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1.
目的:研究降钙素基因相关肽(CGRP)对刀豆蛋白A(ConA)诱导的小鼠肝损伤模型肝脏微循环的影响。方法:昆明种小鼠60只,随机分为ConA损伤组、CGRP干预组和空白对照组(n=20),空白对照组注射生理盐水,ConA损伤组用ConA诱导建立小鼠急性肝损伤模型,CGRP干预组在用ConA诱导建模前体外注射CGRP,各组中10只于处理后用激光多普勒血流仪测肝脏的平均血流灌注量,另10只活体观察肝脏微循环流速,最后处死,全部HE染色观察肝脏病理变化。结果:CGRP干预组肝脏的平均血流灌注量和血液流速较ConA损伤组明显增加(P〈0.01),病理学改变明显减轻。2组的血细胞浓度差异无统计学意义(P〉0.05)。结论:CGRP能够通过改变肝脏组织的灌注影响急性肝损伤时肝脏微循环障碍的程度和病理改变。  相似文献   

2.
为探讨急性胰腺炎(AP)大鼠血浆血栓素、前列环素比值的变化及川芎嗪(TMP)对该比值的影响及其意义。笔者通过十二指肠胆胰管逆行加压注射5%牛磺胆酸钠的方法制备大鼠AP模型,动态测定AP大鼠血浆血栓素与前列腺环的比值(T/P)、淀粉酶(AMY)、腹水量及胰腺病理改变等的变化及TMP对上述指标的影响。结果示AP时,T/P值增高,其增高程度与AP病变程度有关;经TMP治疗后,大鼠T/P值明显降低(P<0.05),且与AP病理改变的减轻、血清淀粉酶的下降基本同步(P<0.05)。提示TMP通过降低T/P值,减轻胰腺微循环障碍,对AP有治疗作用。  相似文献   

3.
急性胰腺炎大鼠胰腺各部血流的改变   总被引:3,自引:2,他引:1  
目的 探讨急性胰腺炎模型大鼠胰腺各部分血流量的变化。方法 急性胰腺炎模型建立后 ,利用激光多普勒血流仪测定大鼠胰头、胰体、胰尾各部的血流量、血细胞浓度和血液流速。结果 急性胰腺炎时大鼠胰腺各部的血流量、血液流速与对照组相比均明显降低 (P <0 .0 1,P <0 .0 1~ 0 .0 5 ) ,但胰腺各部之间差异不显著 (P >0 .0 5 )。结论 急性胰腺炎时胰腺各部血流明显减少。  相似文献   

4.
应用小剂量多巴胺(5μg/(kg.min)对5%牛磺胆酸钠诱导的大鼠急性出血坏死性胰腺炎(AHNP)模型进行治疗,以观察其对AHNP大鼠平均动脉压,胰腺微区血流量,血清淀粉酶和脂肪酶的影响及胰腺的病理学改变,结果:AHNP早期在不影响平均动脉压的情况下,小剂量多巴胺能显著增加大鼠胰腺微区血流量,降低血清淀粉酶和脂肪酶,并减轻胰腺病理改变程度,实验结果提示,小剂量多巴胺在改善胰腺管微血流的基础上对胰  相似文献   

5.
用3%牛磺胆酸钠经胆胰管逆行注射,制成大鼠急性出血坏死性胰腺炎(AHNP)模型,并用丹参进行实验性治疗。结果:模型制作后6小时,对照组胰腺即出现严重的出血坏死及微血管破坏,血清胰酶活性显著升高(P〈0.01),12小时后血清胰酶活性呈进行性降低,胰腺微血管及组织学病变则进行性加重;而丹参治疗组24小时时胰腺微血管损害及组织学病变显著改善(P〈0.01)。作者认为微循环障碍是加重AHNP后期胰腺病变  相似文献   

6.
应用小剂量多巴胺[5μg/(kg·min)]对5%牛磺胆酸钠诱导的大鼠急性出血坏死性胰腺炎(AHNP)模型进行治疗,以观察其对AHNP大鼠平均动脉压、胰腺微区血流量、血清淀粉酶和脂肪酶的影响及胰腺的病理学改变。结果:AHNP早期在不影响平均动脉压的情况下,小剂量多巴胺能显著增加大鼠胰腺微区血流量,降低血清淀粉酶和脂肪酶,并减轻胰腺病理改变程度。实验结果提示:小剂量多巴胺在改善胰腺微血流的基础上对胰腺炎有治疗作用。  相似文献   

