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1.
China Pharmacy ; (12): 1825-1832, 2022.
Article in Chinese | WPRIM | ID: wpr-936486

ABSTRACT

OBJECTIVE To explore the the reg ulation of intestinal flora and effects of Qingjie huagong decoction on intestinal mucosal barrier in severe acute pancreatitis (SAP)mode rats . METHODS SAP rat model was induced by intraperitoneal injection of caerulein and lipopolysaccharide.The survival state of rats in each group were observed.The levels of serum amylase ,interleukin 10(IL-10),IL-18 and IL- 1β in serum were all detected. The pathological changes of pancreatic and small intestinal tissue were observed. The expressions of Occludin,ZO-1 and HMGB1 were detected in small intestinal tissue of rats. The structure and relative abundance of intestinal microflora in rats were detected by 16S rRNA high throughput sequencing. RESULTS After the intervention of Qingjie huagong decoction ,abdominal distension symptoms of SAP model rats were significantly relieved ,and their mental state recovered better ;the levels of serum amylase and IL- 18 in serum were decreased significantly (P<0.05),while the level of IL- 10 was increased significantly (P<0.05). The necrotic area of pancreatic tissue and the infiltration of inflammatory cells were reduced , the degree of intestinal epithelial cell structural disorder was alleviated ,and the shedding of intestinal mucosal epithelium was reduced.The protein expression of HMGB 1 in small intestinal tissue was decreased significantly (P<0.05),and the protein expression of Occludin and ZO- 1 were increased significantly . Results of 16S rRNA high throughput sequencing showed that Qingjie huagong decoction could increased the relative abundance of probiotics such as Bacteroidea and Lactobacillus in rat intestine ,reduced the colonization of harmful bacteria such as Firmicutes. CONCLUSIONS Qingjie huagong decoction can improve the intestinal barrier by up-regulating the expression of Occludin and ZO- 1 in small intestinal tissue and down-regulating the protein expression of HMGB 1. It can also adjust the relative abundances of different flora to protect the intestinal tract.

2.
Article in Chinese | WPRIM | ID: wpr-936348

ABSTRACT

OBJECTIVE@#To assess the effect of early abdominal puncture drainage (APD) on autophagy and Nrf-2/HO-1 pathway in rats with severe acute pancreatitis (SAP) and explore the possibile mechanism.@*METHODS@#Thirty-two male SD rats were randomly divided into sham-operated (SO) group, SAP group with retrograde injection of 4% sodium taurocholate, APD group with insertion of a drainage tube into the lower right abdomen after SAP induction, and APD + ZnPP group with intraperitoneal injection of 30 mg/kg ZnPP 12 h before APD modeling. Blood samples were collected from the rats 12 h after modeling for analysis of amylase and lipase levels and serum inflammatory factors. The pathological changes of the pancreatic tissue were observed with HE staining. Oxidative stress in the pancreatic tissue was detected with colorimetry, and sub-organelle structure and autophagy in pancreatic acinar cells were observed by transmission electron microscopy. The expressions of autophagy-related proteins and Nrf-2/HO-1 pathway were detected using RT-PCR and Western blotting.@*RESULTS@#Compared with those in SAP group, the rats with APD treatment showed significantly alleviated pathologies in the pancreas, reduced serum levels of lipase, amylase and inflammatory factors, lowered levels of oxidative stress, and activated expressions of Nrf-2/HO-1 pathway in the pancreas. The ameliorating effect of ADP was significantly inhibited by ZnPP treatment before modeling. APD obviously reversed mitochondrial and endoplasmic reticulum damages and p62 accumulation induced by SAP.@*CONCLUSION@#APD treatment can suppress oxidative stress and repair impaired autophagy in rats with SAP by activating the Nrf-2/HO-1 pathway, thereby reducing the severity of SAP.


Subject(s)
Acute Disease , Amylases/blood , Animals , Autophagy , Drainage , Heme Oxygenase (Decyclizing) , Lipase/blood , Male , NF-E2-Related Factor 2 , Oxidative Stress , Pancreas/pathology , Pancreatitis/surgery , Punctures , Rats , Rats, Sprague-Dawley
3.
Article in Chinese | WPRIM | ID: wpr-936314

