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10.3969/j.issn.1008-9691.2013.03.015
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Objective To evaluate the value of medical treatment in the management of SAP.Methods From January 2000 to December 2011,a total of 1064 cases out of 931 SAP patients were admitted and retrospectively analyzed.The etiologies,severity score,complication rates,therapies,effectiveness and costs of those SAP cases were summarized.Results There were 559 males and 372 females with a mean age of (51 ± 15)years old.The main cause was biliary tract disease (58.3％),followed by fat-rich diet (31.2％),hyperlipidemia (13.6％) and alcohol (7.1％).At the time of admission,95.5％ of SAP patients presented with level D disease according to Balthazar CT severity index,26.0％ had a Ranson score ≥3 and 30.1％ had an APACHE Ⅱ score ≥ 8.There were 42.7％ cases complicated with systemic inflammatory response syndrome (SIRS).Acute lung injury and acute respiratory distress syndrome (ARDS),acute kidney injury,shock or heart failure,acute liver dysfunction,and diffuse intravascular clotting (DIC)occurred in 24.0％,8.1％,5.4％,3.2％,and 1％ of all patients,respectively.Other complications of SAP included abdominal cavity bleeding (n =17),pseudocyst bleeding (n =9),pancreatic abscess (n =78) and gastrointestinal fistula (n =33).Totally 25 (2.3％) patients died in hospital and 36 (3.4％) patients were discharged against advice,with an overall treatment success rate of 94.3％.The mean hospital stay was (23.7 ± 19.2) d,and the average cost was 52.3 thousands of RMB.Conclusions A comprehensive treatment pathway relying on medical treatment,focusing on organ function support and assisted by miniinvasive intervention may improve the treatment success rate of SAP,which is worth of further application.
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Cholesterol gallstone disease is prevalent and its incidence is increasing in China. Supersaturation of biliary cholesterol is a prerequisite for gallstone formation.Recent studies show that disorders of hepatic-enteric metabolism of lipids play important roles in the pathogenesis of gallstone disease and these include： increased biliary cholesterol which originates from an increased uptake of plasma high density lipoprotein mediated by scavenger receptor B type 1,increased secretion of cholesterol into bile via hepatic canalicular cholesterol transporters, and increased intestinal cholesterol absorption in gallstone patients. These eventually lead to supersaturation of biliary cholesterol. Evidences also suggest that decreasing hepatic cholesterol loading, promoting biliary bile acids and phospholipids secretion, and/or inhibiting intestinal cholesterol absorption can moderate saturation of biliary cholesterol, and prevent gallstone formation.
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ObjectiveTo investigate the single nucleotide polymorphisms (SNPS) in the coding regions of the human ABCA2 gene and to determine the association of some of these SNPs with gallstone disease in a Chinese population. MethodsThe exons and part of the introns of the ABCA2 gene were sequenced using a fluorescent labeling automatic method in 24 patients with gallstone disease to identify and characterize the SNPs in a Chinese population. For SNPs in the exons, case-control studies were performed on patients and controls. ResultsTwelve SNPs were found within a 16911 bp region of the ABCA2 gene. Among them, two were in the exons, ten in the introns and five were novel SNPs. There was no significant difference in the SNPs genotype between the patients and the controis. ConclusionsThere is an important ethnic difference in the SNPs distribution of the human ABCA2 gene. The distribution of SNPs in the coding regions of the human ABCA2 gene is not significantly different between the patients and the controls.
