CO_2气腹对SD大鼠重症急性胰腺炎炎性细胞因子的表达及胰腺病理变化的影响

目的探讨腹腔镜手术时CO2气腹对SD大鼠重症急性胰腺炎(severe acute pancretitis,SAP)胰腺局部病变及血淀粉酶、炎症细胞因子IL-6、TNF-α、C-反应蛋白(C-reactive protein,CRP)及核转录因子-κB(NF-κB)的影响。方法雄性SD大鼠50只,随机分为3组:Ⅰ组20只(CO2组,5%牛磺胆酸钠胆胰管逆行注射方法建立SAP动物模型后,腹腔镜气腹机向大鼠腹腔内注入CO2,压力12mm Hg,维持30min);Ⅱ组20只(开腹组,建立SAP动物模型后关腹,不充入CO2);Ⅲ组10只(对照组,仅开腹翻动胰腺后关腹)。各组均于术后2.5h处死动物,测定血淀粉酶、IL-6、TNF-α及CRP的变化,进行胰腺组织病理学检查,并用免疫组化法检测NF-κB的变化。结果Ⅰ、Ⅱ、Ⅲ组病理组织学评分值分别为(1.90±0.37)分、(1.75±0.26)分、(0.00±0.00)分,差异有统计学意义(F=365.91,P=0.000),但Ⅰ组与Ⅱ组比较,差异无统计学意义(q=2.372,P0.05)。与Ⅲ组相比,Ⅰ组和Ⅱ组血清淀粉酶、IL-6、TNF-α均明显升高(P0.05)。与Ⅱ组相比,Ⅰ组IL-6降低(P0.05),淀粉酶明显升高(P0.05),Ⅰ组与Ⅱ组TNF-α、CRP差异无统计学意义(P0.05)。Ⅰ、Ⅱ组与Ⅲ组NF-κB阳性表达值分别为3.91±0.81、3.55±0.76、0.92±0.51,差异有显著性(F=56.59,P=0.000),Ⅰ组与Ⅱ组比较,NF-κB表达差异有统计学意义(q=3.387,P0.05),Ⅰ、Ⅱ组与Ⅲ组比较,NF-κb阳性表达值有显著性差异(q=14.764,P0.05;q=11.999,P0.05)。结论CO2气腹对SD大鼠SAP胰腺病理变化无明显影响。SAP时CO2气腹对SD大鼠TNF-α、CRP的表达无明显影响,对IL-6的表达有一定的抑制作用,能增强NF-κB阳性表达。

Effect of Carbon Dioxide Pneumoperitoneum on the Expression of Proinflammatory Cytokines and Histopathological Changes of the Pancreas in SD Rats with Severe Acute Pancreatitis

Objective To examine the effect of carbon dioxide pneumoperitoneum on local pathological changes of the pancreas,as well as the levels of serum amylase,IL-6,TNF-α,CRP,and NF-κB in SD rats with severe acute pancreatitis（SAP）.Methods A total of 50 healthy male SD rats were randomly divided into 3 groups：Group Ⅰ（20 rats）：CO2 pneumoperitoneum group,SAP was induced by injecting 5% sodium taurocholate retrogradely through the common bilio-pancreatic duct,afterwards,CO2 pneumoperitoneum was established at 12 mm Hg and maintained for 30 min;Group Ⅱ（20 rats）：laparotomy group,no CO2 was infused after the SAP sample was established;Group Ⅲ（10 rats）：sham operation group,abdomen was opened for 30 minutes without any treatments.Two and a half hours after the surgical procedures,the animals were killed and the blood samples were gathered to determine the levels of serum amylase,IL-6,TNF-α,CRP,and NF-κB;pancreatic tissues was collected as well for histopathologic examination.Results The mean histopathological score of the GroupsⅠ and Ⅱ was significantly higher than that of the Group Ⅲ（1.90±0.37 and 1.75±0.26 vs 0.00±0.00,F=365.91,P=0.000）,no significant difference was detected between the Groups Ⅰ and Ⅱ（q=2.372,P〉0.05）.The levels of serum amylase,IL-6,and TNF-α in Group Ⅲ were significantly lower than those in the Groups Ⅰ and Ⅱ（P〈0.05）.Compared with those in the Group Ⅱ,Group Ⅰ showed significantly lower IL-6 level,but significantly higher serum concentration of amylase（P〈0.05 for both）.No significant difference was observed in TNF-α and CRP levels between Groups Ⅰ and Ⅱ（P〉0.05）.The expression level of NF-κB was significantly different among the Groups Ⅰ,Ⅱ,and Ⅲ（3.91±0.81,3.55±0.76,and 0.92±0.51,respectively;F=56.59,P=0.000;Group Ⅰ vs Ⅱ：q=3.387,P〈0.05;Groups Ⅰ vs Ⅲ：q=14.764,P〈0.05;Groups Ⅱ vs Ⅲ：q=11.999,P〈0.05）.Conclusions CO2 pneumoperitoneum has no adverse effects on the histopathology of the pancreas and the expressions of TNF-α and CRP in SD rats with SAP;whereas it can inhibit the expression of IL-6,while increase the expression of NF-κB.