奥曲肽作用大鼠急性胰腺炎胰腺病理改变及对淀粉酶分泌影响

目的：观察奥曲肽作用于大鼠急性坏死性胰腺炎(ANP)胰腺组织的病理改变及对血液、腹腔液、尿液淀粉酶的影响。方法：实验研究分A、B、C三组，每组8只，共24只，采用随机分配原则分组。A组：空白对照组；B组：ANP模型组：C组：奥曲肽治疗组。通过光镜及透射电镜观察各组胰腺组织的病理改变，同时测定各组血液、腹腔液及尿液中淀粉酶含量。结果：实验性大鼠急性坏死性胰腺炎时胰腺组织充血、水肿、坏死明显，线粒体明显肿胀，嵴消失，间质中可见酶原颗粒，使用奥曲肽治疗时上述变化明显减轻，间质中未见到酶原颗粒积聚。大鼠急性坏死性胰腺炎时血液、尿液淀粉酶水平有下降趋势，但尚无显著差异；腹腔液淀粉酶则有显著下降。结论：奥曲肽作用于大鼠急性坏死性胰腺炎时可减轻胰腺组织充血、水肿及坏死的程度，同时可减少胰腺组织腺泡细胞淀粉酶向腹腔内分泌。     

Pancreatitis coincident with Crohn's ileocolitis

A young woman who developed acute pancreatitis coincident with Crohn's disease is presented. The pancreatitis was documented by pancreatic hyperamylasemia, elevated urine amylase activity, abdominal sonogram, computed tomography, and laparotomy. A cause-and-effect relationship has not been established, however; no etiology other than the Crohn's disease, which was confined to the ileum and colon, could be identified. Surgical removal of the severely involved ileum led to the resolutionof the pancreatitis. A possible relationship between acute pancreatitis and Crohn's disease is proposed, although potential pathophysiologic mechanisms are unknown. The diagnosis of pancreatic involvement in such cases may make an important contribution to therapy.     

急性胰腺炎的早期实验诊断和严重程度判断

目的 探索急性胰腺炎早期诊断和病情严重程度的实验室检测指标.方法 以82例急性腹痛,其中急性胰腺炎39例(急性重型胰腺炎14例和急性轻型胰腺炎25例)和非胰腺急腹症43例,30例健康者为受试者;测定所有受试者血清淀粉酶(Amy)、脂肪酶(Lip)、白介素-6(IL-6),白介素-8(IL-8)和C-反应蛋白(CRP)浓度.结果 方差分析(F检验)显示5个标记物在所观察的疾病组间均存在明显统计学差异(P=0.000).ROC曲线分析显示:对急性胰腺炎的早期诊断,Amy(cut off=93U/L)和Lip(cut off=229U/L)有较高的敏感度(Se),均是94.9%,Lip还有较高的特异性(Sp)是82.2%.曲线下的面积(AUC)分别是0.961和0.935,优于其它标记物.对判断急性胰腺炎的严重度,CRP(cut off=12.3mg/L)和IL-6(cut off=6.5μg/L)的敏感度相近,分别是92.9%和92.7%,IL-8(cut off=76.8μg/L)次之,Se为89.6%,但Sp最高为100.0%.IL-6和IL-8之AUC分别是0.931和0.977,优于其它标记物.结论 Amy和Lip可能是急性胰腺炎的早期诊断指标,IL-6和IL-8可能是其严重程度的判断指标.联合检测Amy(和/或Lip)和IL-6(和/或IL-8)有利于急性胰腺炎的早期诊断和严重度判断.     

AMYLASE CONTENT OF MIXED SALIVA IN CHILDREN

Abstract. Rossiter, M. A., Barrowman, J. A., Dand, A. and Wharton, B. A. (Queen Elizabeth Hospital for Children, Hackney Road, London E.2 and the London Hospital, Whitechapel, London, E.l., England). Amylase content of mixed saliva in children. Acta Paediatr Scand, 63: 389, 1974.–Salivary amylase levels were determined in normal subjects from birth until adult life and in children with conditions sometimes associated with low pancreatic amylase such as malnutrition, coeliac disease and cystic fibrosis. Mixed saliva was collected under carefully standardised conditions and amylase was measured by the method of Dahlqvist. There was a wide scatter of values in the 84 normal subjects, but concentrations rose from very low levels at birth to reach adult levels by the age of 6 months to 1 year. Salivary amylase activity rose normally over ten weeks in one premature infant fed milk by gastrostomy. Thirteen children with coeliac disease and 9 children with cystic fibrosis mostly had normal salivary amylase concentrations. Six out of 12 malnourished children with jejunal villous atrophy of uncertain aetiology had low levels which rose to normal as recovery began.     

