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Objective To determine the clinical features of systemic lupus erythematosus (SLE) patients with pancreatitis.Methods The medical records of 46 patients with pancreatitis among 5 233 SLE patients admitted into Peking Union Medical College Hospital from January 1983 to January 2012 were reviewed for retrospective analyses of clinical manifestations,laboratory tests,radiological findings,treatments and prognosis.Results The prevalence of pancreatitis was 0.88％ (46/5 233) in SLE patients.There were 7 males and 39 females with an average age of (33 ± 13) yeats.Acute pancreatitis (n =40) occurred more frequently than chronic pancreatitis (n =6).It appeared mostly in active course of SLE with an involvement of more organs.Hypertriglyceridemia was found in 81.0％ (17/21) lupus-associated acute pancreatitis patients.The average level of triglycerides in severe acute pancreatitis was higher than that in mild acute pancreatitis (P =0.023).The mortality rate of lupus-associated acute pancreatitis was 37.5％ (15/40).Most patients received high-dose glucocorticoid and immunosuppressants.Acute pancreatitis appeared in only 5 patients during the course of steroids pulse therapy and most symptoms were mild.Concomitant infections were correlated with poor prognosis (P ＜ 0.01).The most common manifestations of lupus-associated chronic pancreatitis were abdominal pain,jaundice and pancreatic enlargement.Autoimmune pancreatitis could be the initial manifestation of lupus.Conclusions Pancreatitis with SLE includes acute and chronic pancreatitis.Among them,acute pancreatitis is more common and severe and it usually occurs in patients with active SLE with a high mortality.Hypertriglyceridemia may induce and aggravate lupus-associated acute pancreatitis.Early aggressive management with high-dose steroids and immunosuppressants is recommended.Concomitant infection is a risk factor of poor prognosis.
ABSTRACT
Objective To detect the expression of aquaporin 1 in pancreas of rats with acute necrotizing pancreatitis (ANP) and to study the effect of Dachengqi decoction on it.MethodsOne hundred and sixty male SD rats were randomly divided into control group ( C group,n =32 ),ANP group ( n =32),Dexamethasone group (De group,n =32),Acetazolamide group (A group,n =32) and Dachengqi decoction group (DD group,n =32).ANP model was induced by retrograde injection of 5％ sodium taurocholate into the biliary and pancreatic duct.Rats in De group received dexamethasone (4 mg/kg) intravenously after ANP induction; while rats in A group received 1 ml acetazolamide via gastric lavage 2 h before ANP induction; rats in DD group received 2 ml Dachengqi decoction via gastric lavage 48,24,2h before ANP induction; rats in C group received laparotomy.Eight rats in each group were sacrificed at 3 h,6 h,12 h and 18h after induction of ANP models.Quantity of ascites and levels of serum amylases were measured.Pathological changes in pancreas tissue were detected by HE and electron microscope.Capillary permeability in pancreas tissue was detected by Evans Blue (EB) extravasations method.AQP1 expression in pancreas tissue was detected by real-time PCR and Western blotting.ResultsLevels of serum amylase in ANP group was significantly higher,and the pancreatic injuries were obvious ; the levels of serum amylase in De group and DD group was lower than that in ANP group,and the pancreatic injuries were attenuated.The levels of serum amylase in A group were higher than that in ANP group,and the pancreatic.injuries were more severe than that in ANP group.Six hours after ANP induction,the levels of EB in pancreas were (13.44 ±2.56),(126.35 ± 14.80),(86.31 ± 14.46),( 108.99 ± 15.07 ),(78.29 ± 16.85 ) mg/L In C group,ANP group,De group,A group and DD group,and the expression of AQP1 mRNA in pancreatic tissue was ( 170.07 ± 22.48 ) ％,( 83.93 ± 8.98 ) ％,( 117.09 ±10.70 ) ％,( 69.00 ± 8.98 ) ％,( 112.82 ± 11.79 ) ％ ; and the expression of AQP1 protein was 0.23 ± 0.06,0.10 ±0.02,0.32 ±0.03,0.13 ±0.02,0.45 ±0.04.The content of EB in ANP group was higher than that in C group,while the expression of AQP1 mRNA and protein in ANP group was significantly lower than that in C group (P ＜ 0.05 ).The content of EB in De group and DD group was significantly lower than that in ANP group,while the expression of AQP1 mRNA and protein was significantly higher than that in ANP group (P ＜ 0.05).ConclusionsAQP1 plays an important role in the pathogenesis of capillary endothelial barrier dysfunction in rats with ANP.Dachengqi Decoction can attenuate pancreatic injuries of rats by regulating the expression of AQP1.