Pancreatic injury in patients with septic shock: A literature review

Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention.     

肠外瘘患者消化液中细菌与酶含量在体外变化的观察

目的 探讨肠外瘘患者消化液中细菌与酶含量在体外的变化.方法 收集1998年7月至2008年1月我院16例高位肠外瘘患者瘘出的新鲜消化液,分别在0、2、4h测定引流液中细菌数量、淀粉酶和脂肪酶的含量.将瘘出的消化液及时回输入远端肠道,同时在肠液回输的0、7、14 d测定患者血清中白蛋白、纤维连接蛋白、转铁蛋白、前白蛋白水平.结果 消化液中细菌数量4h内无增加(F(0,2)=18 812.50,P＞0.05;F(0,4)=387 625.00,P＞0.05).消化液中淀粉酶含量(F(0,2)=190.60,P＞0.05;F(0,4) =631.75,P＞0.05)和脂肪酶含量(F(0,2)=204.10,P＞0.05;F(0,4)=1080.05,P＞0.05) 4h内无变化.肠液回输后患者血清中纤维连接蛋白[0、7、14 d分别为(152.80±16.50)、(167.27±20.54)、(227.05 ±45.36) mg/L; F(0,14) =74.24,P＜0.01; F(7,14)=59.78,P＜0.01]、转铁蛋白[0、7、14 d分别为(2.16 ±0.52)、(2.23 ±0.48)、(2.62±0.41) g/L; F(0,14) =0.46,P＜0.01; F(7,14) =0.39,P＜0.05]、前白蛋白[0、7、14 d分别为(177.74±45.14)、(194.04±49.33)、(232.11±79.57) mg/L;F(0,14) =54.37,P＜0.05]水平显著增加.结论 肠外瘘患者消化液中细菌和酶含量在体外4h内无变化,肠液回输是安全有效的.     

胰蛋白酶原-2检测对急性胰腺炎的诊断价值

目的探讨胰蛋白酶原-2检测对急性胰腺炎的诊断价值。方法采用免疫层析法测定69例急性胰腺炎（AP）患者尿胰蛋白酶原-2,采用免疫抑制法测定胰腺淀粉酶、酶偶联法测定α-淀粉酶。结果69例AP患者中尿胰蛋白酶原-2阳性65例（94．2％）,胰腺淀粉酶阳性63例（91．3％）,α-淀粉酶阳性59例（85．5％）;尿胰蛋白酶原-2诊断AP敏感性94．2％、特异性90．3％;胰腺淀粉酶诊断AP敏感性91．3％、特异性是87．1％;α-淀粉酶诊断AP敏感性85．5％、特异性74．2％。结论尿胰蛋白酶原-2是诊断AP的较好检测指标。     

牛磺胆酸钠致大鼠急性出血坏死性胰腺炎早期胰腺血流的测定

作者以5％的牛磺胆酸钠(Na-Tc)注入大鼠胆胰导管内,引起急性出血坏死性胰腺炎,以注射生理盐水为实验对照组,测定血清脂肪酶和淀粉酶活性,结果注射Na-Tc后3小时此两酶的活性均显著升高,12小时最明显;用~(36)RbCl示踪法测定,显示胰腺血流量和胰组织灌流量于注射Na-Tc后1小时明显升高,并维持较高水平至12小时下降。这些结果提示:Na-Tc致大鼠急性出血坏死性胰腺炎早期胰腺血流量增加,为一般炎症充血反应。     

Sialadenitis with crystalloid formation: A report of six cases diagnosed by fine-needle aspiration

Six cases of sialadenitis diagnosed by fine-needle aspiration contained large numbers of crystalloids. Light microscopy, ultrastructure, and chemical analysis suggest that the crystalloids represent crystallized salivary α-amylase. The inflammatory swelling may mimic benign and/or malignant neoplasms of the salivary glands. Drainage and/or antibiotic therapy may allow surgery to be avoided in these patients.     

