1007例急性胰腺炎病因分析

目的 :探讨急性胰腺炎的病因 ,旨在提高对急性胰腺炎发病因素的认识。方法 :回顾性分析我院自 1 992年 1月至 2 0 0 1年 1 2月的内外科住院急性胰腺炎患者 1 0 0 7例。对其发病因素进行分析。结果 :急性胰腺炎发病例数逐年增多 ,1 992年至 1 996年间病例数占同期内外科住院总人数的 0 .36% ,而 1 997年至 2 0 0 1年间则上升为 0 .59% ,两者差异有显著性意义 (P <0 .0 1 )。其中不明原因者所占比例亦呈上升趋势。1 992年至 1 996年间不明原因的急性胰腺炎占同期急性胰腺炎总例数的 1 6 .8% ,1 997年至 2 0 0 1年则上升为32 .9% ,两者差异有显著性意义 (P <0 .0 1 )。月份分布情况表明 ,急性胰腺炎发病呈明显集中趋势 ,月份分布不平衡。结论 :急性胰腺炎发病因素多而复杂 ,病毒感染可能是不明原因急性胰腺炎发病例数增加的一个原因     

连续性肾脏替代疗法治疗重症急性胰腺炎合并急性肾损伤患者的临床分析

目的：观察连续性肾脏替代疗法（CRRT）治疗重症急性胰腺炎（SAP）合并急性肾损伤（AKI）患者的疗效及预后。方法：采用前瞻性临床对照研究方法,将24例SAP合并AKI患者随机分为常规治疗组（12例）和CRRT治疗组（常规治疗＋CRRT治疗组,12例）。治疗72h后对2组临床治疗效果进行比较（包括APACHEⅡ评分及其他主要临床指标）,同时观察0、6、12、24、48和72h各时间点患者血浆细胞因子TNF-α、IL-1、IL-6及IL-10浓度。结果：2组患者入组基线情况相似,但CRRT组患者存活率明显高于常规治疗组（75.0%vs58.3%,P〈0.05）。治疗72h后,CRRT组患者APACHEⅡ评分（16.7±5.8vs13.1±3.4,P〈0.05）、体温（38.0±1.3vs37.6±0.5,P〈0.05）、血清肌酐（149.9±34.7vs75.6±50.6,P〈0.05）和剩余碱（-4.83±4.06vs0.63±3.78,P〈0.05）较治疗前明显好转,而常规治疗组患者的变化并不显著。同时,CRRT组患者血浆TNF-α,IL-1,IL-10水平均显著下降（均P〈0.05）。结论：CRRT治疗能快速有效改善SAP患者病情,纠正体内酸碱紊乱、清除体内代谢毒素外,还能清除体内生成过多的促炎和抗炎细胞因子,疗效明显优于传统疗法,应在发生AKI之前即进行治疗。     

急性胰腺炎合理应用抗生素的回顾性研究

对１０７例急性胰腺炎治疗中有关抗生素的全用情况进行回顾性研究。认为轻症急性胰腺炎可以不用抗生素;重症者应用第三代抗生素加灭滴灵,一般使用２周左右,然后掌握指征果断停药,以免造成难治性耐药菌感染及医疗费用上升。     

生长抑素治疗重症急性胰腺炎的临床研究

目的观察生长抑素施他宁及其类似物善宁治疗重症急性胰腺炎(SAP)的治疗效果及评估其临床价值。方法按Ranson标准判断病情严重程度,将106例病情大致相近的SAP患者分成施他宁治疗组37例,善宁治疗组36例及对照组33例。对照组用一般常规治疗方法,治疗组在一般常规治疗方法治疗的基础上加用施他宁6mg／d或善宁0．6mg／d,维持治疗7～14d。观察3组血尿淀粉酶变化、平均腹痛持续时间、禁食天数、住院天数、并发症、手术率及住院费用等多项指标。结果施他宁和善宁治疗SAP均能显著降低血尿淀粉酶水平,控制腹痛,缩短禁食时间和住院天数,减少并发症和手术率,并且没有明显的增加住院费用。结论生长抑素施他宁和善宁对SAP有明显疗效,可以阻止病情进展和恶化,减少并发症,改善预后。     

