大鼠重症急性胰腺炎MODS免疫改变及药物影响

目的:观察不同药物对重症急性胰腺炎(SAP)免疫功能的影响。方法:建立大鼠SAP-MODS模型,分别予地塞米松、乌司他丁、善宁、二硫代氨基甲酸吡咯烷(PDTC)及中药莱菔承气汤治疗。观察各组一般情况及死亡率,术后24h血清淀粉酶、TNF-α、IL-6、IL-10及血浆内毒素水平,流式细胞仪对脾脏T淋巴细胞亚群比例及凋亡情况进行三色荧光分析,并取胰腺、肺、肾、肝脏组织行病理学检查。结果:地塞米松可明显降低促炎细胞因子TNF-α和IL-6水平,但同时也使SAP大鼠CD4T细胞的异常凋亡进一步增加,加剧免疫功能障碍。善宁及PDTC可降低TNF-α和IL-6水平,对T细胞功能无明显影响。乌司他丁和莱菔承气汤则可同时降低促炎细胞因子TNF-α、IL-6及抗炎细胞因子IL-10水平,减少CD4+T细胞异常凋亡、改善细胞免疫功能,明显降低死亡率、减轻脏器损伤;只有莱菔承气汤可显著降低血浆内毒素水平。结论:乌司他丁和莱菔承气汤有助于调节促炎/抗炎反应机制平衡、改善机体免疫功能,地塞米松可加剧SAP免疫损伤。

Effect of Different Drugs on Immune Function of Rats in Severe Acute Pancreatitis

Objective To observe the different effects of drugs on immune function in SAP.Methods SAP-MODS model in rats was established, then treated with dexamethasone（DXM）, ulinastatin, octreotide, PDTC or LaiFuChengQiTAng（LFCQ） respectively.The blood levels of amylase, endotoxin and cytokines including TNF-α, IL-6 and IL-10 were measured after 24 h.T lymphocyte subsets of the spleen with their apoptotic rate were measured by Flow Cytometry.Pathologic changes of the pancreas, liver, lung and kidney were also detected.Results DXM decreased the levels of TNF-α and IL-6.At the same time, the abnormal apoptosis rate of CD4＋ T lymphocytes increased all the more, leading to deeper immune disorder.Octreotide and PDTC could decrease TNF-αand IL-6 but no effects on T lymphocyte function.Ulinastatin and LFCQ decreased the levels of inflammatory cytokines（TNF-αand IL-6） and anti-inflammatory cytokine（IL-10） simultaneously;and the abnormal apoptosis rate of CD4＋ T lymphocytes decreased obviously, the mortality rate and pathologic injury reduced either.LFCQ showed the only effect on eliminating endotoxin.Conclusion DXM aggravates immune disorder in SAP, Ulinastatin and LFCQ are helpful in regulating the balance of inflammation and anti-inflammatory response and also improving immune function.