Amylase producing lung cancer

Summary A case of the lung cancer associated with marked elevation of serum (7820 IU/l) and of urinary amylase (2225 IU/l) was autopsied. Material was examined histopathologically, electronmicroscopically and biochemically. The pulmonary tumor tissues showed histological pattern of papillary adenocarcinoma. In addition to the small round bodies which were very similar to secretory glanules, many large round bodies were noticed, diffusely distributed in the tumor cell. These large round bodies ranged from 0.2 to 0.7 m in diameter and showed a lamellar or annular pattern. The soluble phase of the homogenized pulmonary tumor tissues had an amylase level of 11,300 IU/g of protein, which consisted of S-type isoamylase with minor components. Cholesterol, triglyceride and phospholipid were also present at greater concentration in the tumor tissue than the normal pulmonary tissue. The large round bodies appeared too, to be amylase including bodies from the electronmicroscopical and biochemical findings.     

Lipase and pancreatic amylase versus total amylase as biomarkers of pancreatitis: an analytical investigation

OBJECTIVE: To evaluate the biomarkers of pancreatitis Colorimetric Lipase, Total Amylase and Pancreatic Amylase (immunoinhibition) assays on the Roche COBAS INTEGRA 700. RESULTS: Pancreatic and Total Amylase assays and Colorimetric Lipase showed excellent imprecision of 1.6 to 2.3% and linearity (slope = 0.94-0.99, y-intercepts-1 to +3 U/L, r = 0.999) over the range of 17 to 900, 35 to 880, and 21 to 150 U/L, respectively. There was an excellent correlation between Pancreatic and Total Amylase: Pancreatic Amylase = 0.99 (+/- 0.02) x Total Amylase-36(+/- 8) (n = 106, r = 0.97, p < 1 x 10(-5), y intercept p < 1 x 10(-5)). Colorimetric Lipase showed some correlation to Total and Pancreatic Amylase results: Colorimetric Lipase = 1.54 (+/- 0.16) x Total Amylase-81(+/- 37) (n = 100, r = 0.70, p < 1 x 10(-6), y intercept p = 0.03), and Colorimetric Lipase = 1.78 (+/- 0.15) x Pancreatic Amylase-50(+/- 29) (n = 99, r = 0.78, p < 1 x 10(-6), y intercept p = 0.09). CONCLUSION: We recommend running the more specific Pancreatic Amylase as biomarker of pancreatitis on the Roche COBAS INTEGRA.     

重组人生长激素对大鼠急性胰腺炎的治疗作用

目的观察重组人生长激素(rhGH)对大鼠急性胰腺炎(AP)的治疗并探讨其机制。方法ipE.coli复制大鼠AP模型。42只健康♀SD大鼠随机分为对照组(C组)、急性胰腺炎组(AP组)及rhGH治疗组(T组)。AP、T组再按观察时点分为1、3 d两个亚组。C组ip 15 m.lkg-1生理盐水;AP组ip 15 m.lkg-1E.coli(1×1010CFU.L-1)后立即im生理盐水;T组于ipE.coli后立即im 2.25 U.kg-.1d-1rhGH。观察胰腺的病变程度并进行评分,测定血清淀粉酶的活性,免疫组化检测胰腺组织中ICAM-1蛋白的表达及NF-κB核的阳性率。结果AP两亚组胰腺组织病理评分、血清淀粉酶活性、ICAM-1蛋白表达及NF-κB核阳性率均明显高于C组水平(P<0.05);rhGH治疗能明显降低上述指标水平,尤以T3d组降低最为显著。结论rh-GH治疗能明显减轻大鼠急性胰腺炎的损伤程度,其机制可能与降低NF-κB活化程度及ICAM-1蛋白的表达水平等有关。     

早产母乳中淀粉酶活性观察

目的观察不同哺乳阶段早产儿母乳中淀粉酶活性变化,并与足月儿母乳作比较。方法测定36例早产儿乳母和40名足月儿乳母不同泌乳期母乳中淀粉酶活性。结果早产儿乳母其初乳淀粉酶活性较高,为10232.93±1·48IU/L,随着泌乳期的延长,淀粉酶活性逐渐下降。与足月儿母乳相似,早产儿母乳淀粉酶98%为唾液型淀粉酶。不同胎龄早产儿其母乳淀粉酶活性均值较接近,差异无统计学意义。分别比较早产和足月母乳在各泌乳阶段的淀粉酶活性显示,在任何一阶段,早产母乳淀粉酶活性的绝对值略高于足月母乳,但差异无统计学意义,P均>0·05。结论早产儿母乳含有较高活性的淀粉酶,对早产儿的淀粉消化和潜在的抗感染作用具有重要意义,应鼓励对早产儿进行母乳喂养。