Meriläinen Sanna, Mäkelä Jyrki, Koivukangas Vesa, Jensen Hanna Alaoja, Rimpiläinen Eija, Yannopoulos Fredrik, Mäkelä Tuomas, Alestalo Kirsi, Vakkala Merja, Koskenkari Juha, Ohtonen Pasi, Koskela Markku, Lehenkari Petri, Karttunen Tuomo, Juvonen Tatu
Department of Surgery, Oulu University Hospital, Finland.
Hepatogastroenterology. 2012 Mar-Apr;59(114):599-606. doi: 10.5754/hge11157.
BACKGROUND/AIMS: To examine whether intestinal bacterial translocation occurs early in acute mild and severe pancreatitis and whether the intestinal expression of tight junction proteins (claudins-2, -3, -4, -5, -7), apoptosis or proliferation would explain the possible translocation.
Fifteen pigs were randomized to controls (n=5) or to develop mild edematous pancreatitis (n=5, saline infusion to pancreatic duct) or severe necrotic pancreatitis (n=5, taurocholic acid infusion). Translocation was studied by measuring bacterial cultures from portal vein blood and mesenteric lymph nodes. Immunohistochemical expression of the tight junction proteins, apoptosis rate (TUNEL) and Ki-67 were analyzed quantitatively from the epithelium of the jejunum and colon.
There was no bacterial translocation during the 6 hours followup, nor changes in the expression of tight junction proteins claudins-2 and -5 in jejunum or colon. Saturation and proportional area of claudin-3 staining decreased in the colon, as did claudins-4 and -7 staining in the jejunum of the necrotic pancreatitis group. Increased apoptosis was found in all samples from controls and the edematous pancreatitis group but not in jejunum in the necrotic pancreatitis group. Ki-67 activity tended to increase in the upper half of the villus in edematous and necrotic pancreatitis. There were no changes in the basic histology.
The major finding of this study was that bacterial translocation from the gut is not present at the beginning of acute pancreatitis. Tight junction proteins claudin-2 and -5 do not become altered in the early stages of pancreatitis. Claudin-3 decreases in the colon and claudins-4 and -7 in the jejunum in necrotic pancreatitis. Laparotomy itself causes increased apoptosis in the colon and the jejunum.
背景/目的:研究肠道细菌易位是否在急性轻度和重度胰腺炎早期发生,以及紧密连接蛋白(claudins - 2、- 3、- 4、- 5、- 7)的肠道表达、细胞凋亡或增殖是否能解释可能的细菌易位。
15头猪被随机分为对照组(n = 5)或诱导发生轻度水肿性胰腺炎组(n = 5,向胰管内注入生理盐水)或重度坏死性胰腺炎组(n = 5,向胰管内注入牛磺胆酸)。通过检测门静脉血和肠系膜淋巴结的细菌培养物来研究细菌易位。对空肠和结肠上皮进行紧密连接蛋白的免疫组化表达、细胞凋亡率(TUNEL法)和Ki - 67的定量分析。
在6小时的随访期间未发生细菌易位,空肠或结肠中紧密连接蛋白claudins - 2和 - 5的表达也未发生变化。坏死性胰腺炎组结肠中claudin - 3染色的饱和度和比例面积降低,空肠中claudins - 4和 - 7染色也降低。在对照组和水肿性胰腺炎组的所有样本中均发现细胞凋亡增加,但坏死性胰腺炎组空肠中未增加。水肿性和坏死性胰腺炎时,绒毛上半部分的Ki - 67活性有增加趋势。基本组织学无变化。
本研究的主要发现是急性胰腺炎开始时不存在肠道细菌易位。胰腺炎早期紧密连接蛋白claudin - 2和 - 5未发生改变。坏死性胰腺炎时结肠中claudin - 3减少,空肠中claudins - 4和 - 7减少。剖腹手术本身会导致结肠和空肠细胞凋亡增加。