APACHEⅡ, CTSI, and Ranson scoring systems in predicting severity and death of AP patients were also compared.ResultsA total of 451 patients with AP were included in this study, including 85 patients with SAP and 366 patients with non-SAP. Compared with the non-SAP group, the etiology of AP was mainly biliary (P<0.05), with higher levels of white blood cell count (WBC), C reactive protein (CRP), procalcitonin (PCT), and glucose (P<0.05), greater red blood cell distribution width value (P<0.05), longer prothrombin time (PT) and hospital stay (P<0.05), lower albumin (ALB) and blood calcium levels (P<0.05), higher BISAP, APACHEⅡ, CTSI and Ranson points (P<0.05), and higher proportions of patients with pleural effusion, multiple organ dysfunction syndrome, and death (P<0.05) in the SAP group. The highest score of the CPWAG scoring system included CRP, PCT, WBC, ALB, glucose, blood calcium, and pleural effusion was 7. With the increase of CPWAG score, the proportion of SAP and death patients showed an increasing trend (P<0.001). The AUC of the CPWAG scoring system in predicting SAP was 0.866, which was higher than those of Ranson (AUC=0.722, Z=5.317, P<0.001), APACHEⅡ (AUC=0.706, Z=5.019, P<0.001), and CTSI (AUC=0.805, Z=1.962, P=0.005) scoring system, but which had no statistically significant difference as compared with the BISAP scoring system (AUC=0.819, Z=1.816, P=0.070). The AUC of the CPWAG scoring system in predicting death had a high ability (AUC=0.823), which had no significant differences as compared with the Ranson, APACHEⅡ, CTSI, and BISAP scoring systems (P>0.05).ConclusionThe CPWAG score is valuable in predicting the severity and mortality of AP patients, allowing accurate and early assessment of AP patients.
【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.
目的:探討急性胰腺炎的胸腹部X線平片顯示特征及診斷。方法:回顧分析19例急性重癥胰腺炎的胸腹部X線平片資料,總結其影像特征。結果:急性胰腺炎胸腹部X線平片顯示反射性腸郁積15例,十二指腸曲部見弧形壓跡1例, 劍突下胰腺區高密度影1例,麻痹性腸梗阻伴胸腔積液2例。結論:胸腹部X線平片經濟,快捷,在急性胰腺炎早期診斷中有一定價值。
目的 探討聚腺苷二磷酸核糖聚合酶-1（poly ADPribose polymerase-1,PARP-1） mRNA在重癥急性胰腺炎(severe acute pancreatitis，SAP)大鼠腎臟中的表達及意義。方法 48只Wistar大鼠按隨機數字表法分為SAP組和假手術組(SO)組，分別于造模術后1、3、6及12 h測定血清肌酐，觀察胰腺和腎臟組織病理變化，并以RT-PCR法檢測PARP-1 mRNA在腎臟中的表達水平。結果 SAP組大鼠術后血清肌酐逐漸升高，于3、6及12 h明顯高于SO組(Plt;0.05)。SAP組大鼠術后胰腺出現腺體破壞、腺泡壞死、出血、炎性細胞浸潤等病理損害，且呈進行性加重； SO組各時相胰腺組織基本正常。SAP組大鼠術后出現腎小管上皮細胞變性、壞死、腎小球瘀血、缺血等改變，并隨時間延長逐漸加重，其損傷程度在3、6及12 h明顯較SO組嚴重(Plt;0.05)。SO組大鼠腎臟組織僅表達少量PARP-1 mRNA，而SAP組大鼠隨病程延長腎臟組織中PARP-1 mRNA表達逐漸增加，自3 h時起明顯高于SO組（Plt;0.01）。結論 在SAP發病過程中，PARP-1 mRNA的表達在腎臟組織中逐漸增加，PARP-1可能參與了SAP相關腎損傷過程。