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ObjectiveTo investigate the effects of heme oxygenase- 1 ( HO- 1 ) on pancreas and liver in severe acute pancreatitis(SAP) rats, and explore its probable mechanism. MethodsA total of 40 male SD rats were randomLy divided into 4 groups: control group(n = 10) ; SAP group(n = 10) ; HO-1 stimulation group (75 μg/kg hemin was injected intraperitoneally at 30 minutes after model establishment, n = 10 ) ; HO-1 inhibition group(20 μg/kg ZnPP was injected intraperitoneally at 30 minutes after model establishment, n = 10). Sodium Cholate (3％) was retrogradedly injected into the pancreatic duct to produce the SAP model. To observe the histopathological changes of pancreas, liver tissues were observed and serum, pancrease and liver tissues concentration of HO-1, IL-10 and TNF-α in different groups were observed 24 h after the SAP model establishment. ResultsCompared with those in SAP model group, the pathological scores were lower in HO-1 stimuLation group[ (7.50 ±0.58) vs (10.50 ±0. 71) ; ( 1.20 ±0.42) vs (1.70 ±0.48) ]( P ＜ 0.05 ), and the serum, pancreas and liver tissues HO- 1 [ (0.97 ± 0.02) ng/mL, (0.78 ± 0.09) ng/mL,(0.73 ±0.05) ng/mL]and IL-10[(101.72 ±2.63) ng/mL, (63.58 +1.02) pg/mL, (169.40 ±3.06) pg/mL ]concentrations were significantly elevated in HO- 1 stimuLation group ( P ＜ 0.05 ), while the serum, pancreas and liver tissues TNF-α [ (22.85 ± 1.74) pg/mL, (26.50 ± 1.3) pg/mL, (35.88 ±0.98 ) pg/mL]concentrations were significantly decreased in HO-1 stimuLation group (P ＜ 0.05 ). Compared with those in SAP model group, the pathological scores were higher in HO-1 inhibition group (P ＜0.05 ), and the serum, pancreas and liver tissues HO-1 and IL-10 concentrations were significantly decreased( P ＜0.05 ), while the serum, pancreas and liver tissues TNF-α concentrations were significantly elevated (P ＜ 0.05 ). CondusionThe results of the study demonstrated that HO- 1 over- expression has protective effects on the pancreas and liver in SAP. UP-regulated IL-10 expression and down-reguLated TNF-α expression might be served as a potential mechanism.
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Objective To investigate the change of intestinal barrier function and the protection of pentoxifylline (PTX) to intestinal barrier. Methods Fifty-four SD male rats were randomly divided into 3groups, including sham operation group, ANP group, PTX group. ANP rat model were induced by retrograde injection of 5% sodium taurocholate into pancreatic and bile duct. Rats in sham operation group underwent operation without injection of taurocholate. After ANP induction, the rats in PTX group received PTX at a dose of 25 mg/kg weight via penis vein. The rats were sacrificed 3, 6, 24 h after operation, the serum levels of amylase, D-lactic acid, TNF-α were determined. The pancreas tissue and terminal ileum were harvested for pathological examination; ZO-1 levels of ileum epithelial tight junction were analyzed by immunohistochemistry. Results Six hours after induction, the serum levels of amylase, TNF-α, D-lactic acid in ANP group were(9141±672)U/L, (347.96±79.47) pg/ml and (10.21±1.08 ) rmg/L, which were significantly higher than those in sham operation group [(1723 ± 57 )U/L, (134.09 ± 31.36 )pg/ml and (4.33 ±0.49)mg/L, P ＜0.01]. The serum levels of amylase, TNF-α, D-lactic acid in PTX group were (7965 ± 318 ) U/L, (238.48 ± 44.35 ) pg/ml and ( 8.75 ± 1.28 ) mg/L, which were significantly lower than those in ANP group, but they were significantly higher than those in sham group ( P＜0.05 or ＜0.01). The positive rate of ZO-1 was (3.29±0.36)% in sham operation group, and it was (1.91 ± 0. 32)% in ANP group,which was significantly lower than that in sham operation group (P ＜ 0.05 ); and the value was (2.53±0.43)%in PTX group, which was lower than that in sham group, but it was higher than that in ANP group(P＜0.05).Conclusions PTX may attenuate intestinal barrier function injury by decreasing the breakdown of intestinal ZO-1.
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Severe acute pancreatitis is sometimes complicated by a syndrome of cerebral dysfunction, referred to as pancreatic encephalopathy. Demyelination is found in autopsy and considered as basic pathologic evidence in patients with pancreatic encephalopathy. Myelin basic protein detection in cerebrospinal fluid and blood, combined with magnetic resonance imaging scan might indicate the demyelinatic change. Further large-scale study on both pathogenesis and diagnosis of this disease is needed.