ABSTRACT

OBJECTIVE@#To investigate the expression of Ca2+/calmodulin-dependent protein kinase II (CaMK Ⅱ) in pancreatic tissues of mice with severe acute pancreatitis (SAP) and explore the protective effect of KN93, a CaMK Ⅱ inhibitor, against pancreatic injury in SAP and the possible mechanism.@*METHODS@#Thirty-six healthy male C57 mice were randomly divided into sham operation group, SAP group, KN93 group and SAP + KN93 group (n=9). Serum and pancreatic tissue samples were collected 24 h after modeling. The pathological changes in the pancreatic tissues were observed using HE staining. Serum lipase and amylase activities and the levels of inflammatory factors were detected using ELISA. Western blotting was used to detect the expressions of CaMK Ⅱ, p-CaMK Ⅱ, p-NF-κB, MAPK and p-MAPK in mouse pancreas.@*RESULTS@#Compared with those in sham operation group, the expressions of p-CaMK Ⅱ, p-NF-κB and p-MAPK were significantly increased in SAP group (P < 0.05). KN93 treatment obviously alleviated pathological injuries of the pancreas in SAP mice, and significantly lowered serum levels of lipase, amylase and inflammatory factors (TNF-α and IL-6) and phosphorylation levels of NF-κB, ERK and MAPK proteins (P < 0.05).@*CONCLUSION@#The activity of CaMK Ⅱ is significantly increased in the pancreatic tissue of SAP mice. KN93 can alleviate pancreatic injury and inflammation in SAP mice possibly through the ERK/MAPK signaling pathway.


Subject(s)
Acute Disease , Animals , Inflammation/metabolism , Male , Mice , NF-kappa B/metabolism , Pancreas/pathology , Pancreatitis/pathology
4.
Journal of Chinese Physician ; (12): 371-376, 2022.
Article in Chinese | WPRIM | ID: wpr-932072

ABSTRACT

Objective:To discuss the value of dynamic detection of serum intestinal fatty acid binding protein (I-FABP), heparin binding protein (HBP) and interleukin-1β(IL-1β) in early predicting and evaluating the severity of abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) postoperative patients.Methods:The clinical data of 65 SAP patients treated in the Second Hospital of Anhui Medical University from July 2019 to Jan 2021 were retrospective analyzed. According to whether ACS has occurred, the patients were divided into non ACS group (48 cases) and ACS group (17 cases). The serum I-FABP, HBP and IL-1β of the two groups were dynamically monitored. Correlation analysis and receiver operating characteristic (ROC) curve were used to evaluate the efficacy and early prediction value of each observation index in evaluating the severity of SAP patients complicated with ACS.Results:There were no significant differences in age, sex, body mass index (BMI) and pathogenesis between the two groups (all P>0.05). The serum levels of C-reactive protein (CRP), white blood cell (WBC), Acute Physiology and Chronic Health Enquiry (APACHE-Ⅱ) score and intra-abdominal pressure (IAP) in ACS group were significantly higher than those in non ACS group (all P<0.05). The serum levels of I-FABP [(97.41±15.02)ng/ml vs (37.28±18.34)ng/ml, (103.32±18.40)ng/ml vs (56.96±19.12)ng/ml, (85.69±22.94)ng/ml vs (36.88±10.49)ng/ml], HBP [(92.19±14.59)ng/ml vs (24.56±10.96)ng/ml, (106.11±15.03)ng/ml vs (37.17±13.83)ng/ml, (128.11±16.43)ng/ml vs (68.94±15.91)ng/ml] and IL-1β[(15.78±1.44)pg/ml vs (11.26±1.34)pg/ml, (19.34±1.87)pg/ml vs (13.51±2.84)pg/ml, (20.95±1.96)pg/ml vs (16.03±1.04)pg/ml] on 1st, 4th, 7th day in ACS group were continuously and evidently higher than those in non ACS group ( P<0.01). Correlation analysis revealed that I-FABP, HBP and IL-1β were positively correlated with IAP ( r=0.745, 0.793, 0.770) and APACHE Ⅱ score ( r=0.510, 0.489, 0.445) (all P<0.01). ROC curve analysis showed that the AUC of early prediction by I-FABP, HBP and IL-1β on the occurrence of ACS were 0.846, 0.873 and 0.902 respectively, which were higher than the CRP (0.681), WBC (0.765) and APACHE Ⅱ score (0.795), the sensitivity and specificity can be significantly improved to 0.997 and 0.994 by parallel and series tests respectively combined with the three indicators. Conclusions:Dynamic detection of serum I-FABP, HBP and IL-1β has a certain clinical value in evaluating the severity of ACS in SAP patients. At the same time, early detection with serum I-FABP, HBP and IL-1β has high predictive power for ACS in SAP patients and the combined application of three has higher predictive value.

