目的總結自身免疫性胰腺炎（AIP）的影像學特點。 方法回顧性分析13例經手術病理學檢查或糖皮質激素治療證實的AIP患者的臨床資料。 結果13例均行CT檢查，7例同時行MRI檢查、DWI掃描及磁共振胰膽管造影（MRCP）檢查，2例同時行超聲檢查。8例表現為胰腺彌漫性腫大，4例表現為胰腺局限性腫大，1例表現為胰腺混合型腫大。CT動態增強掃描結果提示，胰腺病變呈“雪花狀”漸進性強化，T1WI信號減低，T2WI信號略高，DWI信號增高；MRCP檢查可見膽總管胰內段呈“鳥嘴樣”狹窄；超聲檢查顯示胰腺病變部位腫大，回聲減低。 結論AIP具有典型的影像學特征，影像學檢查是發現和診斷AIP的重要手段。
In order to choose the appropriate antibiotics for treating secondary pancreatic infection, permeability of antibiotics to pancreatic tissue was investigated on experimental dogs with acute hemorrhagic necrotizing pancreatitis. The concentrations of 8 different antibiotics were determined in the blood and the pancreatic tissue using highperformance liquid chromatography. Pancreatic tissue permeability of Cefotaxime, Ofloxacin, Amikacin, Piperacllin, Cefoperazone, Ampicillin, Metronidazole and Ciprofloxacin was 12%, 19%, 20%, 46%, 55%, 63%, 71% and 132% respectively. The study shows that this eight antibiotics have different permeability to the pancreatic tissue. Such observations support the existence of a bloodpancreas barrier, which acts to restrict the permeation of antibiotics into the pancreas. The results suggest that antibiotics with high permeability rate be used to treat the patient with secondary pancreatic infection.
To evaluate the present status of treatment of chronic pancreatitis, 116 consecutive patients with chronic pancreatitis during the last decade (1986～1996) have been surveyed retrospectively. The clinical date has been analized statisticaly. Etiology: biliogenic 56 cases (48.3%), alcoholic 17 (14.6%), idiopathic 34 (29.3%) and other 9 cases (7.8%). Better result was achieved in surgical treatment group (81 cases) than in conservative group (35 cases), pain free: 65.5% vs 33.3%. The accumulated five-year survival rate was 56.3%, 92.2% and 78.1% in alcoholic, billiogenic and idiopathic type of chronic pancreatitis respectively. Morbidity and mortality of diarrhea and diabetes mellitus increased at followup. The authors conclude that the chronic pancreatitis patients associated with obstruction of biliopancreatic duct should undergo operation early and will ameliorate abdominal pain.
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 study the function of selectin in the pathogenesis and advancement of acute pancreatitis(AP), so as to guide further investigation and clinical treatment. MethodsCorrelative articles in recent years were reviewed. ResultsSelectins act as an indicator of the activation of endothelium. Their expression changes markedly during AP and is closely related to cytokines, oxygen free radicals and complements. Conclusion Selectin is a component which is engaged in the pathology of AP, the level of selectin is useful in guiding clinical observation and treatment.
To investigate changes of serum nitric oxide (NO) levels and therapeutic effects of sodium nitroprusside (SNP) in acute hemorrhagic necrotizing pancreatitis (AHNP) in rats, one hundred and twenty Wistar rats were divided into three groups randomly (forty in each group) animal models of AHNP group were produced by retrograde injection of 5% sodium taurocholate into pancreatobiliary duct.In the treatment group SNP (0.05mg/100g) was injected intraperitoneally after AHNP models established and then repeated three hours later. In the control group only retrograde injection of normal saline (0.5ml) into pancreatobiliary duct was performed. The results showed: compared with the treatment group, serum NO and SOD levels were significantly lower in AHNP group (Ｐ＜0.05); serum amylase levels and pancreatic indexes were markedly higher in AHNP (Ｐ＜0.01 and Ｐ＜0.05 respectively);the mortality in 24 hours was significantly higher and survival time was significantly shorter in AHNP group (Ｐ＜0.01).Pathologic changes of pancreas were significantly severe in AHNP group. From the above results we can draw the conclusion that NO plays an important role in the pathogenesis of AHNP and SNP has therapeutic effects on AHNP in rats.
Objective To discuss the methods of producing experimental models of chronic pancreatitis and their individual properties. Methods The recent literatures about experimental models of chronic pancreatitis were reviewed and analyzed. Methods of producing experimental models and their individual properties were summarized, and best models suitable for varied chronic pancreatitis were afforded. Results Diet, ligation of pancreatic duct, caerulein, dibutyltin dichloride (DBTC), arterial ligation, injecting microspheres into artery, and injection of pancreatic duct could induce different experimental models of chronic pancreatitis. Spontaneous chronic pancreatitis was induced by diet, chronic obstructive pancreatitis produced by ligation and injection of pancreatic duct, chronic relapsing pancreatitis evoked by caerulein, and chronic active pancreatitis made by arterial ligation and injecting microspheres into artery.Conclusion Different methods could induce models of chronic pancreatitis, which had their individual properties.
Objective To investigate protective effect of apocynin, the inhibitor of NADPH oxidase Ⅱ (NOX2), on lung injury induced by acute necrotic pancreatitis (ANP) in rat. Methods Forty SPF adult male Wistar rats were randomly divided into 4 groups: shame operation group (SO group, n=10), ANP model group (ANP group, n=12), apocynin treated group (APO group, n=10), and apocynin control group (APO-CON group, n=8). The ANP models were induced by the retrograde injection of 5% sodium taurocholate through the biliopancreatic duct in the ANP group and the APO group. The apocynin was injected at 30 min before the induction of ANP models in the APO group. The pancreas and duodenum of rats were just flipped and the apocynin and the 10% DMSO (2 mL/kg) were injected in the APO-CON group and SO group respectively. All the rats were sacrificed at 12 h after the operation. The blood samples were collected by the inferior vena cava puncture, and the levels of serum amylase and lipase were measured by the auto-chemistry analyzer. The lung tissues were harvested and the integrated optical densities (IODs) of the nuclear factor-κB (NF-κB), tumor necrosis factor-α (TNF-α), and NOX2 were detected by the immunohistochemistry assay. The IODs of the myeloperoxidase (MPO), Toll like receptor 4 (TLR4), and CD68 were detected by the immunofluorescence assay. The concentration of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) were tested by the ELISA method. Results The levels of the serum amylase and lipase and the IODs of the NF-κB, TNF-α, NOX2, MPO, TLR4, CD68, and concentration of MDA of the lung tissues in the ANP group were significantly increased as compared with the SO group (P<0.05), these indices in the APO group were significantly decreased as compared with the ANP group (P<0.05). The SOD activity of the lung tissue in the ANP group was significantly decreased as compared with the SO group (P<0.05), which in the APO group was significantly increased as compared with the ANP group (P<0.05). Conclusion Apocynin can ameliorate lung injury induced by ANP through inhibiting activity of NOX2.
Seventeen cases of pancreatic encephalopathy (PE) with acute pancreatitis were studied retrospectively. It was found that on the basis of brain damage caused by pancreatic enzyme, many factor might play a role in the development of PE. It suggests that PE should not be accepted as an operative indication separately in severe acute pancreatitis. Chinese medicine can benefit the patient in the treatment of this disease. Operation is the only choice while patient get worsened even after appropriate and enough nonoperative therapy, as well as while pancreatic necrosis become infected or pancreatic abcess formed. Mortality of PE in this series is 52.9%, slightly less than the level (66.7%-100%) reported by other authors.