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Objective To investigate the etiology of acute recurrent pancreatitis (ACP) and de-termine how to further enhance its level of treatment.Methods The clinical data of 33 patients with ACP treated in Ruijin Hospital from 2003 to 2007 were retrospectively analyzed.Results Of the 33 patients with an average age of 55 (22-86), 18 (55%) were male and 15 (45%) female.ACP occurred once in 26 patients, twice in 4 and 3 times in 3.The disease appeared whithin 1 year in 29 patients, 1-2 years in 2, 2-3 years in 1 and 3 years in 1 after being dischared from hospital.For its etiology, it was of biliary origin in 29 patients, hyperlipidemia in 1, pancreatic tumor in 1 and unknow reasons in 2.Twenty-four patients were treated with operation or endoscopy.Two patients died and the mortali-ty was 9.1%.Conclusion ACP is mainly due to biliary origin in China.Operative intervention at an appropriate opportunity can effectively reduce the recurrence of biliary-origin pancreatitis.
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Objective To investigate the variation of procalcitonin(PCT) in blood and tissue level of acute pancreatitis rats and probe its significant. Methods One hundred and two male Wistar rats were randomly divided into control group ( n = 6 ), lipopolysaccharide group ( LPS, n = 24 ), acute edematous pancreatitis (AEP) group ( n = 24), acute necrotizing pancreatitis (ANP) group ( n = 24), AN P + LPS group ( n = 24). Subcutaneous injection of cerulein was used for AEP induction, while ANP model was induced by retrograde injection of sodium taurocholate into the biliary and pancreatic duct. The rats were sacrificed at 3,6, 18 and 24 hours after model induction. Pancreatic tissue was harvested and the pathological scores were assessed. Levels of PCT in serum, liver, lung, spleen, pancreas, small intestine, large intestine tissue was harvested and tissue levels of PCT were determined. Results AEP and ANP models were established successfully. At 6 h, the serum levels of PCT in control group, LPS group, AEP group, ANP group and ANP +LPS group were (0.0144 ±0.0082) ng/ml, (0. 1722 ±0.0449) ng/ml,(0.4751 ±0.0572) ng/ml, (0.7070 ±0. 1040) ng/ml and ( 1. 1960 ±0.8644) ng/ml, respectively; and the difference was statistically significant (P < 0.05 ). PCT could be detected in liver, lung, spleen, pancreas, small intestine and large intestine tissue of normal rats. PCT levels in liver and pancreas of ANP group were not statistically different, but the PCT levels in lung, spleen, and large intestine tissue significantly decreased, and the corresponding values were (5.63 ±0.62) ng/ml vs. (6.85 ±0.46) mg/ml, (4.73 ±1.27) mg/ml vs. (6.88 ±0.37) ng/ml, (1.08 ±0.52) ng/ml vs. (4.12 ± 1.02) ng/ml (P <0.01 ). However, the PCT levels in small intestine significantly increased, which were (2.51 ±0.90) ng/ml vs (0.98 ±0. 12) ng/ml (P<0. 01). Conclusions Serum PCT level was associated with the severity of AP and infection; the changes of PCT levels in different tissues may be related with the changes of organ's function.
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Objective To investigate the cause and the therapy of acute pancreatitis. Methods 994 patients of acute pancreatitis admitted in the Surgery Ward in Ruijin Hospital between Jan. 2003 to Jan. 2007 were retrospectively analyzed. They were divided into groups according to etiology and therapy. Results In these 994 patients, 825 cases were with biliary origin (83.0%); 24 cases were alcoholic origin (2.41%); 29 cases were hyperlipidemia origin (2.92%); 16 cases were pregnancy origin (1. 61% ), 71 cases were idiopathic origin (7.14%); 4 cases were traumatic origin (0.40%); 25 cases were mixed origin (2.52%).There were 767 cases (77.2%)of mild acute pancreatitis (MAP) and 227 (22.8%) cases of severe acute pancreatitis (SAP). The overall cure rate was 91.2% , 87 cases were dead with a mortality of 8.8%. The mortality of alcoholic acute pancreatitis was 37.5% , which was significantly higher than that in biliary acute pancreatitis. Non - surgical treatment, ERCP + EST, cholecystectomy and exploration of common bile duct, or laparoscopic cholecystectomy after ERCP or debridement treatment was used for biliary acute pancreatitis. All patients underwent debridement treatment were SAP patients with a post-operative mortality of 25.0% , which was significantly higher than those in other treatment group ( P ＜ 0.01 ). There was no significant difference among the other 3 groups as regard to SAP patients and mortality. Conclusions The major cause of acute pancreatitis was biliary factor. Alcoholic pancreatitis was critical with poor prognosis. For biliary acute pancreatitis, the therapeutic efficacies of multiple treatment were not significantly different.