5.
Article in Chinese | WPRIM | ID: wpr-931826

ABSTRACT

Objective:To explore the risk factors of abdominal hemorrhage (AH) in patients with severe acute pancreatitis (SAP) and its impact on outcome.Methods:The clinical data of 231 SAP patients admitted to Diagnosis and Treatment Center for SAP of Guizhou Province from January 1, 2015 to December 31, 2019 were retrospectively analyzed. These patients were divided into AH group and non-AH group. The general information, etiology, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, organ failure, complications, interventions, bleeding time, bleeding site and outcome were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the risk factors of AH in SAP patients and whether the time and location of AH were risk factors affecting the outcome.Results:A total of 231 patients were enrolled in the analysis, including 198 patients without AH and 33 with AH (14.3%). There was no significant difference in gender, age or etiology between the two groups. The scores of APACHE Ⅱ and SOFA in AH group were significantly higher than those in non-AH group [APACHE Ⅱ score: 18 (12, 24) vs. 13 (9, 19), SOFA score: 9 (5, 15) vs. 5 (4, 11), both P < 0.01]. The incidences of acute kidney injury (AKI), gastrointestinal dysfunction, coagulation disorders, necrotic infection, pseudocyst and gastrointestinal fistula in AH group were significantly higher than those in non-AH group (66.7% vs. 47.0%, 36.4% vs. 7.1%, 18.2% vs. 6.6%, 66.7% vs. 9.1%, 66.7% vs. 34.3%, 9.1% vs. 1.5%, all P < 0.05). The proportions of requiring mechanical ventilation (MV) and surgical intervention in AH group were significantly higher than those in non-AH group (69.7% vs. 43.4, 48.5% vs. 14.6%, both P < 0.01). The length of intensive care unit (ICU) stay and hospital stay in AH group were significantly longer than those in non-AH group [length of ICU stay (days): 13 (8, 19) vs. 7 (3, 16), length of hospital stay: 24 (13, 40) vs. 17 (12, 24), both P < 0.01], and the hospital mortality was significantly higher (60.6% vs. 9.6%, P < 0.01). Multivariate Logistic regression analysis showed that APACHE Ⅱ score [odds ratio ( OR) = 1.157, 95% confidence interval (95% CI) was 1.030-1.299, P = 0.014], infectious necrosis ( OR = 12.211, 95% CI was 4.063-36.697, P < 0.01), pseudocyst ( OR = 3.568, 95% CI was 1.238-10.283, P = 0.019) and requiring MV ( OR = 0.089, 95% CI was 1.354-6.625, P = 0.007) were the risk factors of AH in SAP patients. In 33 AH patients, there was no significant difference in hospital mortality between early hemorrhage (occurred within 2 weeks of onset) and late hemorrhage (occurred 2 weeks after onset) groups [66.7% (8/12) vs. 57.1% (12/21), P > 0.05]. All 4 patients in the unspecified bleeding site group died during hospitalization; half or more patients died in the pseudocyst/abscess bleeding (14 cases), mesenteric/intestinal bleeding (13 cases) and gastric variceal bleeding (2 cases) groups (7 cases, 8 cases and 1 case respectively), and there were significant differences among the groups ( P < 0.05). Multivariate Logistic regression analysis showed that neither bleeding time ( OR = 0.989, 95% CI was 0.951-1.028, P = 0.574) nor bleeding site ( OR = 2.009, 95% CI was 0.822-4.907, P = 0.126) was the risk factor of death in patients with SAP combined with AH. Conclusions:Both early and late bleeding significantly increased the length of hospital stay and mortality of SAP patients. APACHE Ⅱ score, infectious necrosis and pseudocyst were the risk factors of AH in SAP patients. Neither bleeding time nor bleeding site was the risk factors of death in patients with SAP combined with AH. However, it still needed to be confirmed by a large sample clinical study.

6.
Article in Chinese | WPRIM | ID: wpr-930844

ABSTRACT

Objective:To investigate the clinical characteristics and prognosis of children with acute pancreatitis(AP)admitted to the pediatric intensive care unit(PICU).Methods:The etiology, clinical data, imaging features, complications, and outcomes of children with AP admitted to PICU at Shanghai Children′s Hospital from July 2016 to June 2021 were retrospectively analyzed.Results:Totally, 47 patients with AP including 24 males and 23 females were enrolled.The mean age was 84(48, 144)months.Four patients with mild AP, 5 patients with moderately severe AP(MSAP)and 38 cases with severe AP(SAP)were diagnosed.The main etiology was drug-related pancreatitis in 23 cases(48.9%). The organ dysfunction mainly included shock in 28 cases(59.6%), acute respiratory failure in 21 cases(44.7%), gastrointestinal disorders in 30 cases(63.8%), and coagulopathy in 29 cases(61.7%). The complications included capillary leakage syndrome in 18 cases(38.3%)and hyperglycemia(>8 mmol/L)in 24 cases(51.1%). Serum amylase and lipase levels were increased in 47 cases(100%). There were significant differences in blood lactate[3.0(2.1, 4.5)mmol/L vs.1.6(1.1, 3.1)mmol/L, P=0.013], and the use of vasoactive drugs[15.0(0, 75.0)vs.0(0, 8.8), P=0.035] between drug-induced pancreatitis and non-drug-induced pancreatitis.All the patients′conditions were improved after treatment and transferred out of PICU. Conclusion:The etiology of acute pancreatitis in children is mainly drug-related, and the main organ dysfunction includes shock, acute respiratory failure, gastrointestinal dysfunction and coagulation dysfunction.The prognosis of childhood pancreatitis is good.

