不同时段静脉滴注乌司他丁预防ERCP术后胰腺炎效果分析

目的 探讨不同给药时间静脉滴注不同剂量乌司他丁对预防ERCP术后胰腺炎的效果.方法 选取88例行ERCP术的患者,平均分为4组,分别在术前3d、术前1d及术中给予45万U和15万U乌司他丁静脉滴注,观察4组患者术后阳性率、尿淀粉酶恢复正常天数及术后淀粉酶水平.结果 术前3d组ERCP术后患者血液中TNF-α、IL-6与CRP含量明显低于其他3组（P＜0.05）;其他3组ERCP术后血液中三项指标含量比较差异无统计学意义（P＞0.05）.术前3 d组及术中45万组患者术后阳性率、尿淀粉酶恢复正常天数低于术前1d组及术中15万U组患者（P＜0.05）;术前3d组与术中45万U组相比差异无统计学意义（P＞0.05）.术前3d组及术中45万组患者术后1d尿淀粉酶值明显低于术前1d组及术中15万U组患者（P＜0.05）;术前3d组与术中45万U组尿淀粉酶值差异无统计学意义（P＞0.05）;术后2d及3d4组之间尿淀粉酶值差异无统计学意义（P＞0.05）.结论 术前3d应用15万U乌司他丁乌司他丁预防ERCP术后胰腺炎效果最佳.     

Intraoperative amylase level of pancreatic juice as a simple predictor of pancreatic fistula after pancreaticoduodenectomy

IntroductionA soft remnant texture of the pancreas is commonly accepted as a risk factor for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). However, its assessment is subjective. The aim of this study was to evaluate the significance of intraoperative amylase level of the pancreatic juice as a risk factor of POPF after PD.MethodThis study included 75 patients who underwent PD between November 2014 and April 2020 at Jikei University Hospital. We investigated the relationship between pancreatic texture, intraoperative amylase level of pancreatic juice, results of the pathological evaluations, and the incidence of POPF.ResultsTwenty-three patients (31%) developed POPF. The significant predictors of POPF were non-ductal adenocarcinoma (p < 0.01), soft pancreatic remnant (p < 0.01), high intraoperative blood loss (p < 0.01), high intraoperative amylase level of pancreatic juice (p < 0.01), and low pancreatic fibrosis (p < 0.01). Multivariate analysis revealed that the significant independent predictors of POPF were high intraoperative blood loss (p < 0.01) and high intraoperative amylase level of pancreatic juice (p = 0.02). Receiver operating characteristic (ROC) analysis showed that the cut-off value for the intraoperative amylase level of pancreatic juice was 2.17 × 10⁵ IU/L (area under the curve = 0.726, sensitivity = 95.7%, and specificity = 50.0%)ConclusionsThe intraoperative amylase level of pancreatic juice is a reliable objective predictor for POPF after PD.     

Pancreatic Secretory Proteins in Sera from Rats before and after Induction of Experimental Pancreatitis

This study has traced the behavior of rat anionic trypsin-like immunoreactivity and pancreatic secretory trypsin inhibitor (PSTI) immunoreactivity in the serum of rats undergoing bile-pancreatic duct infusions of buffered solutions with and without the addition of the bile salt taurocholate. Enzymatic analysis of α-amylase was also done. A mild pancreatic inflammation followed infusion of buffer alone, as determined by gross inspection of the pancreas and the behavior of serum levels of the above proteins. Animals infused with buffer and 4% taurocholate had major inflammatory changes, including gross hemorrhage into the gland, and marked elevations in serum levels of the three proteins studied. Graphic analysis of the serum levels revealed distinct sharp rises in the serum levels of all three proteins in the taurocholate group. In the buffered saline group only an initial sharp rise was present, followed by a prolonged decrease back towards base-line values. The immunoreactive trypsin in the taurocholate group was present in three fractions with different molecular weights: trypsin in complex with protease inhibitors, trypsinogen, and degradation products. PSTI immunoreactivity showed the molecular size of free inhibitor and that of degradation products. The presence of trypsin in complex with protease inhibitors indicates the formation of active trypsin during acute pancreatitis, which is further supported by the presence of degradation products of trypsin and PSTI.     

胰蛋白酶原-2在AP诊断中的作用及与淀粉酶和脂肪酶的对比实验

目的:探讨尿胰蛋白酶原-2在急诊急性胰腺炎(AP)诊断中的应用及与淀粉酶、脂肪酶的比较。方法:尿胰蛋白酶原-2采用免疫层析法,淀粉酶采用PNP-G7法,脂肪酶采用比浊法。对急诊AP病人59例在入院时进行上述三个项目的测定。对照组为诊断为非胰腺炎的病人。结果:AP患者中有58例胰蛋白酶原-2为阳性,诊断敏感性、特异性、阳性预期值和阴性预期值分别达到98.3%、92%、93.5%和97.9%,明显高于淀粉酶和脂肪酶,AP组和对照组差别有统计学意义。结论:胰蛋白酶原-2具有简便、快速、准确的优点,是急诊诊断AP的一个良好的指标。     

