乌司他丁联合清胰汤治疗急性重症胰腺炎大鼠的实验研究

目的观察乌司他丁联合清胰汤对急性重症胰腺炎大鼠模型血淀粉酶和胰腺病理学的影响，为临床应用提供依据。方法SD大鼠90只，体质量（271．59±11．13）g，雄性，常规适应性喂养1周，实验前12h禁食，自由饮水。随机分成5组：假手术组；急性重症胰腺炎组；清胰汤治疗组；乌司他丁治疗组；联合治疗组；每组18只。并将各组随机分成6、12、24h3个亚组，每个亚组6只。急性重症胰腺炎模型组经胰胆管逆行注入5％牛磺胆酸钠（0．1ml／100g），假手术组胰胆管不穿刺、注药，仅翻动胰腺；乌司他丁治疗组、清胰汤治疗组、联合治疗组的大鼠分别于造模成功即刻、5h、11h给予尾静脉注射乌司他丁20000U／kg，清胰汤（1ml／100g）灌胃及两药联合治疗。动态观察记录各组及亚组（6h、12h、24h）血清淀粉酶，并同步取胰腺组织观察其大体及光镜下病理学变化情况。结果急性重症胰腺炎组6、12、24h各时间点血清血清淀粉酶值（16518±327）、（16796±338）、（1554±373）U／L]与假手术组（1671±175）、（1751±223）、（1724±187）U／L]比较明显升高，差异有统计学意义（F值分别为3296．24、3802．44、2382．54，P均〈0．01）；与急性重症胰腺炎组比较，乌司他丁治疗组、清胰汤治疗组血清血清淀粉酶值降低，与急性重症胰腺炎组比较差异有统计学意义（P〈0．01）；与清胰汤治疗组、乌司他丁治疗组比较，联合治疗组血清血清淀粉酶降低；差异有统计学意义（P〈0．05）；胰腺病理评分清胰汤组、乌司他丁组和联合治疗组各时间点与急性重症胰腺炎组比较逐渐降低，以联合治疗组下降最明显，差异有统计学意义（P〈0．01）。结论联合治疗组血清各指标及胰腺组织病理评分与单一药物治疗组比较差异有统计学意义，提示联合治疗效果优于单一中药或西药。

Experimental study on ulinastatin combined with qingyitang in treatment of severe acute pancreatitis of rats

Objective To investigate the changes of serum concentration of amylase （AMY）and pathological of pancreas in severe acute pancreatitis of SD-rats treated with Ulinastatin combined with qingyitang and to provide the basis for clinical application. Methods Ninty male SD-rats with average weight of（271.59 ± 11.13 ）g were conventional feeding for a week. Twelve hours before experiment, they were forbidden to take food. They were randomly divided into five groups （with 18 in every group） ：sham operation group, severe acute panereatitis group, Ulinastatin treated group, qingyitang treated group, Ulinastatin combined with qingyitang treated group. Then eighteen rats in every group were divided randomly into 6 h, 12 h and 24 h groups with six rats in each group. Severe acute panereatitis model was created by retrograde injection of 5% sodium tauroeholate （0. 1 ml/100 g） through pancreatic duct,in sham operation group,only pancreas were flipped. The three treated groups were treated with vein injection of Ulinastatin （20 000 U/kg）or qingyitang perfusion （1 ml/100 g）or Ulinastatin combined with qingyitangat 0 h, 5 h and 11 h after severe acute pancreatitis model successfully created. AMY and patholigieal changes of pancreas were measured. Results There was significant difference on AMY level at 6 h, 12 h and 24 h between severe acute pancreatitis group and sham operation group 6 h： （16 518 ±327）U/L vs（1671 ±175）U/L,F=3296.24,P〈0. 01;12 h：（16 796 ± 338） U/L vs（1751 ±223） U/L,F = 3802. 44,P 〈0. 01 ;24 h： （1554 ±373） U/L vs（ 1724 ± 187） U/L,F =2382. 54,P 〈0. 01 ]. Compared with severe acute pancreatitis group, the AMY level and pathologic score both decreased significantly in Ulinastatin treated group, qingyitang treated group and Ulinastatin combined with qingyitang treated group （ P 〈 0.05 or P 〈 0. 01 ）. At the same time, the AMY level and pathologic score both decreased more in Ulinastatin combined with qingyitang treated group than Ulinastatin treated group and qingyitang treated group（P 〈0.05 or P 〈 0. 01 ）. Conclusion Combination of Ulinastatin with qingyitang in treatment of severe acute pancreatitis of rats is superior to treatment with single medicine.