吗替麦考酚酯对重症急性胰腺炎血清细胞因子的影响

目的 探讨肿瘤坏死因子（TNF）-α、白细胞介素（IL）-1β和可溶性细胞间黏附分子（sICAM-1）-1 在重症急性胰腺炎（SAP）早期的动态变化及意义,并观察吗替麦考酚酯（MMF）的干预性作用.方法 将104 只雄性Wistar 大鼠随机分成4 组：正常组（（n=8,仅开腹后即缝合）,假手术组（n=32,开腹后仅翻动胰腺并以钝器轻划胰腺组织5 次）,SAP 组（（n=32,逆行胰胆管注射牛黄胆酸钠以建立SAP 模型）,和MMF 组（（n=32,建立SAP 模型后1h 经尾静脉注射MMF 250 mg/kg）.术后3 h、6 h、12 h、24 h 各组分批处死大鼠,采用全自动生化分析仪检测血清淀粉酶（AMS）、血清C 反应蛋白（CRP）;常规HE 染色进行胰腺组织病理学评分;ELISA 法检测血清TNF-α、IL-1β和sICAM-1 的含量.结果 在各时间点,SAP 组的胰腺组织病理评分,血清AMS、CRP,以及TNF-α、IL-1β和sICAM-1 的含量均显著高于正常组、假手术组（均P＜0.05）;而MMF 组的上述数值均显著低于SAP 组（均P＜0.05）.结论 SAP 早期阶段细胞因子的变化与病情进展密切相关,MMF 可通过抑制细胞免疫及炎性细胞因子的产生,减轻炎症损伤反应.

Effects of mycophenolate mofetil on serum cytokines in severe acute pancreatitis:experiment with rats

Objective To observe the dynamic changes and significance of the inflammatory cyctokines： tumor necrosis factor （TNF）-α, interleukin （IL）-1β, and soluble intercellular adhesion molecule-1 （slCAM-1） in severe acute pancreatitis （SAP）, and assess the effects of mycophenolate mofetil （MMF） thereupon Methods one hundred and four Wistar rats were randomly divided into 4 groups： normal group （n=8, only undergoing laporotomy）, sham operation group （n=32, only undergoing gentle flipping of the pancreatic tissue 5 times after laporotomay）, SAP group （n=32, undergoing retrograde injection of sodium taurocholate into the pancreatic duct to induce SAP）, and MMF group （n=32, undergoing retrograde injection of sodium tauroeholate into the pancreatic duct to induce SAP and then injection of MMF 250 mg/kg into the caudal vein one hour later）. 3h, 6h, 12h, and 24h later 2 or 8 rats from each group were killed by abdominal aorta exsangnination respectively. Automatic biochemical detector was used to measure the serum activity of amylase （AMS） and C-reactive protein （CRP）; ELISA was used to measure the concentrations of TNF-α, IL-1β, and slCAM-1. Pathological scoring was conducted on the tissues of pancreas. Results Compared with THE normal and sham operation groups the pancreatic histological score and levels of serum AMS, CRP, TNF-α, IL-1β, and slCAM-1 at different time points of the SAP group were all significantly higher than those of the normal and sham operation groups （allP〈0.05）, and the above mentioned values of the MMF group at different time points were all significantly lower than those of the SAP group （all P〈0.05）. Condtmion Many eytokines play an important role in the early progress of SAP. MMF attenuates the severity of inflammatory response through inhibiting the cellular immunity and regulating the pro-inflammatory cytokines produced.