7.
扩张皮肤微循环变化特征及其对血供的影响   总被引:10,自引:2,他引:8  
目的 研究扩张皮肤微循环变化特征,确定其稳定供形成时间。方法 用微循环显微成像、碱性磷酸酶组织化学染色等形态学研究手段,对扩张皮肤微血管直径、密度、血流速度、流量等指标进行观测。结果 扩张组各观测指标均明显高于对照组(P<0.01)。微血管直径、血流量从第1-3周逐渐增加,此后呈下降趋势;微血管密度在第1-4周逐渐增加;第5周出现下降;血流速度则在较高水平维持。结论 皮肤扩张后微循环功能增强,早期以血管增生扩张为主,以后逐步稳定并向正常组织微循环状态转化,其稳定血供的形成至少需要1个月的时间。  相似文献   

8.
目的探讨大鼠急性水肿性胰腺炎(AEP)动物模型的早期微循环改变及中药复方清下1号(MCP-1)对AEP胰腺微循环的作用。方法用异硫氰酸荧光素-荧光标记红细胞(FITC-RBC)胰腺活体微循环技术、微血管树脂/墨汁灌注光镜和扫描电镜、透射电镜技术,用蛙皮缩胆囊肽诱发大鼠急性胰腺炎(AP)动物模型,观察36只Wistar大鼠的早期微循环改变、MCP-1应用后胰腺局部微循环的反应。结果与AEP自然病程组比较,MCP-1治疗组血清淀粉酶由(2997.7±801.4)?IU/L降至(1909.7±295.5)?IU/L(P<0.01);胰腺间质炎性细胞浸润减少;腺泡细胞胞浆内空泡减少;毛细血管密度由(52.8±6.1)%增至(63.2±5.5)%(P<0.01);微血管管径由(4.5±0.4)?μm增至(5.9±0.6)?μm(P<0.05);FITC-RBC显示胰腺微循环流速、流量增加,灌流稳定(0.87±0.06)nl/min(P<0.01)。结论MCP-1具有显著改善AP胰腺微循环的作用,抗AP胰腺局部微循环损伤是实现MCP-1疗效的重要机制。  相似文献   

9.
超量扩张皮肤血流量改变的初步临床观察   总被引:3,自引:0,他引:3  
目的 探讨超量扩张时皮肤血流量的变化与皮瓣存活的关系。方法 对临床10例患者21个扩张器在扩张器置入前、满量、超量注水时,应用激光多谱勒血流测定仪测定扩张皮肤微循环血流量及其波幅,并与最终临床效果进行观察比较。结果 正常皮肤血流量及血管的运动波较小且较稳定,扩张后尤其是超量扩张后其血流量明显增加。与正常皮肤相比差异有统计学意义(P〈0.05),血管的运动波与正常皮肤相比差异亦有统计学意义(P(0.05),与超量注水扩张皮肤相比差异有显著的统计学意义(P(0.01)。结论 扩张皮肤血流量的增加,主要表现为血管数量的增加和增粗,当扩张皮瓣的长宽比例较大时,尤其在过度扩张时,扩张皮肤的血供不像延迟皮瓣具有方向性,加上微血管括约肌的功能异常,更易出现皮瓣远端血供的不足,并为皮瓣转移时带来风险。  相似文献   

10.
目的探讨急性胰腺炎(AP)胰腺内源性肾素一血管紧张素系统(RAs)的活化与胰腺局部做循环障碍之间的关系,为进一步阐明AP时胰腺局部微循环损伤的机制提供实验依据:方法采用异硫氢酸荧光素(FTTC标记红细胞进行胰腺局部微循环活体观察,放免法检测局部微循环血浆及咦腺局部组织AngⅡ的含量变化。结果(1)与正常对照组相比,AEP组胰腺微循环血浆及局部组织AngⅡ的表达自2h开始上调,直至8h(P<0.05),其中自4h开始局部组织AngⅡ的含量明显高于血浆中AngⅡ的含量,差异有显著性(P<0.05);(2)与正常对照组相比,AEP组胰腺局部组织在疾病早期即开始出现血液流速减慢、流量减少等微循环障碍表现;(3)胰腺局部微循环血量随着RAS活化的上调而逐渐减少,相关分析显示两者呈显著线性相关(r=0.5449,P<0.05)。结论胰腺局部组织的RAS参与AP早期的微循环损伤的病理过程,抑制或拮抗胰腺局部组织的RAS的活化可能有助于胰腺局部微循环障碍的改善。  相似文献   

