Wilson C, Shenkin A, Imrie C
Department of Surgery, Royal Infirmary, Glasgow, UK.
Br J Surg. 1991 Jan;78(1):78-81. doi: 10.1002/bjs.1800780124.
The peritoneal exudate formed during experimental pancreatitis is toxic when administered intraperitoneally or intravenously to other animals. Overwhelming of the peritoneal antiprotease defences by proteolytic enzymes released from the pancreas may be a key factor responsible for this toxicity and is examined in the current study. Human pancreatitis exudates possessed tryptic amidase activity indicating trypsinogen activation. The trypsin inhibitory capacities of exudates were reduced indicating a degree of consumption of the peritoneal antiproteases. Of 21 exudates examined, three showed marked reduction of their trypsin inhibitory capacity indicating almost complete consumption of their antiproteases. All three patients were shocked at the time of sampling, two dying of fulminant pancreatitis within 24 h. Overwhelming of the peritoneal antiproteases was not confirmed, but may occur in a few instances where proteolytic enzyme release or zymogen activation continues. Intraperitoneal administration of exogenous antiproteases prolongs survival in rats with pancreatitis and has been suggested as a therapy in man. The current data suggests that few patients are likely to benefit from such an approach.
实验性胰腺炎期间形成的腹膜渗出液，经腹腔内或静脉内给予其他动物时具有毒性。胰腺释放的蛋白水解酶使腹膜抗蛋白酶防御功能不堪重负，可能是造成这种毒性的关键因素，本研究对此进行了探讨。人胰腺炎渗出液具有胰蛋白酶酰胺酶活性，表明胰蛋白酶原被激活。渗出液的胰蛋白酶抑制能力降低，表明腹膜抗蛋白酶有一定程度的消耗。在所检查的21份渗出液中，有3份的胰蛋白酶抑制能力显著降低，表明其抗蛋白酶几乎完全消耗。所有这3例患者在采样时均处于休克状态，其中2例在24小时内死于暴发性胰腺炎。虽然未证实腹膜抗蛋白酶已被完全耗尽，但在少数蛋白水解酶持续释放或酶原持续激活的情况下可能会发生。腹腔内给予外源性抗蛋白酶可延长胰腺炎大鼠的存活时间，有人建议将其作为人类的一种治疗方法。目前的数据表明，很少有患者可能从这种方法中获益。