7.
Article in Chinese | WPRIM | ID: wpr-930248

ABSTRACT

Objective:To investigate the early evaluation potential of serum levels of apolipoprotein B/apolipoprotein A1 (Apo B/A1), microtubule-associated protein 1-light chain 3 (MAP1-LC3) and intercellular adhesion molecule-1 (ICAM-1) in acute pancreatitis (AP) patients.Methods:A total of 413 AP patients who were treated at the Second Affiliated Hospital of Anhui Medical University between January 2019 and August 2020 were enrolled. Serum samples were collected from AP patients within 24 h of admission. Patients were divided into the non-severe acute pancreatitis (Non-SAP, n=315) and severe acute pancreatitis (SAP, n=98) groups according to the severity of the disease. Sixty healthy controls were recruited. The differences of serum Apo B/A1, MAP1-LC3 and ICAM-1 among the three groups were compared by one-way analysis of variance, and the correlation between Apo B/A1, MAP1-LC3 and ICAM-1 and the severity of AP was analyzed by Pearson correlation analysis. Sensitivity and specificity in assessing AP severity were predicted by receiver operating characteristic curve (ROC). Results:The early levels of Apo B/A1, MAP1-LC3 and ICAM-1 were all significantly higher for AP patients than for healthy controls ( P<0.05), and the levels of Apo B/A1, MAP1-LC3 and ICAM-1 in SAP patients were significantly higher than those in non-SAP patients[Apo B/A1: 2.21±1.40 vs. (0.96±0.34); MAP1-LC3: 0.92±0.29 vs. (0.48±0.24) ng/mL and ICAM-1: (235.57±54.50 ) vs. (120.28±61.69)ng/mL; P<0.05]. Pearson correlation analysis showed that levels of Apo B/A1, MAP1-LC3 and ICAM-1 were positively correlated with the first Ranson score after admission ( P<0.05), and ICAM-1 showed the highest degree of correlation with AP severity ( r=0.519). Areas under the receiver operating characteristic curve (AUROC) were 0.769 for Apo B/A1, 0.811 for MAP1-LC3, 0.828 for ICAM-1, and 0.938 for combined detection. Conclusions:Serum levels of Apo B/A1, MAP1-LC3 and ICAM-1 within 24 h after admission are significantly correlated with the severity of AP, which has clinical significance for early prediction of the severity of AP.

8.
Article in Chinese | WPRIM | ID: wpr-930111

ABSTRACT

Objective:To evaluate the clinical efficacy of TCM Qingjie Huagong Decoction combined with routine internal medicine in the treatment of severe acute pancreatitis with cholelithiasis (bile duct stones) in the early stage.Methods:Thirty-two patients with severe acute pancreatitis combined with cholelithiasis in the first affiliated Hospital of GuangXi University of Traditional Chinese Medicine were selected and randomly divided into two groups with 16 in each, both groups were treated for 14 days. Serum amylase (AMS) was detected by iodine-starch colorimetry, GOT and GPT were detected by continuous monitoring method, and CRP, IL-6 and procalcitonin (PCT) were detected by immune transmission turbidimetry. Acute Physiological and Chronic Health Score Ⅱ (APACHE Ⅱ), CT Severity Index Score (CTSI) and Modified Marshall Score were used to evaluate the severity of SAP. The recovery time of body temperature, the relief time of abdominal distension pain, the recovery time of bowel sounds and the total hospital stay were observed and recorded to evaluate the clinical effect.Results:The total effective rate was 93.8% (15/16) in the treatment group and 75.0% (12/16) in the control group. There was significant difference between the two groups ( χ2=8.19, P=0.042). After treatment, the level of AMS, WBC, CRP, PCT, AST, ALT and IL-6 in the treatment group were lower than those in the control group ( t values were 14.3, 7.24, 9.63, 5.48, 7.05, 7.33, 28.34, respectively, all Ps<0.05); After treatment, the time for body temperature to return to normal [(2.91±0.12)d vs. (3.78±0.38)d, t=8.76], the time for relief of abdominal distension pain [(4.77±0.68)d vs. (7.13±1.55)d, t=9.52], the time for recovery of bowel sounds [(3.90±1.80)d vs. (4.89±1.38)d, t=2.98] and the total hospital stay [(22.60±2.80)d vs. (30.37±3.89)d, t=7.88] in the treatment group were all significantly shorter than those in the control group ( P<0.01); APACHE Ⅱ, CTSI and the Modified Marshall Score in the treatment group were lower than those in the control group ( t values were 11.82, 12.72, 7.71, respectively, all Ps<0.01). Conclusion:Qingjie Huagong Decoction combined with ERCP and conventional western medicine therapy can reduce the level of inflammation in patients with cholelithiasis in the early stage of SAP, relieve clinical symptoms and improve clinical efficacy.