11.
Hackert T  Werner J  Gebhard MM  Klar E 《Surgery》2004,135(2):131-138
BACKGROUND: Acute pancreatitis (AP) is a complication of diagnostic or therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In a recent clinical trial, a decreased rate of post-ERCP pancreatitis was shown after prophylactic heparin treatment. The aim of this study was to evaluate the effects of prophylactic heparin application in various experimental models of AP and pancreatic duct obstruction and to assess the underlying mechanisms. METHODS: In various experimental models, pancreatic injury of graded severity was induced in Wistar rats: (1) mild pancreatitis by IV cerulein infusion over 6 hours; (2) severe pancreatitis by infusion of glycodeoxycholic acid into the pancreatic duct plus IV cerulein application over 6 hours. The clinical ERCP situation was imitated in groups (3) obstruction of the pancreatic duct and (4) infusion of contrast medium into the pancreatic duct plus obstruction. In every group the animals received either no heparin (n=six per group) or continuous IV heparin (n=six per group) starting before pancreatic injury. Histologic changes, amylase, and lipase in plasma were evaluated 12 hours after induction of pancreatic injury. Additional animals were treated to investigate pancreatic microcirculation by intravital microscopy (n=six per group). RESULTS: In groups 1, 3, and 4 (mild AP/duct obstruction/duct obstruction plus contrast medium), IV heparin-treated animals showed reduced edema, inflammation, and peak amylase values compared with the corresponding non-heparin-treated animals (P<.05). Moreover, mean erythrocyte velocity was significantly higher and leukocyte-endothelium interaction was reduced in these groups after prophylactic administration of heparin. In contrast, group 2 (severe AP) did not show any difference between control animals and animals that received heparin as assessed by histology and intravital microscopy. CONCLUSIONS: Prophylactic systemic application of heparin provides a protective effect in mild AP and in experimental post-ERCP pancreatitis. The mechanism of the protective effects of heparin seems to be the reduction of leukocyte-endothelium interaction and the normalization of pancreatic microcirculation.  相似文献   

12.
OBJECTIVE: To determine whether blocking the cell surface expression of intracellular adhesion molecules (ICAM-1) in established severe acute pancreatitis (AP) would ameliorate pulmonary injury. SUMMARY BACKGROUND DATA: Lung injury in AP is in part mediated by infiltrating leukocytes, which are directed to lung tissue by ICAM-l. The authors' laboratory has previously demonstrated that AP results in overproduction of inflammatory cytokines, upregulation of pulmonary ICAM-1 expression, and a concomitant infiltration of neutrophils, which results in lung injury. METHODS: Young female mice were fed a choline-deficient/ethionine-supplemented diet to induce AP and were treated with a blocking dose of monoclonal antibody specific to the ICAM-1 receptor. Antibody treatment was administered at 72, 96, and 120 hours after beginning the diet, and all animals were killed at 144 hours. The degree of pancreatitis was evaluated by serum biochemical and tumor necrosis factor alpha levels as well as histology. The dual radiolabeled monoclonal antibody method was used to quantitate ICAM-1 cell surface expression in pulmonary tissue. Lung injury was assessed histologically and by determining lung microvascular permeability by measuring accumulated 125I-radiolabeled albumin. Pulmonary neutrophil sequestration was determined by the myeloperoxidase assay. RESULTS: All mice developed severe AP, and pancreatic injury was equally severe in both treated and untreated groups. Pulmonary ICAM-1 expression was significantly upregulated in animals with AP compared with controls. Treatment with a blocking dose of anti-ICAM-1 antibody after the induction of AP resulted in inhibited ICAM-1 cell surface expression to near control levels. Compared to untreated animals with AP, mice treated with anti-ICAM-1 mice had significantly reduced histologic lung injury and neutrophil sequestration, and a decreased microvascular permeability by more than twofold. CONCLUSIONS: These results demonstrate for the first time that treatment targeting the cell surface expression of ICAM-1 after the induction of AP ameliorates pulmonary injury, even in the face of severe pancreatic disease.  相似文献   

