Schmidt J, Lewandrowsi K, Warshaw A L, Compton C C, Rattner D W
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Int J Pancreatol. 1992 Aug;12(1):41-51. doi: 10.1007/BF02927069.
Extreme maldistribution and immediate establishment of severe cellular injury are typical features of traditional bile salt models of acute pancreatitis; both factors complicate assessment and interpretation of therapeutic benefits in trials of experimental therapy. Even more important, both are indications not of the desired induction of pancreatitis but rather of local injury by barotrauma and noxious chemicals. This study contrasts the severity and regional variability of cellular injury in traditional high-dose bile salt models with that seen in a new preparation employing the combination of intravenous (iv) caerulein (CAE) and intraductal (id) low-dose glycodeoxycholic acid (GDOC). Thirty-six male Sprague-Dawley rats (350-450 g) were induced with (group A) high-dose GDOC id (34 mmol/L), low-dose GDOC id (10 mmol/L) (group B), or low-dose GDOC id combined with caerulein iv for 6 h (group C). The regional distribution of histopathologic injury within the pancreas was assessed in 20 fields/organ by two pathologists unaware of the induction technique used. High-dose GDOC id (group A) resulted in extremely heterogenous distribution of injury for all variables (edema, p = 0.001; acinar necrosis, p = 0.0001; inflammation, p = 0.0001; and hemorrhage p = 0.001). The lesions were confined to the head of the pancreas, which showed large areas of necrosis involving entire lobules, whereas adjacent areas were unaffected. Low-dose GDOC id (group B) was more homogenously distributed, but the injury was mild and regional variability (edema, p = 0.0001; acinar necrosis, p less than 0.04; inflammation, p = 0.0001; and hemorrhage p less than 0.05) was still demonstrable. In contrast, low-dose GDOC id combined with CAE iv (group C) produced moderately severe pancreatitis, which equally affected all areas of the gland. There were no geographical differences in acinar necrosis or inflammation. This feature of the new model provides a desirable prerequisite for accurate and reproducible assessment of histopathology in studies aimed at detecting effects of therapy. We suggest that it replace traditional id bile salt infusion models.
极度分布不均和严重细胞损伤的迅速形成是传统急性胰腺炎胆盐模型的典型特征;这两个因素都使实验性治疗试验中治疗效果的评估和解释变得复杂。更重要的是,这两者都不是理想的胰腺炎诱导指标,而是气压伤和有害化学物质导致局部损伤的指标。本研究对比了传统高剂量胆盐模型与一种新制剂(采用静脉注射(iv)蛙皮素(CAE)和导管内(id)低剂量甘氨脱氧胆酸(GDOC)联合使用)中细胞损伤的严重程度和区域变异性。将36只雄性Sprague-Dawley大鼠(350 - 450克)分为三组进行诱导:A组为高剂量GDOC导管内注射(34 mmol/L),B组为低剂量GDOC导管内注射(10 mmol/L),C组为低剂量GDOC导管内注射联合静脉注射蛙皮素6小时。由两名不了解诱导技术的病理学家在每个器官的20个视野中评估胰腺内组织病理学损伤的区域分布。高剂量GDOC导管内注射(A组)导致所有变量(水肿,p = 0.001;腺泡坏死,p = 0.0001;炎症,p = 0.0001;出血,p = 0.001)的损伤分布极不均匀。病变局限于胰头,显示大片坏死累及整个小叶,而相邻区域未受影响。低剂量GDOC导管内注射(B组)分布更均匀,但损伤较轻,区域变异性(水肿,p = 0.0001;腺泡坏死,p < 0.04;炎症,p = 0.0001;出血,p < 0.05)仍可显现。相比之下,低剂量GDOC导管内注射联合静脉注射蛙皮素(C组)产生中度严重的胰腺炎,对胰腺的所有区域影响相同。腺泡坏死或炎症没有区域差异。新模型的这一特征为旨在检测治疗效果的研究中准确且可重复的组织病理学评估提供了理想的前提条件。我们建议用它取代传统的导管内胆盐注入模型。