急性胰腺炎后患者血清再生相关细胞因子与胰腺功能的相关性研究

目的 探讨血清肝细胞生长因子(HGF)、表皮生长因子(EGF)、碱性成纤维生长因子(bFGF)、再生蛋白(Reg)-1、Reg-4的水平变化对急性胰腺炎(AP)恢复期胰腺内、外分泌功能的影响及机制.方法 根据2007年中国AP诊治指南草案对25例轻症AP恢复期和34例重症AP恢复期患者进行随访研究.同时选取20名健康志愿者作对照.应用酶联免疫吸附法检测血清HGF、EGF、bFGF、Reg-1、Reg-4表达水平,同时检测空腹血糖、胰岛素、C肽及粪弹力蛋白酶(FE)1水平,评估胰腺内、外分泌功能.统计分析胰腺功能与发病时临床指标的相关性以及这些再生相关因子与胰腺功能的相关性.结果 患者组FE1水平[(205.9±18.3)μg/g]较正常对照组[(333.9±19.7)μg/g]显著下降(P<0.01),空腹血糖、胰岛素及C肽水平则显著升高(P<0.01).轻、重症胰腺炎组恢复期胰腺内、外分泌功能差异无统计学意义(P值均>0.05).轻症与重症胰腺炎组HGF、EGF、bFGF、Reg-1、Reg-4表达水平差异无统计学意义(P值均>0.05).AP恢复期重度和轻、中度外分泌功能受损者血清HGF表达水平[分别为(983.76±372.65)和(946.80±254.47)pg/ml]高于外分泌功能正常者[(263.44±110.35)pg/ml,P值均<0.05].AP恢复期糖尿病患者EGF表达水平[(704.41±190.37)pg/ml]高于血糖正常者[(360.03±48.39)pg/ml,P<0.05].血清HGF水平与FE1水平负相关(r=-0.331,P<0.01).AP恢复期是否发生糖耐量异常或糖尿病与急性发病时的CT分级相关(P<0.05).结论 患者在AP恢复期存在明显胰腺内、外分泌功能不全.血清EGF、HGF表达水平可能分别与AP恢复期内、外分泌功能修复有关.

Association of serum cytokines with pancreatic function in patients after acute pancreatitis

Objective To investigate the effect of cytokines on pancreatic function in patients after acute pancreatitis(AP) and its mechanisms. Methods Fifty-nine patients (mild in 25 and severe in 34) after AP and 20 healthy controls were enrolled in the study. Serum levels of cytokines including hepatocyte growth factor (HGF), epidermal growth factor(EGF), basic fibroblast growth factor (bFGF), regeneration protein(Reg)-1 and Reg-4 were determined using enzyme-linked immunosorbent assay (ELISA). Fasting blood-glucose, insulin, C-peptide and fecal elastase 1 (FE1) were detected for evluation of endocrine and exocrine pancreatic function. The association of pancreatic function with clinical parameters and serum cytokines was analyzed. Results The expression of FE1 was lower in patients [(205.9±18.3) μg/g] after AP in comparison with the controls [(333.9±19.7) μg/g, P<0. 01], but levels of fasting blood-glucose, C-peptide and insulin were higher in patients group (P<0.01). Serum level of HGF was higher in patients with insufficient pancreatic exoerine [(983.76±372.65) pg/ml] than those with normal exocrine function [(263.44±110. 35) pg/ml]. Meanwhile,EGF level was higher in patients with DM after AP [(704.41±190. 37) pg/ml] than those without DM [(360. 03±48.39) pg/mh P<0.05]. There was a negatively correlation between FE1 and HGF (P ＜0. 01). The abnormal fasting blood glucose was correlated with CT grading (P<0. 05).Conclusions The patients after AP develope insufficient exocrine and endocrine function. Serum EGF and HGF may be associated with restoration of pancreatic endocrine and exocrine function.