13.
目的 探讨内源性一氧化氮(NO)对急性坏死性胰腺炎大鼠胰腺炎大鼠胰腺微血管通透性的影响。方法 以5%牛磺胆酸钠溶液胰胆管注射(1ml/kg)制成大鼠急性坏死性胰腺炎模型,以工具药L-硝基精氧酸(L-NNA)和内源性NO的阻断Evans Blue的漏出代表微血管的通透性,观察内源性NO对胰腺组织损伤程度、胰腺内Evans Blue漏出等的影响。结果 牛磺胆酸钠胆管注射造成大鼠胰腺组织明显坏死和炎性细胞浸润,以及血清淀粉酶浓度升高、胰腺湿/干重比率产加和明显的胰腺组织内Evans Blue积聚。以L-NNA(12.5mg/kg)阻断内源性NO后,胰腺组织坏死和炎性细胞浸润进一步加重,并使血清淀粉酶浓度升高,胰腺湿/干重比率增加,Evans Blue的漏出率也较之单纯胰腺炎组大鼠明显增加。结论 内源性NO具有胰腺保护作用,其保护机制可能与维持胰腺微血管的完整性有关。  相似文献   

14.
BACKGROUND: Severe acute pancreatitis leads to a systemic inflammatory response characterized by widespread leucocyte activation and, as a consequence, distant lung injury. In CC chemokines the first two cysteine residues are adjacent to each other. The aim of this study was to evaluate the effect of Met-RANTES, a CC chemokine receptor antagonist, on pancreatic inflammation and lung injury in caerulein-induced acute pancreatitis in mice. METHODS: Acute pancreatitis was induced in mice by hourly intraperitoneal injection of caerulein. Met-RANTES was administered either 30 min before or 1 h after starting caerulein injections, and pancreatic inflammation and lung injury were assessed. There were five groups of eight mice each including controls. RESULTS: Treatment with Met-RANTES had little effect on caerulein-induced pancreatic damage. Met-RANTES, however, reduced lung injury when given either before administration of caerulein (mean(s.e.m.) lung myeloperoxidase (MPO) 1.47(0.19) versus 3.70(0.86)-fold increase over control, P = 0.024; mean(s.e.m.) microvascular permeability 1.15(0.05) versus 3.57(0.63) lavage to plasma fluorescein isothiocyanate-labelled albumin fluorescence ratio (L/P) per cent, P = 0.002) or after caerulein administration (lung MPO 1.96(0.27) versus 3.65(0.63)-fold increase over control, P = 0.029; microvascular permeability 0.94(0.04) versus 2.85(0.34) L/P per cent, P < 0.001). CONCLUSION: Treatment with Met-RANTES reduces lung damage associated with caerulein-induced pancreatitis in mice. Chemokine receptor antagonists may be of use for the treatment of the systemic complications of acute pancreatitis.  相似文献   

15.
Background: Calcitonin gene-related peptide (CGRP) is known to have an extremely potent and prolonged vasodilator effect on the coronary arteries. Studies have shown that CGRP increased coronary blood flow and alleviated reperfusion injury in vitro. It is still unknown, however, whether exogenous CGRP has a protective effect on the reperfusion heart associated with cardiopulmonary bypass (CPB). Methods: An in vivo porcine model of CPB was established. Twenty pigs, 10 controls and 10 CGRP used animals (CGRP group), were performed a median sternotomy followed by a standard CPB. All the hearts were arrested for 45 minutes. In the CGRP group, 1mg/kg CGRP was added into the cardioplegia, and another 1mg/kg was reperfused just before the aortic cross-clamp was removed. In both groups, myocardial microvascular perfusion, coronary arterial microvessel diameter and microvessel blood flow were detected by a laser doppler flowmeter and a contact microscope with TV monitor on five consecutive time perioperatively. Result: Myocardial microvascular perfusion was significantly higher and coronary arterial microvessel diameter was larger in the CGRP group on every point of time of reperfusion compared to those in the control group. In the CGRP group, microvessel blood flow also improved significantly than that in the control group during reperfusion. Conclusion: CGRP improves myocardial microcirculation during cardiac ischemia-reperfusion associated with CPB and could become a new, potent myocardial protector.  相似文献   

