高压氧和乌司他丁对急性坏死性胰腺炎患者血浆内毒素、可溶性 CD14、内毒素中和能力及细胞因子的影响。

Effect of hyperbaric oxygen and ulinastatin on plasma endotoxin, soluble CD14, endotoxin-neutralizing capacity and cytokines in acute necrotizing pancreatitis.

机构信息

Beijing Tongren Hospital, Capital Medical University, China.

出版信息

Can J Surg. 2010 Aug;53(4):241-5.

PMID:20646397

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2912018/

Abstract

BACKGROUND

We sought to study the effect of a combination therapy comprised of hyperbaric oxygen (HBO) and ulinastatin on the plasma levels of endotoxin, soluble CD14 (sCD14), endotoxin neutralizing capacity (ENC) and cytokines in acute necrotizing pancreatitis (ANP) in rats.

METHODS

We randomly allocated 90 Sprague-Dawley rats into 6 groups: group 1 (ordinary control), group 2 (sham operation), group 3 (ANP), group 4 (ANP with HBO), group 5 (ANP with ulinastatin) and group 6 (ANP with HBO and ulinastatin). We induced ANP by retrograde injection of 3.5% sodium taurocholate (2.5 mL/kg) via the pancreatic duct. Five minutes after induction, animals in groups 5 and 6 were infused with ulinastatin (20 000 U/kg) via the portal vein. Thirty minutes after induction, animals in groups 4 and 6 received HBO therapy. We collected samples 3, 6 and 10 hours after induction of ANP.

RESULTS

We found that the plasma level of endotoxin in group 3 was significantly higher than in group 4 (3, 6 h, both p < 0.001), group 5 (3 h, p < 0.001; 6 h, p = 0.014) and group 6 (both p < 0.001). The level of plasma sCD14 in group 3 was significantly higher than in group 4 (3, 6 h, both p < 0.001), group 5 (3, 6 h, both p = 0.001) and group 6 (3 h, p < 0.001; 6 h, p = 0.001). The plasma endotoxin and sCD14 levels in group 6 were significantly lower than in groups 4 and 5. The plasma ENC level in group 6 was significantly higher than in groups 3, 4 and 5 (p < 0.001). The ENC level in groups 4 and 5 were higher than in group 3, but there was no significant difference. The plasma level of tumour necrosis factor-alpha (TNF-alpha) and IL-6 in group 6 were significantly lower than in groups 3, 4 and 5 (p < 0.001). The TNF-alpha and IL-6 levels in groups 4 and 5 were lower than in group 3, but there was no significant difference.

CONCLUSION

The use of an early combination therapy of HBO and ulinastatin was more effective than either therapy alone in the treatment of ANP.

摘要

背景

本研究旨在探讨高压氧（HBO）和乌司他丁联合治疗对急性坏死性胰腺炎（ANP）大鼠血浆内毒素、可溶性 CD14（sCD14）、内毒素中和能力（ENC）和细胞因子水平的影响。

方法

将 90 只 Sprague-Dawley 大鼠随机分为 6 组：第 1 组（普通对照组）、第 2 组（假手术组）、第 3 组（ANP 组）、第 4 组（ANP+HBO 组）、第 5 组（ANP+乌司他丁组）和第 6 组（ANP+HBO+乌司他丁组）。通过胰管逆行注射 3.5%牛磺胆酸钠（2.5 mL/kg）诱导 ANP。诱导后 5 分钟，第 5 组和第 6 组大鼠通过门静脉输注乌司他丁（20 000 U/kg）。诱导后 30 分钟，第 4 组和第 6 组大鼠接受 HBO 治疗。在 ANP 诱导后 3、6 和 10 小时采集样本。

结果

我们发现，与第 4 组（3、6 小时，均 p < 0.001）、第 5 组（3 小时，p < 0.001；6 小时，p = 0.014）和第 6 组（均 p < 0.001）相比，第 3 组大鼠血浆内毒素水平显著升高。与第 4 组（3、6 小时，均 p < 0.001）、第 5 组（3、6 小时，均 p = 0.001）和第 6 组（3 小时，p < 0.001；6 小时，p = 0.001）相比，第 3 组大鼠血浆 sCD14 水平显著升高。与第 4 组和第 5 组相比，第 6 组大鼠血浆内毒素和 sCD14 水平显著降低。与第 3 组、第 4 组和第 5 组相比，第 6 组大鼠血浆 ENC 水平显著升高（p < 0.001）。与第 3 组相比，第 4 组和第 5 组大鼠的 ENC 水平有所升高，但差异无统计学意义。与第 3 组、第 4 组和第 5 组相比，第 6 组大鼠血浆肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）水平显著降低（p < 0.001）。与第 3 组相比，第 4 组和第 5 组大鼠的 TNF-α和 IL-6 水平有所降低，但差异无统计学意义。