Role of Ghrelin and Leptin in Predicting the Severity of Acute Pancreatitis

Ghrelin and leptin are the hormones that influence endocrine and exocrine functions of the pancreas and regulate feeding behaviors and energy metabolism. The aim of this study was to investigate the levels of ghrelin and leptin in pancreatitis of different severities and the relation of these hormones with blood glucose level and proinflammatory cytokines. The study was performed on 90 Wistar Albino rats. Three experimental groups composed of 30 rats were established: control group, 0.9% NaCl solution was injected intraperitoneally (i.p); acute edematous pancreatitis (AEP) group, 1 μg/100 g cerulein was injected i.p. five times, at 1-hr intervals; and acute necrotizing pancreatitis (ANP) group, 500 mg/100 g l-arginine was injected i.p. Ten animals in each group were sacrificed under anesthesia 12, 24 and 48 hr after the last injection. After blood withdrawal, the pancreas was totally excised. The levels of blood sugar, lipase, serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), ghrelin, and leptin were investigated and histopathologic examination was performed. Following pancreatitis induction, serum ghrelin levels increased at 24 hr and reached the peak level at 48 hr. Its level in the AEP group was higher than in the ANP group. Serum leptin levels in the AEP and ANP groups increased after 12 hr and stayed at high levels until 48 hr compared with the control group. Similarly to ghrelin and leptin, blood glucose levels increased in both pancreatitis groups, but the increase was more prominent in the ANP group, with levels >200 mg/ml at 48 hr. The levels of TNF-α and IL-1β in the AEP and ANP groups reached the peak level at 24 hr and then decreased to a level close to that of the control group at 48 hr. We conclude that serum leptin and ghrelin levels increase in the first 48 hr of AEP and ANP. As the serum ghrelin levels in ANP are higher than in AEP, it can be used as a marker to show the severity of pancreatitis. While TNF-α and IL-1β can be used as a prognostic factor in the first 24 hr, ghrelin and leptin can be used subsequently.     

全身炎症反应综合征对急性胰腺炎预后的影响

目的：探讨全身炎症反应综合征（ＳＩＲＳ）对急性胰腺炎预后的影响。方法２３例非手术治疗的急性胰腺炎患者，按是否伴有ＳＩＲＳ，分为ＳＩＲＳ组（１５例）和非ＳＩＲＳ组（８例），对其合并脏器功能障碍、病程及死亡率进行前瞻性观察。结果：ＳＩＲＳ组和非ＳＩＲＳ组器官功能障碍发生率分别为７３．３％和１２．５％（Ｐ＜０．０５）；ＳＩＲＳ组的死亡率为２０％，而非ＳＩＲＳ组无一例死亡；ＳＩＲＳ组平均住院日也显著高于非ＳＩＲＳ组（Ｐ＜０．０５）。结论：ＳＩＲＳ对急性胰腺炎的预后呈显著负性影响，并使病程延长，住院费用增加。     

急性胰腺炎患者致炎与抗炎因子的变化及生长抑素的调节作用

目的:探讨急性胰腺炎患者血浆中致炎因子肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和抗炎因子转化细胞生长因子-β(TGF-β)、白介素-10(IL-10)的变化、意义及生长抑素的调节作用。方法:急性胰腺炎48例,随机分成生长抑素治疗组和常规治疗组,分别在治疗前(入院时)、治疗后8 h和第2、3、4 d清晨空腹抽肘静脉血3 ml,测定TNF-α、IL-6、TGF-β和IL-10,并设对照组。结果:TNF-α和IL-6各监测点均比对照组显著升高(P<0.05,P<0.01),高峰在入院时。TGF-β和IL-10入院后8 h以后各监测点均比对照组显著升高(P<0.05,P<0.01);第2天达高峰。生长素抑素治疗组TNT-α、IL-6、和TGF-β、IL-10含量治疗后8 h明显低于常规治疗组。治疗后各观察点持续降低(P<0.05,P<0.01)。结论:急性胰腺炎患者血中致炎因子与抗炎因子均升高,机体免疫功能紊乱。生长抑素对致炎因子与抗炎因子的升高有抑制作用。     

西米替丁对急性胰腺炎的影响及机制探讨

目的:探讨西米替丁治疗急性胰腺炎的利弊及其机制。方法:对156例急性水肿型胰腺炎患者进行传统疗法与传统疗法加西米替丁的治疗对照研究,并检测了50例消化性溃疡患者服用西米替丁前后的血清胃泌素及24例急性胰腺炎患者急性发病期的血清胃泌素。结果西米替丁组腹痛消失时间、血尿淀粉酶下降时间、住院时间均较对照组明显延长。另有40.16％(51/127)的患者出现病情反复。溃疡病患者服用西米替丁后血清胃泌素明显升高。急性胰腺炎发病期血清胃泌素明显高于正常,发病当日超过正常值4～10余倍。结论:急性胰腺炎的发病可能与血清胃泌素过高有关,西米替丁虽能降低胃酸,但因反馈性升高血清胃泌素而不利于急性胰腺炎的恢复。     