9.
Article in Chinese | WPRIM | ID: wpr-941033

ABSTRACT

OBJECTIVE@#To explore the correlation of coagulation function with the severity and prognosis of acute pancreatitis (AP) and identify the laboratory markers for early prediction and dynamic monitoring of the prognosis of AP.@*METHODS@#We retrospectively analyzed the clinical data of patients with AP admitted less than 72 h after onset to our hospital from December 1, 2017 to November 30, 2018. The correlation of coagulation function-related markers at admission and their changes during hospitalization with the prognosis of the patients was analyzed.@*RESULTS@#We screened the data of a total of 1260 patients with AP against the inclusion and exclusion criteria, and eventually 175 patients were enrolled in this analysis, among whom 52 patients had severe AP (SAP) and 12 patients died. Logistic regression analysis identified vWF: Ag, PT, PC, AT Ⅲ and D-dimer markers at admission as independent risk factors for predicting SAP and death. Dynamic monitoring of the changes in coagulation function-related markers in the disease course had greater predictive value of the patients' prognosis, and the indicators including vWF: Agmax, PTmax, APTTmax, TTmax, FIBmin, D-dimermax, PLTmin, PCmin, PLGmin, AT Ⅲmin, and their variations were all independent risk factors for predicting SAP and death. ROC analysis suggested that dynamic monitoring of the changes in the indicators, especially those of △vWF: Ag, △PT, △APTT, △FIB, △TT, △D-dimer, △PLT, △PC, △AT Ⅲ, △PLG, could effectively predict SAP and death in these patients (with AUC range of 0.63-0.84).@*CONCLUSION@#Patients with AP have vascular endothelial injuries and coagulation disorders. The markers including vWF: Ag, PT, PC, AT Ⅲ and D-dimer at admission are independent risk factors for predicting SAP and death, and dynamic monitoring of the changes in vWF: Ag、PT、APTT、TT、FIB、D-dimer、PLT、PC、AT Ⅲ and PLG can further increase the predictive value.


Subject(s)
Acute Disease , Biomarkers , Humans , Pancreatitis/diagnosis , Prognosis , ROC Curve , Retrospective Studies , Severity of Illness Index , von Willebrand Factor
10.
Article in Chinese | WPRIM | ID: wpr-940424

ABSTRACT

ObjectiveTo investigate the therapeutic effect of Xuebijing injection (XBJ) on sodium taurocholate (Na-Tc)-induced severe acute pancreatitis (SAP) in rats. MethodForty rats were randomly assigned into 5 groups: sham operation group, SAP model group, and low-, medium-, and high-dose (4, 8, 12 mL·kg·d-1, respectively) XBJ groups. SAP model was established by retrograde injection of Na-Tc (1 mL·kg-1) into the biliary and pancreatic ducts. XBJ was injected intraperitoneally 3 days before and 0.5 h after modeling. The ascitic fluid volume and the pancreas weight-to-body weight ratio were measured. The pathological changes of pancreatic tissue were observed via hematoxylin-eosin (HE) staining. The protein levels of formyl peptide receptor 1 (FPR1) and nucleotide-binding oligomerization domain-like receptor 3 (NLRP3) in pancreatic tissue were detected by immunohistochemistry. Western blot was employed to determine the expression levels of NADH-ubiquinone oxidoreductase chains 1-6 (MT-ND1, MT-ND2, MT-ND3, MT-ND4, MT-ND5, and MT-ND6) in rat plasma. ResultCompared with sham operation group, the SAP model group showcased increased ascitic fluid volume and pancreas weight-to-body weight ratio (P<0.05), serious lesions in pancreatic tissue, increased total pathological score (P<0.05), and up-regulated protein levels of FPR1 and NLRP3 in pancreatic tissue (P<0.05). The model group had lower MT-ND2 level (P<0.05) and higher MT-ND1, MT-ND3, and MT-ND6 levels in plasma (P<0.05) than the sham operation group, while MT-ND4 and MT-ND5 had no significant differences between the two groups. Compared with SAP model group, the XBJ treatment decreased ascitic fluid volume and pancreas weight-to-body weight ratio (P<0.01), ameliorated pancreatic lesions, and down-regulated the protein levels of FPR1 and NLRP3 in pancreatic tissue (P<0.01). The treatments, especially high-dose XBJ (P<0.01), down-regulated the expression of MT-ND1 (P<0.01), MT-ND3 (P<0.01), MT-ND6 (P<0.01), and MT-ND4 and did not change that of MT-ND5. ConclusionXBJ may antagonize partial mitochondrial N-formyl peptides and excessive inflammatory response mediated by FPR1/NLRP3 to treat SAP in rats.

