早期腹腔穿刺引流对重症急性胰腺炎大鼠肠道细菌移位的影响

目的 探讨早期腹腔穿刺引流(abdominal paracentesis drainage,APD)对重症急性胰腺炎(severe acute pancreatitis,SAP)大鼠肠道细菌移位的影响.方法 将质粒标记有绿色荧光蛋白的大肠杆菌(E.coli marked with green fluorescent protein,GFP-E.coli)灌饲给SD大鼠,使其成功定植于大鼠肠道.将定植了GFP-E.coli的大鼠分为假手术组(Sham组)、SAP组和APD组,每组12只.逆行胰胆管注射5％牛磺胆酸钠制作大鼠SAP模型.SAP造模后于右下腹留置腹腔引流管,为APD治疗组.造模后24 h无菌条件下取材并处死.对比各组大鼠胰腺组织病理学评分,血液、肠系膜淋巴结(mesentericlymph nodes,MLN)、胰腺组织细菌移位情况,以及血清炎性因子CRP、TNF-α及IL-1β水平.结果 与假手术组比较,SAP组及APD组胰腺组织病理学评分,血液、MLN及胰腺组织细菌移位程度,血清内毒素水平,以及血清炎性因子CRP、TNF-α及IL-1β水平均显著升高(P＜0.05);与SAP组比较,APD组上述各项指标均显著降低(P＜0.05).结论 早期APD能减少SAP大鼠肠道细菌移位及全身炎症水平,并可能因此改善SAP.

Effects of early abdominal paracentesis drainage on intestinal bacterial translocation in rats with severe acute pancreatitis

Objective To determine the effect of abdominal paracentesis drainage (APD) on the intestinal bacterial translocation in rats with severe acute pancreatitis (SAP).Methods The rats were intragastrically fed with Escherichia coli whose plasmids were reconstructed with green fluorescent protein (GFP-E.coli).These GFP-E.coli labeled rats were randomly divided into 3 groups:sham operation group (Sham group),SAP group and APD group.The SAP rats were established by retrograde infusion of sodium taurocholate into biliopancreatic duct.The APD treatment was applied by inserting a drainage tube into the right lower quadrant of rats after SAP establishment.Spleen specimens were harvested in a sterile manner along with scarifying the rats in 24 h after operation.Bacterial translocation in the blood,mesenteric lymph nodes (MLNs) and pancreatic tissues,level of serum eudotoxin,histological scores of pancreas,and serum levels of inflammatory factors CRP,TNF-α and IL-1 β were assessed and compared among the 3 groups.Results Compared with sham operation group,the histological score of pancreas,bacterial translocation in the blood,MLNs and pancreatic tissues,serum endotoxin level,and serum levels of CRP,TNF-α and IL-1β were all significantly higher in the SAP group and APD group (P ＜ 0.05).While compared with the SAP group,the above indicators were obviously lower in the APD group (P ＜ 0.05).Conclusion Early APD reduces intestinal bacterial translocation and systemic inflammatory response in rats with SAP,and thus attenuates the severity of SAP.