急性胰腺炎胃肠激素变化的初步研究

目的:观察急性胰腺炎(AP)患者血浆内皮素(ET)、钙基因相关肽(CGRP)、血清胃泌素(GAS)的变化,并探讨这三种“胃肠激素”在AP发病机制中的作用及其临床意义。方法:应用放射免疫法测定29例AP患者治疗前(A组)、治疗后(B组)及22例健康人(C组)血浆ET、CGRP及血清GAS水平。结果:A组血浆ET、CGRP、ET/CGRP、血清GAS水平与B组或C组比较,显著升高(P<0.05或P<0.01)B组三种激素ET/CGRP与C组比较无明显差异(P<0.05)。结论:血浆ET、CGRP、血清GAS在AP时增高,测定血液ET、CGRP及GAS对于AP有相当重要的临床意义。     

生长抑素对急性胰腺炎患者血小板参数的影响

目的：研究血小板参数在急性水肿型胰腺炎（ＡＥＰ）和出血坏死型胰腺炎（ＡＨＮＰ）中的变化特点及生长抑制（ＳＳ）治疗后对其影响。方法;血细胞自动分析仪检测血小板计数（ＰＬＴ）、平均血小板体积（ＭＰＶ）和血小板分布宽度（ＰＤＷ）。结果：ＡＥＰ患者血小板参数无明显变化。１周后,ＰＬＴ无明显升高,ＭＰＶ和ＰＤＷ有显著性升高;常规治疗后,对血小板参数无影响;ＳＳ治疗后,ＭＰＶ和ＰＤＷ有显著性升高。而ＡＨＮＰ患     

毛细胞白血病外周血淋巴细胞亚群和NK细胞活性的初步观察

用一组抗Ｔ、Ｂ细胞分化抗原的单克隆抗体检测５例毛细胞白血病病人外周血单个核细胞的表面标记。其中３例Ｂ淋巴细胞占优势（ＣＤ２０：５８％、５０％、６７％；ＣＤ２２：４８％、４３％、５０％，ＳｍＩｇ：８０％、４７％、６０％），包括１例伴有ＩｇＭ单珠峰的病人；２例Ｂ细胞表面标记阳性率很低（ＣＤ２０：２０％，１７％；ＣＤ２２；１５％；１０％；ＳｍＩｇ：１７％、１８％）。５例病人外周血ＷＴ３＋、ＷＴ４＋细胞及ＷＴ４／ＷＴ８比值明显低于正常对照组（Ｐ＜０．００１），ＷＴ８＋细胞增高与正常组比较差异无显著意义（Ｐ＞０．０５）。４例病人ＮＫ细胞活性降低，脾切除后的ＮＫ细胞活性明显升高。     

Plasma Calprotectin Levels in Patients Suffering from Acute Pancreatitis

Calprotectin (Cal) concentration is elevated in acute inflammatory reactions and its increase in the plasma suggests a diagnostic potential for Cal assay. This study aimed (a) to evaluate the Cal plasma levels in patients suffering from acute pancreatitis (AP) and (b) to assess whether early assay of Cal plasma levels can be helpful in assessment of the severity of AP. Forty-six consecutive patients, median age 45 years, suffering from a first attack of AP were recruited at two medical centers. Data collected on admission included age, sex, delay between pain onset and admission, and Glasgow score. A severe outcome was defined according to the Atlanta criteria. AP was defined as edematous or necrotic according to the CT findings. Plasma Cal and serum C reactive protein (CRP) were assayed in all patients within the first 24 hr after hospitalization. Sixty subjects suffering from blood hypertension were recruited as controls. Plasma Cal was measured by a commercial ELISA system. In all AP patients and in none of the controls, plasma Cal concentration was higher than the normal limit. Cal values in AP patients were significantly higher than in controls (P < 0.0001). There was not a statistically significant difference in Cal values between patients with severe and patients with mild AP. Plasma Cal values did not differ in necrotizing and edematous AP. During the follow-up plasma Cal was reassayed in six of the patients with abdominal fluid collection and the values were higher in the two patients with infected necrosis. We conclude that plasma Cal is elevated in patients with AP but it is not a useful marker for early prediction of pancreatitis severity. Further studies could evaluate its usefulness in pancreatic infected necrosis.     