11.
Chinese Critical Care Medicine ; (12): 1149-1152, 2021.
Article in Chinese | WPRIM | ID: wpr-909472

ABSTRACT

Acute pancreatitis (AP) is one of the common diseases of the digestive system mainly characterized by acute inflammation of the pancreas and acinar cell destruction, and it can often develop into severe acute pancreatitis (SAP). Acute respiratory distress syndrome (ARDS) is one of the most common and serious complications of SAP and a common cause of death in patients with SAP. In recent years, there have gained new understanding of the pathogenesis, diagnosis, and treatment of SAP-related ARDS, however, a variety of drugs that have been shown to prevent ARDS in SAP animal models have not improved the prognosis of SAP-related ARDS patients in clinical researches. At present, the treatment of SAP-related ARDS still follows the general treatment principles of ARDS, such as treatment of primary disease, lung protective ventilation strategy, prone position ventilation, early short-term use of neuromuscular blockers and extracorporeal membrane oxygenation (ECMO), and so on. However, the influence of high intra-abdominal pressure, intestinal function failure, abdominal incision, and drainage tube on the treatment measures should also be considered for patients with SAP-related ARDS. This article reviews the recent progress in diagnosis and treatment of SAP-related ARDS.

12.
Article in Chinese | WPRIM | ID: wpr-907737

ABSTRACT

Objective:To explore the mechanism of pioglitazone in reducing lung injury induced by acute pancreatitis.Methods:Thirty healthy male SD rats were randomly(random number) divided into the sham operation group, model group and pioglitazone group, with 10 rats in each group. After anesthesia, the rats in the sham operation group were injected with normal saline retrogradely through the pancreaticobiliary duct. In the model group, after anesthesia, the rats were retrogradely injected with sodium taurocholate into the pancreaticobiliary duct to construct the lung injury model of severe acute pancreatitis. In the pioglitazone group, the model was established after intraperitoneal injection of pioglitazone. Six rats in each group were randomly selected and killed 12 h after operation, and then lung tissue and venous blood were collected. The levels of serum amylase and TNF-α and NO in lung tissue homogenate were detected and compared among the three groups; the expression of TLR2 mRNA and TLR4 mRNA in lung tissue was detected by RT-PCR and compared among the three groups; the lung tissue pathological injury score and lung leakage index were calculated and compared among the three groups. The correlation of TLR2 and TLR4’s mRNA expression with lung tissue pathological injury score and lung leakage index was analyzed.Results:The levels of serum amylase and the levels of TNF-α and NO in lung tissue homogenate in the model group were significantly higher than those in the sham operation group, and the above indexes in the pioglitazone group were significantly lower than those in the model group ( P<0.05). The expression levels of TLR2 mRNA and TLR4 mRNA in lung tissue, the lung tissue pathological injury score and lung leakage index in the model group were significantly higher than those in the sham operation group, and the above indexes in the pioglitazone group were significantly lower than those in the model group ( P<0.05). Spearman correlation analysis showed that the expression levels of TLR2 mRNA and TLR4 mRNA in lung tissue were significantly positively correlated with the lung tissue pathological injury score ( rs=0.959, P<0.001; rs=0.924, P<0.001). Pearson correlation analysis showed that the expression levels of TLR2 mRNA and TLR4 mRNA in lung tissue were significantly positively correlated with the lung leakage index ( r=0.957, P<0.001; r=0.958, P<0.001). Conclusions:Pioglitazone may reduce the severity of severe acute pancreatitis induced lung injury by inhibiting the expression of TLR2 mRNA and TLR4 mRNA in lung tissue.