16.
Increased vascular permeability is an early and sensitive indicator of ischemic muscle injury, occurring before significant histologic or radionuclide changes are evident. We investigated the effect of iloprost, a stable prostacyclin analog, on microvascular permeability in a rat striated muscle model. In six control and six experimental animals the cremaster muscle was dissected, placed in a closed-flow acrylic chamber, and suffused with a bicarbonate buffer solution. Dextran labeled with fluorescein was injected intravenously as a macromolecular tracer, and microvascular permeability was determined on the basis of clearance of the fluorescent tracer. Two hours of ischemia were followed by 2 hours of reperfusion. In the experimental group iloprost (0.5 microgram/kg/min) was given in a continuous intravenous infusion. Microvascular permeability increased significantly during reperfusion in both control and experimental animals (p less than 0.0001). Treatment with iloprost, however, significantly attenuated this response compared to the control group, 4.8 +/- 0.3 versus 7.3 +/- 0.5 microliters/gm/min, respectively (p less than 0.0001). Iloprost decreases the rise in vascular permeability after ischemia and reperfusion. Experimental clinical use of iloprost under controlled conditions in the treatment of patients with acute skeletal muscle ischemia appears justified.  相似文献   

17.
BACKGROUND: Despite improving results, exocrine complications remain a major challenge in clinical pancreas transplantation. The etiology of posttransplantation pancreatitis relates almost certainly to cold ischemia/reperfusion-induced microvascular injury with an imbalance of vasoconstricting and vasodilating mediators due to endothelial dysfunction. We therefore studied the effectiveness of a nitric oxide donor on postischemic microvascular reperfusion injury after pancreas transplantation. METHODS: Heterotopic isogeneic pancreaticoduodenal transplantation was performed in spontaneously breathing, chloralhydrate-anesthetized Sprague Dawley rats after 16 hr (n=5) of cold storage of the graft in 4 degrees C histidine-tryptophane-ketoglutarate solution. An additional five animals received L-arginine immediately before (50 mg/kg i.v.) and during the first 30 min of reperfusion (100 mg/kg i.v.). Five animals that did not undergo transplantation served as controls. Intravital fluorescence microscopy was used for analysis of functional capillary density, capillary diameters, and capillary red blood cell velocity in exocrine pancreatic tissue during 120 min of reperfusion. Histology served for quantitative assessment of inflammatory response (leukocytic tissue infiltration) and endothelial disintegration (edema formation). RESULTS: In L-arginine-treated animals, functional capillary density of exocrine tissue of pancreatic grafts was found slightly higher after 30 and 60 min, and significantly higher after 120 min of postischemic reperfusion compared with untreated pancreatic grafts. This was accompanied by a significant increase of capillary diameters. In parallel, pancreatic histology revealed significant attenuation of both leukocytic tissue infiltration and edema formation in the L-arginine-treated animals when compared with the nontreated controls. CONCLUSIONS: Besides reduction of leukocyte-dependent microvascular injury, L-arginine improves postischemic microvascular reperfusion, supposedly by capillary dilatation. Thus, our results suggest that supplement of nitric oxide during reperfusion is effective in attenuating exocrine microvascular reperfusion injury.  相似文献   

18.
Jaffray C  Yang J  Carter G  Mendez C  Norman J 《Surgery》2000,128(2):225-231
BACKGROUND: Select pancreatic enzymes, primarily elastase, precipitate pulmonary injury similar to pancreatitis-associated adult respiratory distress syndrome and stimulate leukocyte cytokine production in vitro via nuclear factor kappa B (NF-kappaB) activation. This study explores the effect of systemic pancreatic enzymes on pulmonary NF-kappaB and inhibitory kappa B (IkappaB) proteins and their role in enzyme-induced pulmonary injury. METHODS: Mice received pancreatic elastase, amylase, lipase, or trypsin intraperitoneally. Bronchoalveolar lavage IkappaBalpha/IkappaBbeta proteins were measured by immunoblot. Pulmonary NF-kappaB activation, tumor necrosis factor (TNF) gene expression, and neutrophil infiltration (myeloperoxidase) were determined and myeloperoxidase experiments repeated in p55 TNF receptor-deficient (TNF KO) animals. Additional animals received pyrrolidine dithiocarbamate (PDTC), an inhibitor of NF-kappaB activation, and TNF protein and pulmonary microvascular permeability were measured after elastase administration. RESULTS: Pancreatic elastase induced pulmonary IkappaBalpha/IkappaBbeta degradation (30 minutes), NF-kappaB activation (60 minutes), and TNF gene expression (60 minutes) with subsequent neutrophilic inflammation (4 hours) and microvascular leakage (24 hours), whereas amylase, lipase, and trypsin did not. Furthermore, lung injury was markedly reduced in TNF KO animals and PDTC significantly attenuated TNF production and pulmonary microvascular leakage. CONCLUSIONS: Pancreatic elastase induces cytokine-mediated lung injury and this pathway involves the NF-kappaB second messenger system, further supporting elastase as a factor linking pancreatic inflammation to systemic illness during severe acute pancreatitis.  相似文献   