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Objective To assess the cost-utility and medical economics of surgjcal treatment for SAP.Methods A retrospective study of SAP patients admitted from January to December 2003 to Ruijin Hospital was carried out.The cost of treatment was obtained from financial department and patients questionnaire;health-related quality of life was assessed by using the SF-36 brief questionnaire and the results were compared with normal population and were converted into rQALY,then utility scores were obtained so as to conduct CUA (cost-utility analysis)and related factors were analyzed.Results 98 patients with SAP were discharged,85 were discharged healthy;of them,59 patients had complete records were followed up,2 died during follow up,with a mortality of 3.4%,one patients could not finish the questionnaire and 6 did not respond,finally 50 finished the questionnaire;the total cost in hospital was 9899095 yuan,per capita 101011 yuan;the corrected post-discharge cost was 681737 yuan;the total cost was 10580832 yuan.The cost of medication was the highest,which accounted for 56%of all the cost.The means and deviations for each of eight scales(PF,RP,RE,BP,VT,MH,SF,GH)scores of SF-36 in SAP patients were 83.00±14.64,61.5.0±42.32,68.67±36.52,79.98±14.90,68.80±18.94,72.40±14.75,75.00±17.53,64.70±18.28.compared with normal population,gained 1929.05 QALYs;the cost-utility analysis was 5485 yuan per QALY.The patient's age,length of stay,chronic co-morbidity was associated with the cost of treatment.Conclusions SAP treatment in surgery department was justified in medical economics.Medication contributed to the most part of total costs.The related factors of cost included age,length of stay and chronic co-morbidity.
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Objective To investigate the mRNA expression of liver receptor homolog 1 (LRH-1) gene in patients with cholesterol gallstone disease so that to elucidate the biomolecular pathogenesis of gallstone for- mation.Methods Twenty-seven patients with cholesterol gallstone (CGS) and 14 controls were included in this study.Biliary composition was assayed and mRNA expression of hepatic LRH 1 gene was determined by real time polymorphism chain reaction.Results In CGS patients,expression of LRH-1 was significantly higher than that in controls (14.18?9.37 vs 7.86?6.19,P＜0.05),and cholesterol of bile was oversaturated (1.17?0.27).Conclusion The formation of CGS may be related to increased expression of hepatic LRH-1 gene.
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AIM: To elucidate the relationship of inflammation, coagulation and cholesterol gallstone formation. METHODS: Hamsters were divided into four groups: control group (feeding normal diet), lithogenic diet (LD) 2 weeks group, LD 6 weeks group and LD+aspirin 6 weeks group. Gallstone incidence, antithrombin antigen (AT-Ⅲ:Ag), antithrombin activity (AT-Ⅲ:Ac), thrombin (F-Ⅱa:Ac), plasminogen activator inhibitor activity (PAI:Ac), plasmin activity (Plm:Ac), D-dimer:Ag and C-reactive protein (CRP) in gallbladder bile were observed as read-out parameters. RESULTS: The incidence of gallstones in control group, LD 2 weeks group, LD 6 weeks group and LD+aspirin group were 0%, 20%, 73% and 25%, respectively. AT-Ⅲ:Ag, F-Ⅱa:Ac, D-dimer and CRP in LD 2 weeks group and LD 6 weeks group were significantly higher than those in the control group (P