13.
Article in Chinese | WPRIM | ID: wpr-907736

ABSTRACT

Objective:To explore the mechanism of Dahuangfuzi decoction on intestinal motility disorder by observing its effect on serum motilin, Cajal interstitial cells and motilin receptor in rats with severe acute pancreatitis (SAP).Methods:Eighteen clean male Sprague-Dawley rats were randomly divided into the control group, SAP group and Dahuangfuzi group ( n=6 each group). The SAP rat model was prepared by retrogradely injected 4% sodium taurocholate into cholangiopancreatic duct. The rats in the SAP group were given 2 mL normal saline (37℃) enema at 12 and 24 h after operation. The rats in the Dahuangfuzi group was given 2 mL Dahuangfuzi decoction (37℃) enema at 12 and 24 h respectively. For the control group, the pancreas was exposed in the same way and then the abdomen was closed. Forty-eight h after operation, the abdominal aorta blood samples were taken for determination of serum endotoxin and amylase, and for detection of serum motilin by enzyme-linked immunosorbent assay (ELISA); the pathological changes of pancreas and ileum were observed by hematoxylin-eosin (HE) staining. The expression of c-kit and motilin receptor protein in ICC in ileum tissue was detected by immunohistochemistry. Results:Compared with the control group, the levels of serum endotoxin and amylase in the SAP group were significantly higher [(504.98±88.81) pg/mL vs. (17.76±5.01) pg/mL; (532.28±66.53) vs. (69.45±3.61) U/L, P<0.05], while the levels of serum motilin were significantly lower [(195.4±6.7) ng/L vs. (301±8.10) ng/L, P<0.05], and the scores of c-kit and motilin receptor protein were decreased ( P<0.05); compared with the SAP group, the levels of serum endotoxin and amylase in the Dahuangfuzi group were significantly reduced [(189.9±38.23) pg/mL vs. (504.98±88.81) pg/mL; (294.23±25.66) vs. (532.28±66.53) U/L, P<0.05], while the levels of serum motilin were significantly increased [(264.2±8.3) ng/L vs. (195.4±6.7) ng/L, P<0.05], and the scores of c-kit and motilin receptor protein were increased ( P<0.05). Conclusions:Dahuangfuzi decoction can improve the intestinal motility of SAP rats by promoting the secretion of motilin, increasing the activity of ICC cells and the expression of motilin receptor.

14.
Article in Chinese | WPRIM | ID: wpr-907735

ABSTRACT

Objective:To explore the early prediction value of neutrophil to lymphocyte ratio (NLR) combined with platelet to lymphocyte ratio (PLR) for severe acute pancreatitis (SAP).Methods:A total of 216 patients were collected in the Emergency Department of Peking University People's Hospital who met the diagnostic criteria of acute pancreatitis (AP) from January to December in 2019. Patients were assigned to 3 groups according to the severity of AP: the mild acute pancreatitis group (MAP, n=86), moderately severe acute pancreatitis group (MSAP, n=40), and severe acute pancreatitis group (SAP, n=90). The peripheral blood was taken immediately. White blood cell count (WBC), neutrophil count (NEUT), lymphocyte count (LYM), hemoglobin (HGB), platelet count (PLT), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low density lipoprotein (LDL), serum creatinine (CR), and glucose (GLU) were detected. At the same time, CT imaging and other examinations were completed. NLR and PLR were calculated and compared among the three groups. The correlation between NLR, PLR, APACHE II score and Ranson score were compared. The receiver operating characteristic (ROC) curve was drawn to calculate the optimal thresholds of NLR and PLR. NLR-PLR was calculated according to the optimal thresholds of NLR and PLR, and the ROC curve was drawn to study the predictive value of NLR-PLR for SAP. Results:NLR [ OR=1.071, 95% CI (1.025, 1.120), P=0.002] and PLR [ OR=1.003, 95% CI (1.000, 1.244), P=0.044] were risk factors for SAP. NLR was positively correlated with Ranson score ( r=0.0342). NLR was positively correlated with APACHE II score ( r=0.0210). PLR was positively correlated with Ranson score ( r=0.0218, P=0.002). There was no correlation between PLR and APACHE II score ( P=0.157). The areas under the ROC curve (AUC) of NLR and PLR were 0.894 and 0.728. The optimal threshold, sensitivity and specificity of NLR were 6.105, 92.9% and 76.1%, and the optimal threshold, sensitivity and specificity of PLR were 154.358, 78.2% and 73.2%. The AUC of NLR-PLR (0.864) was the largest. Conclusions:NLR and PLR have predictive value for SAP patients within 48 h of the onset of AP. NLR-PLR combined detection have early predictive value for SAP within 48 h of onset.