19.
An in vivo microscopic technique was used to clarify the increase in microvascular permeability and enhanced leukocyte–endothelium interaction of pancreatic microcirculation in experimental pancreatitis of differing severity. Using bovine albumin fluorescein isothiocyanate (FITC) and carboxyfluorescein diacetate succinimidyl ester (CFDASE) as tracers, the change in permeability and the behavior of leukocytes in the acinar microcirculation were quantified during the initial 1, 2, 6, and 12 h after the induction of caerulein pancreatitis in mice. Cold stress was added to produce the severe model. It was revealed that the early microcirculatory changes in the pancreas of caerulein pancreatitis included the increased permeability of endothelial lining and an accumulation of extravasated fluid in the perilobular space, which were more severe if cold stress was added. A decrease in flow velocity was also noted 2 h after the onset of severe pancreatitis. Leukocyte adherence to the endothelial cells was not observed during the first 12 h in either model of severity. In contrast, observation of the hepatic microcirculation revealed a significant number of adherent leukocytes 2 h after the induction of severe pancreatitis. These results suggest that during the early course of acute pancreatitis, leukocyte adherence in the pancreatic microcirculation is a secondary event following the increase in pancreatic vascular permeability. Received: February 21, 2000 / Accepted: March 6, 2001  相似文献   

20.
BACKGROUND: Pulmonary complications from pancreatitis involve parenchymal destruction via proteolytic enzymes. Matrix metalloproteinases (MMPs) may play an important role in pulmonary injury following acute severe pancreatitis. We hypothesized that local and distant organ injury would be decreased by the presence of an MMP inhibitor (Batimistat; BB-94) following severe acute pancreatitis (AP). METHODS: Eighteen male rats were randomized into two groups: BB-94 (AP + 40 mg/kg/24 h BB-94 ip x three doses) or control (AP + 20 ml/kg/24 h normal saline ip x three doses). Necrotizing AP was induced by retrograde infusion of 5% sodium taurocholate (1.5 ml/kg) into the pancreatic duct. Twenty additional animals were randomized into BB-94 and control groups for the survival study. Serum was evaluated for amylase and MMP activity. Pancreatic sections were graded for edema, necrosis, neutrophil infiltrate, and hemorrhage. Myloperoxidase (MPO) activity was used to determine PMN infiltration in the lung. Evan's Blue dye extravasation was used to quantify vascular permeability. RESULTS: Animals in the BB-94 group had decreased amylase levels (1086.0 +/- 61.7 U/L vs 2232.7 +/- 309.9 U/L; P < 0.05), decreased cellular infiltrate (1.4 +/- 0.2 vs 2.3 +/- 0.2; P < 0.02), and decreased necrosis (4.1 +/- 0.3 vs 6.1 +/- 0.4; P < 0.005) compared to the control group. Lung tissue following pancreatitis in the BB-94 group demonstrated decreased MPO activity (41.5 +/- 2.4 units vs 57.3 +/- 2.9 units; P < 0.05) and decreased vascular permeability (18.3 +/- 2.8 mg/100 g vs 30.1 +/- 4.6 mg/100 g; P < 0.05). Animals treated with BB-94 had 100% survival compared to 50% survival in control at 72 h. CONCLUSIONS: Pancreatitis results in increased local and distant MMP activity. Pulmonary and pancreatic injury following AP can be abrogated by treatment with an MMP inhibitor (Batimistat; BB-94) which may result in decreased morbidity and mortality.  相似文献   

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