尿胰蛋白酶原-2对诊断急性胰腺炎的临床意义

目的:探讨快速试纸法检测尿胰蛋白酶原2在急性胰腺炎(acutepancreatitis,AP)诊断中的临床意义。方法:对38例AP患者(其中重型AP12例,轻型AP26例)及35例其他急腹症患者的血清和尿液标本分别测定尿胰蛋白酶原2和血、尿淀粉酶(AMY)活性,并将结果进行比较。结果:尿胰蛋白酶原-2检测对AP诊断的敏感性、特异性分别为94.7%和93.6%,血AMY为81.6%和79.5%,尿AMY为71.4%和70.8%。尿胰蛋白酶原2的敏感性和特异性高于血、尿AMY检测。结论:快速试纸法检测尿胰蛋白酶原-2诊断AP具有较高的特异性和敏感性,是筛选AP简便而快速的方法。     

Isoamylases in diabetes mellitus

Summary We have evaluated the relationship between diabetes mellitus and exocrine pancreatic insufficiency in diabetic subjects by measuring a specific isoamylase arising from the pancreas. The pancreatic- and salivary-type isoamylase activity in serum and urine were evaluated and related to duration of disease, sex, age, weight, blood glucose level and glycosuria in 153 diabetics. In the insulin-dependent diabetics diagnosed between 15 and 24 years of age, a significant decrease in pancreatic isoamylase activity was found in serum and urine (means with 2 SD range, 50 U/l, 19–137 U/l, and 47 U/l, 4–607 U/l, respectively), as compared with control subjects (79 U/l, 45–140 U/l, and 183 U/l, 43–789 U/l, respectively). In this group of patients a low stimulated output of amylase into the duodenum was also observed (mean with range, 537 U, 87–1808 U), compared with controls (the lower limit of normal 2183 U). A significant positive correlation was found between stimulated output of amylase into the duodenum and pancreatic isoamylase activity in serum (r = 0.84, p < 0.01). In the non-insulin dependent diabetics, a significant negative correlation was found between blood glucose levels and pancreatic isoamylase activity in serum (r = -0.46, p < 0.01). In the diet-treated non-insulin dependent diabetics the pancreatic isoamylase activity in serum was increased compared with controls (mean and 2 SD range, 102 U/l, 49–211 U/l). In patients with blood glucose level above 12 mmol/l, however, a lowered pancreatic isoamylase activity in serum, and no apparent rise in serum immunoreactive insulin in glucose loading test was observed. The results suggest that production of pancreatic amylase is related to endocrine pancreatic function in diabetes mellitus.     

Latent period for symptomatic sensitization in bakeries

AIM: To describe the latent period for symptomatic sensitization in bread bakery workers. METHODS: Data on the latent period for symptomatic sensitization, resulting in either asthma or rhinitis, were obtained from an in-house health surveillance programme in a single large organization. RESULTS: Over a period of 10 years, 90 employees were identified with symptoms attributable to sensitization. The mean latent period was 7.3 years, with three employees describing the onset of symptoms in their first year of exposure. CONCLUSIONS: The long latent period, typically more than 1 year, suggests that health surveillance on appointment and then at annual intervals thereafter should be adequate to identify affected individuals in a bakery environment.     

An embryonic chick pancreas organ culture model: characterization and neural control of exocrine release

An embryonic chick (Gallus domesticus) whole-organ pancreas culture system was developed for use as an in vitro model to study cholinergic regulation of exocrine pancreatic function. The culture system was examined for characteristic exocrine function and viability by measuring enzyme release, and noting histological, morphological, and anti-amylase immuno-fluorescence staining changes over a series of incubation times. This embryonic culture system exhibits loss of viability and morphological degeneration after 12 h of incubation time. Characterization and development of this exocrine model system was an important aspect of this study. Assessment of the 18-day-old embryonic chick pancreas model clearly indicated biochemical and cholinergic functionality, and morphological integrity, of the tissue after 4-h incubation. This embryonic age and incubation period were utilized for all subsequent cholinergic studies. The in vitro model was used to study parasympathetic regulation of exocrine function via the muscarinc receptors present in the embryonic chick pancreas. The effects of synthetic muscarinic agonists (bethanechol and carbachol) and subtype-specific antagonists affected amylase release to varying degrees suggesting heterogeneity of receptors. The effects of the muscarinic receptor antagonists atropine (non-specific), pirenzepine (M(1)-selective) and 4-DAMP [4-diphenylacetoxy-N-methyl-piperidine methiodide] (M(3)-selective) on bethanechol-stimulated amylase release were examined. Atropine and 4-DAMP at concentrations of 2 microM and higher significantly inhibited (p<0.05) agonist-stimulated amylase release, while pirenzipine did not at 2 microM, but did at 200 microM. The M(3) subtype selective antagonist 4-DAMP (2 pM-2 mM) significantly inhibited (p<0.05) 5 mM bethanechol-stimulated amylase release at concentrations of 2 microM and greater (amylase activity decreased from 100.61 to 49.41 U/l/mg). The data suggest the existence of a muscarinic receptor subtype for the embryonic chick pancreas exocrine cells characteristic to the mammalian M(3) glandular subtype.