Liu Q, Djuricin G, Nathan C, Gattuso P, Weinstein R A, Prinz R A
Department of General Surgery, Rush-Presbyterian St. Luke's Medical Center, Chicago, Illinois 60612, USA.
J Surg Res. 1997 Apr;69(1):171-7. doi: 10.1006/jsre.1997.5069.
Bacterial translocation (BT) from the gastrointestinal tract to mesenteric lymph nodes (MLN) and other extraintestinal organs is an important source of infection in acute pancreatitis (AP). Epidermal growth factor (EGF), a peptide hormone with trophic effects on gut mucosa, has decreased intestinal mucosal injury in septic rats and decreased burn-induced BT in mice. The purpose of this study is to examine whether EGF could affect BT in acute necrotizing pancreatitis. Forty-eight male Sprague-Dawley rats (250-350 g) were studied. AP was induced in Group I and Group II by pressure injection of 3% taurocholate and trypsin into the biliopancreatic duct (1 ml/kg of body weight). Group III and Group IV underwent laparotomy without induction of acute pancreatitis. Group I rats received human recombinant EGF (100 micrograms/kg, subcutaneously twice daily) and Group II rats received a similar volume of 0.1% bovine serum albumin as a placebo postoperatively. Group III and Group IV received EGF and placebo, respectively. At 48 hr postoperatively, blood was drawn for culture and amylase determinations. Jejunum and ileum were obtained to measure mucosal protein content, mucosal thickness, villus height, and crypt depth. Specimens from MLN, spleen, liver, pancreas, and cecum were harvested for pathology and culture of gram positive (G+), gram negative (G-), and anaerobic bacteria. Ileal mucosal protein levels were increased significantly in Group I (1.96 +/- 0.14 mg/cm) compared to Group II (0.95 +/- 0.15 mg/cm intestinal segment) (P < 0.01). Jejunal and ileal mucosal thickness, villus height, and crypt depth in Group I were significantly increased when compared to Group II (P < 0.05). All 12 rats in Group II had BT to MLN compared to 58% (7 of 12 rats) in Group I (P < 0.05). Thirty-three percent (4 of 12 rats) had BT to distant sites such as pancreas, spleen, liver, and/or blood in Group I vs 83% (10 of 12 rats) in Group II (P < 0.05). EGF treatment minimizes intestinal damage, decreases BT to MLN and bacterial spread to distant sites, and may be beneficial in preventing septic complications in AP.
细菌从胃肠道向肠系膜淋巴结（MLN）及其他肠外器官的移位（BT）是急性胰腺炎（AP）感染的重要来源。表皮生长因子（EGF）是一种对肠黏膜有营养作用的肽类激素，可减轻脓毒症大鼠的肠黏膜损伤，并减少小鼠烧伤诱导的BT。本研究旨在探讨EGF是否会影响急性坏死性胰腺炎中的BT。研究了48只雄性Sprague-Dawley大鼠（250 - 350克）。通过向胆胰管压力注射3%牛磺胆酸钠和胰蛋白酶（1毫升/千克体重），在第一组和第二组诱导AP。第三组和第四组进行剖腹手术但不诱导急性胰腺炎。第一组大鼠术后接受人重组EGF（100微克/千克，皮下注射，每日两次），第二组大鼠术后接受相同体积的0.1%牛血清白蛋白作为安慰剂。第三组和第四组分别接受EGF和安慰剂。术后48小时，取血进行培养和淀粉酶测定。获取空肠和回肠以测量黏膜蛋白含量、黏膜厚度、绒毛高度和隐窝深度。采集MLN、脾脏、肝脏、胰腺和盲肠的标本进行病理学检查以及革兰氏阳性（G +）、革兰氏阴性（G -）和厌氧菌培养。与第二组（0.95±0.15毫克/厘米肠段）相比，第一组回肠黏膜蛋白水平显著升高（1.96±0.14毫克/厘米）（P < 0.01）。与第二组相比，第一组空肠和回肠的黏膜厚度、绒毛高度和隐窝深度显著增加（P < 0.05）。第二组的所有12只大鼠均发生向MLN的BT，而第一组为58%（12只大鼠中的7只）（P < 0.05）。第一组33%（12只大鼠中的4只）发生向胰腺、脾脏、肝脏和/或血液等远处部位的BT，而第二组为83%（12只大鼠中的10只）（P < 0.05）。EGF治疗可使肠道损伤最小化，减少向MLN的BT以及细菌向远处部位播散，可能有助于预防AP中的脓毒症并发症。