血尿淀粉酶检验指标在急性胰腺炎诊断中的应用

目的：运用实验室血尿淀粉酶检验指标对急性胰腺炎的诊断提供参考。方法：观察我院2010-2011年收治的急性胰腺炎患者19N,探讨在不同的病变过程中血尿淀粉酶的变化情况。结果：19例急性胰腺炎患者血尿淀粉酶测定指标都不同程度的高出正常值,其中有2例误诊。结论：急性胰腺炎（Ap）起病急,发展迅速,演变复杂,临床表现不典型,容易误诊,导致不良后果。因此,凡遇突然发作的持续性腹痛,应详细询问病史,认真查体,结合血尿淀粉酶测定,综合分析,可减少误诊。     

Transtracheal puncture: a forgotten procedure

Transtracheal puncture has long been known as a safe, low-cost procedure. However,with the advent of bronchoscopy, it has largely been forgotten. Two researchers havesuggested the use of α-amylase activity to diagnose salivary aspiration, but thenormal values of this enzyme in tracheobronchial secretions are unknown. We aimed todefine the normal values of α-amylase activity in tracheobronchial secretions andverify the rate of major complications of transtracheal puncture. From October 2009to June 2011, we prospectively evaluated 118 patients without clinical orradiological signs of salivary aspiration who underwent transtracheal puncture beforebronchoscopy. The patients were sedated with a solution of lidocaine and diazepamuntil they reached a Ramsay sedation score of 2 or 3. We then cleaned the cervicalregion and anesthetized the superficial planes with lidocaine. Next, we injected 10mL of 2% lidocaine into the tracheobronchial tree. Finally, we injected 10 mL ofnormal saline into the tracheobronchial tree and immediately aspirated the salinewith maximum vacuum pressure to collect samples for measurement of the α-amylaselevel. The α-amylase level mean ± SE, median, and range were 1914 ± 240, 1056, and24-10,000 IU/L, respectively. No major complications (peripheral desaturation,subcutaneous emphysema, cardiac arrhythmia, or hemoptysis) occurred among 118patients who underwent this procedure. Transtracheal aspiration is a safe, low-costprocedure. We herein define for the first time the normal α-amylase levels in thetracheobronchial secretions of humans.     

CAPD患者腹膜电荷屏障与腹膜透析液蛋白质丢失的关系

目的测定持续非卧床腹膜透析（CAPD）患者腹膜电荷屏障,并对原发病为糖尿病肾病（DN）与慢性肾小球肾炎（CGN）的CAPD患者的腹膜电荷屏障以及腹膜透析液蛋白进行比较,进而探讨CAPD患者腹膜电荷屏障与腹膜透析液蛋白丢失的相关性。方法选择32例CAPD患者,收集血清以及腹膜透析液,采用清除法测定胰淀粉酶清除率（Cpam）以及唾液淀粉酶的清除率（Csam）的比值（Cpam/Csam）用以评价腹膜电荷屏障;同时测定腹膜透析液蛋白的丢失量。结果①32例CAPD患者腹膜Cpam/Csam的比值为（6.296±21.514）;腹膜透析液蛋白为（4.14±1.91）g;②CGN组腹膜透析液蛋白显著低于DN组[（4.35±1.88）g比（5.61±0.86）g,P=0.011〈0.05];而CGN组Cpam/Csam的比值显著高于DN组[（9.94±28.35）比（0.68±0.86）,P=0.017〈0.05]。③所有患者Cpam/Csam与腹膜透析液蛋白丢失量之间具有显著负相关,相关系数为-0.584,P〈0.01。而且其自然对数与腹膜透析液蛋白丢失量呈直线负相关。结论CAPD患者腹膜电荷屏障的丢失可增加腹膜透析液蛋白的漏出。     

诊断急性胰腺炎的生化检测指标评析

目的通过检测血淀粉酶（S-Amy）、胰脂肪酶（LPS）、C反应蛋白（CRP）及尿淀粉酶（U—Amy）、尿胰蛋白酶原激活肽（TAP）5项生化指标,探讨急性胰腺炎（AP）早期诊断及病情评估的有效指标。方法将541例急腹症患者分为AP组和非AP组,其中AP组分为轻症AP（MAP）和重症AP（SAP）,同时选取80例健康体检者作为正常对照组,于患者人院后6h内采集静脉血并留取新鲜尿液,对各组5项生化指标进行检测和分析。S-Amy,U—Amy、LPS采用速率法,TAP、CRP采用EusA法。结果S-Amy、U—Amy和TAP水平在AP组最高,非AP组次之,正常对照组最低,各组之间差异均具有统计学意义（P〈0．01）。AP组LPS水平较非AP组及正常对照组显著增高（P〈0．01）。AP组与非AP组CRP水平均较正常对照组增高（P〈0．01）,但AP组CRP水平与非AP组比较无显著差异。SAP组U—Amy、TAP及CRP水平显著高于MAP组（P〈0．01）,而S-Amy、LPS水平在这两组间无显著差异（P〉0．05）。LPS用于AP早期诊断的敏感度为92．1％、特异度为91．6oA,显著高于S—Amy、U—Amy、TAP及CRP。结论血、尿淀粉酶、LPS指标对于AP的早期诊断具有重要意义,TAP和CRP有助于评估病变的严重程度、观察疗效及评估预后。