急性早幼粒细胞白血病治疗前血象与预后分析

目的:探讨急性早幼粒细胞白血病(APL)患者治疗前外周血白细胞计数变化规律与预后的关系。方法:总结12例首诊时被误诊为其他疾病(或急性白血病的其他类型),最后在我科确诊为APL的患者首诊及确诊时血象、凝血功能变化及转归。结果:首诊至确诊为APL的时间4~45d不等,平均13.4d。9例确诊时WBC计数较首诊时升高,3例下降。首诊和确诊时平均WBC计数分别为5.13×109/L、25.16×109/L。经治疗后5例死亡,均在诱导治疗期间死于颅内出血,其余7例至今均为持续完全缓解(CCR)状态。结论:APL发病早期,患者外周血WBC计数多低于正常,以后,WBC计数可逐渐升高,凝血功能紊乱及出血倾向亦渐加重,患者的预后也明显变差。     

奥美拉唑对大鼠急性出血坏死性胰腺炎的保护作用

为探讨奥美拉唑(OM)对大鼠急性出血坏死性胰腺炎(AHNP)的保护作用,采用大鼠十二指肠结扎加用闭襻内胆汁注射法制备AHNP模型.并观察用药后病鼠胰腺病理学和血液生化学变化。以及提高生存率的效果 结果表明:OM3或9mg/kg可显著减轻AHNP大鼠胰腺组织炎性损害,明显降低血清淀粉酶及乳酸脱氢酶水平 提高生存率。结论:OM对大鼠实验性胆汁反流所致的ANHP具有明显保护作用 其机理尚不明.可能与降低胰酶活性,减轻组织坏死有关。     

重症急性胰腺炎并发糖尿病酮症酸中毒的急诊救治及预后分析

目的 研究重症急性胰腺炎并发糖尿病酮症酸中毒的急诊救治及预后情况.方法 纳入2017年3月—2020年3月该院66例重症急性胰腺炎并发糖尿病酮症酸中毒患者为研究对象,随机分为对照组与实验组,对照组33例采取常规急诊救治,实验组33例在常规组基础上采用小剂量胰岛素急诊救治.比较两组总有效率、空腹血糖、餐后2 h血糖、血淀...     

The Relevance of Serum Ghrelin Concentration to Severity of Acute Pancreatitis

Background/Aims

Ghrelin has recently been reported as exerting a protective effect in the damaged pancreas in rats. We investigated the correlation between severity of acute pancreatitis and serum ghrelin concentrations.

Methods

Blood samples were collected three times (at admission, after 48 hours, and at discharge) from patients admitted with acute pancreatitis. We divided the patients into nonrisk and risk groups. The risk group was defined as the presence of at least one of following risk factors for severe acute pancreatitis: Ranson''s score ≥3, acute physiology and chronic health evaluation (APACHE) II score ≥8, C-reactive protein (CRP) ≥150 mg/L, and CT severity index (CTSI) ≥4. Serum ghrelin concentrations were measured with RIA kit and analyzed based on clinical and biochemical parameters.

Results

A total of 53 patients was enrolled in this study: 28 in the nonrisk group and 25 in the risk group. At admission, the ghrelin concentration was significantly higher in the risk group (286.39±272.19 vs 175.96±138.87 pg/mL [mean±SD], p=0.049). However, the ghrelin concentration did not differ significantly between the two groups after 48 hours (p=0.450) and at discharge (p=0.678). The overall ghrelin concentration was significantly lower at admission than at discharge (240.65±247.96 vs 369.41±254.27 pg/mL, p=0.001).

Conclusions

Patients with risk factors for severe acute pancreatitis have higher serum ghrelin concentrations.     

急性胰腺炎患者血清白介素-8和C-反应蛋白含量变化及其临床意义

目的 :检测急性胰腺炎 (AP)患者血清白细胞介素 8(IL 8)和C 反应蛋白 (CRP)含量变化 ,探讨其临床意义。方法 :检测 30例AP患者入院时和入院后第 3、5、7天时血清IL 8和CRP含量 ,与 30例健康人作对照。结果 :入院时 ,AP患者血清IL 8和CRP含量均显著高于对照组 (P <0 .0 5 ) ,其中重症急性胰腺炎 (SAP)患者血清IL 8和CRP含量又明显高于轻症急性胰腺炎 (MAP)患者 (P <0 .0 5 )。入院后第 5、7天 ,MAP组中血清IL 8和CRP含量均显著低于入院时 (P <0 .0 5 ) ,入院后第 3天 ,SAP组中血清IL 8和CRP含量均显著性高于入院时 (P <0 .0 5 ) ,血清IL 8含量和CRP含量变化呈正相关 (r =0 .6 931,P <0 .0 5 )。结论 :血清IL 8和CRP含量变化与AP病情变化密切相关 ,联合检测有助于了解病情发展     

施他宁在急性坏死性胰腺炎治疗中的应用

目的:探讨施他宁在急性坏死性胰腺炎治疗中的作用。方法:1995年8月至1996年9月本院消化科共收治急性坏死性胰腺炎27例,其中24例用施他宁治疗,3例转外科手术治疗。结果:用施他宁保守治疗的24例患者中除2例死亡外均存活,存活率92％,转外科手术3例中2例死亡。结论:施他宁不失为一个治疗急性坏死性胰腺炎的良药,能大大地提高患者的存活率。