重症急性胰腺炎并发肺损伤促/抗炎症因子的变化及大黄附子汤的干预研究

目的观察大黄附子汤对重症急性胰腺炎并肺损伤（SAP-ALI）时血清促/抗炎症因子的影响。方法健康长白猪,体重25～30kg,13头,随机分成三组：对照组（n=4）、重症急性胰腺炎肺损伤组（模型组,n=4）、大黄附子汤治疗组（治疗组,n=5）。其中模型组采用主胰管内逆行注入4%牛磺胆酸钠（1ml/kg）诱导SAP-ALI模型。三组均于术后即刻、术后6h、12h、24h、48h、72h取血,ELISA法动态检测血清中促炎因子（TNF-α和IL-1β）、抗炎因子（IL-4）浓度变化,同时动态比浊法测定血清内毒素（LPS）含量。术后72h处死动物,计算肺组织湿/干重比,观察胰腺与肺病理形态学变化。结果模型组6～72h血清淀粉酶、内毒素、TNF-α、IL-1β浓度及肺病理组织学评分均较对照组明显升高（P〈0.05）,IL-4浓度在术后24h开始较对照组逐渐升高（P〈0.05）。治疗组各时间点血清淀粉酶、内毒素、TNF-α、IL-1β浓度均较模型组明显下降（P〈0.05）,但血清IL-4浓度于术后12h出现明显升高,48h达到峰值。结论促炎因子（TNF-α、IL-1β）、抗炎因子（IL-4）及内毒素等共同参与了SAP-ALI的发病过程。大黄附子汤通过降低血清LPS水平,进而下调血清TNF-α及IL-1β表达,上调IL-4表达,减轻SAP-ALI的程度。

Treatment role of Dahuangfuzi decotion on severe pancreatitis-acute lung injury

Objective To investigate the effects of Dahuangfuzi Decotion on serum proinflammatory and anti-inflammatory factors in severe acute pancreatitis and lung injury. Methods Thirteen health Landrace were randomly divided into three groups： control group（ n = 4） ,model group（ n = 4） ,treatment group （ n = 5） . The pigs model of SAP-ALI were induced by injecting 1 ml/kg of 4% sodium taurocholate into the main pancreatic duct. Serum levels of amylase,lipopolysaccharide（ LPS） and TNF-α,IL-1β and IL- 4 by ELISA at once and in 6,12,24,48,72 h after the operation,the wet-to-dry（ W/D） ratio of lung tissues, and pathomorphological changes of pancreatitis and lung tissue here observed. Results Serum concentration of amylase,LPS,TNF-α,IL-1β and pathologic scores of pancreas and lung in model group were significantly higher than those of the control group 6-72 h after sodium taurocholate induction（ P 〈0. 05） . The serum concentration of interleukin-4 in model group were also higher than that of control group 24 h after operation（ P 〈0. 05） . In comparison with model group,serum concentration of amylase,LPS,TNF-α,IL- 1β were significantly decreased in treatment group,but interleukin-4 increased beginning with 12 h after operation,reached the peak at 48 h（ P 〈0. 05） . Conclusions Proinflammatory factor （ TNF-α and IL-1β） , anti-inflammatory factor （ IL-4 ） and LPS participate together in pathogenesis of SAP. Serum levels ofTNF-α,IL-1β were involved in the pathogenesis of SAP-ALI. Dahuangfuzi decoction can significantly reduce the degree of SAP-ALI through inhibiting the elevation of LPS and down-regulating expression of TNF-α,IL- 1β and up-regulating expression of IL-4.