腹腔引流灌洗时机对大鼠重症急性胰腺炎的影响及作用机制

目的 拟在大鼠重症急性胰腺炎（SAP）模型中探讨腹腔引流灌洗时机对病程转归的影响并探究其作用机制。方法 清洁级SD大鼠，随机分为SAP模型组、早期引流组、延期引流组、早期灌洗组和延期灌洗组。比较各组24 h后大鼠生存率，检测大鼠血清和腹水中IL-1β、IL-6、IL-8、IL-10和TNF-α的浓度。结果 ①与模型组比较，早期引流组和早期灌洗组生存率显著提高（P＜0.01 ），而延期引流组和延期灌洗组与模型组差异无统计学意义（P＞0.05）。②与模型组比较，早期引流组血清TNF-α浓度显著下降（P＜0.05）；与早期引流组比较，早期灌洗组血清IL-8浓度下降、IL-10浓度升高（P＜0.05）。③与模型组比较，早期引流组和早期灌洗组腹水中IL-1β、IL-6、和TNF-α水平显著降低（P＜0.05），且早期灌洗组腹水中IL-10浓度升高（P＜0.05）；延期引流组中仅腹水TNF-α水平显著降低（P＜0.0），但延期灌洗组中细胞因子未见明显变化（P＞0.05）。与早期引流组相比，延期引流组的IL-1β、IL-8浓度升高，IL-10水平下降（P＜0.05），而早期灌洗组的IL-1β、IL-8浓度降低，IL-10水平升高（P＜0.05）。早期灌洗组与延期灌洗组的腹水中IL-1β、IL-6、IL-8、IL-10和TNF-α浓度均有显著差异（P＜0.05）。结论 在SAP病程早期进行腹腔置管引流灌洗可以提高大鼠生存率。与血清中细胞因子浓度变化相比，腹水中细胞因子浓度的改变更为明显。早期引流灌洗后降低腹水中TNF-α、IL-1β、IL-6和IL-8浓度，并使IL-10浓度升高可能是提高大鼠生存率的关键因素。

The influence of timing peritoneal drainage and lavage on the disease progress and its mechanism in a rat model of severe acute pancreatitis

Objective To observe the impact of timing peritoneal drainage and lavage on the disease progress and explore its mechanism in a rat model of severe acute pancreatitis (SAP). Methods Clean grade healthy male Sprague-Dawley rats were randomly divided into model control group, early stage drainage group, delayed drainage group, early stage lavage group and delayed lavage group. The survival rates after 24 h among groups were compared. The serum and ascites concentrations of IL-1β, IL-6, IL-8, IL-10 and TNF-αwere measured. Results ①The survival rate of early stage drainage group or early stage lavage group was significantly higher than that of model control group (P<0.01). Neither delayed drainage group nor delayed lavage group had significant difference in survival rate with that of model control group (P>0.05). ②Compared with the model control group, the serum TNF-αconcentration in early stage drainage group was decreased significantly (P<0.05); Compared with the early stage drainage group, the serum IL-8 concentration in early stage lavage group was decreased significantly, while the level of IL-10 was increased remarkably (P<0.05). ③Compared with the model control group, the ascites concentrations of IL-1β, IL-6 and TNF-αin early stage drainage group were decreased significantly (P<0.05), only ascites concentration of TNF-αwas decreased significantly in delayed drainage group (P<0.05); the ascites concentrations of IL-1β, IL-6, IL-8 and TNF-αin early stage lavage groupwere decreased, and the IL-10 level was increased significantly (P<0.05), however, there were no significant changes of ascites cytokine levels in delayed lavage group (P>0.05). Compared with the early stage drainage group, the ascites concentrations of IL-1β, IL-8 in delayed drainage group were increased, with IL-10 level decreased significantly (P<0.05), while in early stage lavage group, the ascites concentrations of IL-1β, IL-8 were decreased and the concentration of IL-10 was increased (P<0.05). Significant differences of concentrations of IL-1β,IL-6, IL-8, IL-10 and TNF-αwere observed between early stage and delayed lavage group (P<0.05). Conclusion The rat survival rate can be increased by early stage peritoneal drainage and lavage in SAP model. Compared with the changes of cytokine levels in serum, the changes of cytokine levels in asites are more evident. The decrease of the concentrations of TNF-α, IL-1β, IL-6, IL-8, and the increase of the concentration of IL-10 in ascites after early stage drainage and lavage may be the key factors to enhance the survival rate of rat.