急性胰腺炎病人免疫功能的变化与细菌移位及大黄干预的关系

目的探讨重型急性胰腺炎（severeacutepancreatitis，SAP）病人免疫功能的变化与细菌移位及大黄干预的关系。方法健康Wistar大鼠30只，随机分成三组。SAP模型组（M组，n=10）：5％牛磺胆酸钠溶液0．1ml·100g^-1胰胆管内以0．2ml／min速度逆行推注，复制模型；大黄治疗组（T组，n=10）：在复制模型后即刻胃管内注入精制大黄粉溶液1m1（5mg·100g^-1）；假手术组（S0组，n=10）：开腹后自胰管内逆行注入生理盐水0．1ml·100g^-1后关腹。24h后用流式细胞仪检测SAP大鼠T淋巴细胞亚群CD4＋、CD8＋阳性细胞百分比并计算CD4＋／CD8＋的值；对血液、胰腺和肠系膜淋巴结进行细菌培养。结果M组血中CD4阳性细胞数以及CD4＋／CD8＋值明显低于S0组及T组（P〈0．01，P〈0．05）。M组细菌培养阳性率较高，T组细菌培养阳性率明显低于M组（P〈0．01）。结论SAP时存在细胞免疫功能紊乱，CIM阳性细胞数以及CD4＋／CD8＋值明显降低。SAP后肠细菌移位与机体的细胞免疫功能紊乱有关。大黄能上调SAP血中CD4阳性细胞数以及CD4＋／CD8＋值，对SAP有一定治疗作用。

The relationship between the changes of immune function and the bacterial translocation and rhubarb intervention in patients with severe acute pancreatitis

Objective ： To investigate the relationship between the changes of immune function and the bacterial translocation and rhubarb intervention in patients with severe acute pancreatitis. Methods ： Thirty Wistar rats were randomly divided into three groups ： Models group of SAP （ M, n = 10） were induced by injecting adversely 5% sodium tauroeholate （0. 2 ml · min^-1, 0.1 ml · 100 g^-1）into the common biliary-pancreatic duct and saline was used in the rats of Sham operation group （SO ,n = 10） instead of sodium taurocholate . Therapeutic group （T, n = 10） were made as same as M group besides Rhubarb （50mg · kg^-1） were injected into their stomach on the instant after operation; Peripheral blood samples were drawn after 24hours of induced SAP, and the percentages of CD4 ＋ and CD8＋ lymphocyte were determined by the flow ey- tometry. Bacterial culture in pancreas ,blood and mesenterie lymph nodes （MLN） were made. Results： The percentages of CD4 ＋and CD4＋/CD8 ＋ratio in M group were significantly lower than those in SO group（ P 〈 0. 01 ）. The volume of ascite in M group was much higher than that in SO group（P 〈0. 01 ） and T group （P 〈0. 01 ）. However the bacterial positive rates of blood,pancreas and MLN were much higher than that in T group. Conclusion：Damage to cellular immunity function occurs and may be a main cause that results in the bacterial translocation in the early stage of SAP. Rhubarb has therapeutic efficacy on SAP by the improvement of cellular immune function.