胰腺炎相关腹水致胃肠电生理紊乱机制的研究

目的 探讨急性胰腺炎相关腹水对在体胃肠平滑肌电生理和运动的影响及肠道nNOS神经变化。方法以5％牛磺胆酸钠溶液逆行注入胰胆管制作ANP模型．24小时后收集腹腔液低温离心取上清液作为胰腺炎相关腹水。24只Wistar大鼠随机分为正常对照、实验对照、腹水模型组和LNNA治疗组。用Maclab数据分析系统．对肠运动和电信号同时记录。记录后取实验对照组与腹水组距出门15厘米的空肠全层标本，常规制成石蜡切片，SP方法做nNOS免疫组化染色。结果正常组与实验对照组之间空肠运动频率和平均振幅无明显差异；慢波峰值频率和平均振幅与正常组比较差异无显著性（P〉0．05）；腹水组与实验对照组比较运动频率和平均振幅均明显降低（P〈0．05）；慢波峰值频率和平均振幅比正常组差异也有显著性（P〈0．05）并伴有明显节律紊乱；LNNA治疗组慢波频率和运动频率均恢复。但反应空肠收缩的运动指标和慢波平均振幅指标虽然有一定的恢复，但用药前后无显著差异（P〉0．05）。正常肌闻神经丛和粘膜下层可见nNOS阳性神经元和神经纤维，腹水组与实验对照组比较．神经元、神经纤维着色加深差异有显著性（P〈0．05）。结论胰腺炎相关腹水可引起胃肠动力抑制和胃肠电节律紊乱。胰腺炎相关腹水的这种抑制作用可能部分通过增加肠壁肌间神经丛和粘膜下层NANC神经中nNOS的活性。

The Effect of Pancreatitis-associated Ascites on Electro Gastrointestinal Arrhythmia and Its Mechanisms

Objective To investigate the effect on gastrointestinal motility of ascites associated with experimental acute pancreatitis and on electro gastrointestinal arrhythmia in rats and its mechanisms.Methods AP was produced with 5% sodium taurocholate by the method of retrograde pancreatic-injection. At 24hr after the induction of pancreatitis, the rats were sacrificed and the peritoneal exudates were aseptically collected followed by centrifugation at 40C. The supernatants from the rats were combined which were designated as pancreatitis-associated ascitic fluids (PAAF). A total of 24 Wister rats were randomly divided into 4 groups: normal group, sham group, model group and LNNA plus model group. We completed directly A/D change and achieved the computer real-time recording by combining the traditional recording device with Maclab/4e date recording and analysis systems. Furthermore, the nNOS located in enteric neurons was assayed by semi-quantitatived immunohistochemical methods in rat jejunum.Results The frequency and amplitude of the slow wave (SW) of the rat jejunum were inhibited when 5ml PAAF was injected peritoneally after 24 hours (PAAF group); while the percentage of dysrhythmias was increased (P< 0.05),the contractive function of the intestinal smooth muscle were also inhibited more significantly than that of the sham group (P< 0.05),The gray values in the enteric neurons in rat jejunum of the PAAF group were increased obviously than that of the sham group (P< 0.05).Conclusions PAAF has effect on the electro gastrointestinal arrhythmia in rats and the mechanisms may be related with the activation of nNOS in jejunum mesenteric plexus during acute pancreatitis.