15.
Chinese Journal of Digestion ; (12): 466-470, 2021.
Article in Chinese | WPRIM | ID: wpr-912203

ABSTRACT

Objective:To analyze the clinical characteristics and risk factors of fungal infections secondary to severe acute pancreatitis (SAP), so as to provide experience for clinical diagnosis and treatment.Methods:From January 2013 to August 2020, at The First Affiliated Hospital of Chongqing Medical University, 48 SAP patients with secondary fungal infection (infection group) were enrolled. At the same period, 72 SAP patients without fungal infection (non-infection group) were selected as control group. The location of fungal infection, bacterial species distribution, anti-fungal treatment of the infection group, and the prognosis of the two groups were analyzed. Independent sample t test, Wilcoxon rank sum test and chi-square test were used for statistical analysis. The factors that may affect the secondary fungal infection of SAP were analyzed by binary logistic regression analysis in order to detect the independent risk factors of SAP with secondary fungal infection, and receiver operating characteristic curve analysis was performed to evaluate their value in predicting SAP with secondary fungal infection. Results:There were 74 fungal infection sites in the infection group, mainly respiratory infections (25.7%); 54 fungal strains were isolated and all of which were Candida infection, mainly Candida albicans (48.1%). In the infection group, 36 patients received antifungal therapy, among whom 20 patients (55.6%) died; the remaining 12 patients did not receive antifungal therapy, six of them died, in total 26 (54.2%) patients died. In the non-infection group there were nine patients (12.5%) died. There was a significant difference in mortality between the infection group and the non-infection group (54.2% vs. 12.5%, χ2=24.20, P<0.01). Compared with the non-infection group, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score at admission, time of fasting and drinking, time of urinary catheter catheterization and deep venous catheterization, types and duration of broad-spectrum antibiotics usage, hospital stay, time of invasive ventilator using and indwelling time of abdominal drainage tube were higher in the infection group ((16.92±5.70) point vs. (13.32±4.73) point, (16.38±6.87) d vs. (9.51±4.90) d, (15.65±9.68) d vs. (10.40±9.45) d, (19.48±10.43) d vs. (12.74±10.28) d, (4.13±1.02) type vs. (2.35±1.78) type, (30.54±12.94) d vs.(19.10±9.48) d, (36.10±26.27) d vs.(21.93±9.91) d, 6.00 d (0.00 d, 21.75 d) vs. 0.00 d(0.00 d, 7.00 d), 9.00 d (0.00 d, 18.00 d) vs. 0.00 d (0.00 d, 0.00 d)), and the differences were statistically significant ( t=-3.61, -6.56, -3.08, -3.82, -6.86, -5.06 and -3.95, Z=-2.71 and -4.19, all P<0.01). The results of binary logistic regression analysis showed that APACHEⅡ score at admission, time of fasting and drinking, and broad-spectrum antibiotic usage were independent risk factors of SAP with secondary fungal infection (odds ratio=1.181, 2.589 and 1.205, 95% confidence interval ( CI) 1.036 to 1.347, 1.409 to 4.757 and 1.060 to 1.370), and the differences were statistically significant (all P<0.05). The area under curve values of APACHEⅡ score, broad-spectrum antibiotics usage and time of fasting and drinking were 0.695 (95% CI 0.596 to 0.794), 0.853 (95% CI 0.784 to 0.923) and 0.907 (95% CI 0.798 to 0.923), respectively; and the cut-off values at 17.5 point, 3.5 types, and 11.5 d were most effective in predicting secondary fungal infection of SAP. Conclusions:Respiratory tract is the most common site for secondary fungal infections in SAP. Candida albicans infection is more common. SAP patients with APACHE Ⅱ score >17 point at admission, time of fasting and drinking >11 d and more than three kinds of broad-spectrum antibiotics application are prone to secondary fungal infections in the later stage.

16.
Article in Chinese | WPRIM | ID: wpr-931722

ABSTRACT

Nutritional support is one of the core issues in the treatment of severe acute pancreatitis (SAP). Recently, with continued advances in this field, more and more evidences were found in the strategies, methods and routes of nutritional support for patients with SAP. Meanwhile, with deeper understanding of pathogenesis and metabolic characteristics of severe patients in acute phase, we may have a better understanding in the strategies of nutritional support from the pathogenesis and pathophysiology aspects. In this paper, we discuss the hotspots and challenges over recent year in the nutritional support of SAP. We aim to give a clear insight into current progress and help to individualize the nutritional program.

17.
Article | IMSEAR | ID: sea-213165

ABSTRACT

Background: The management of acute pancreatitis (AP) is determined by an accurate assessment of severity of disease. Numerous severity indicators have been described till date, most of which require reassessment after admission and resuscitation. Authors propose a novel indicator, the neutrophil-lymphocyte and hematocrit (NLH) scoring as a predictor of acute pancreatitis at the initial time of diagnosis. NLH may have a role in predicting the length of hospital stay and intensive care unit admission and also to predict adverse manifestations of severe acute pancreatitis (SAP).Methods: A retrospective analysis of 107 patients done who diagnosed with acute pancreatitis based on Atlanta 2012 definitions, who were admitted and treated between August 2018 and November 2019. NLH score calculated by adding NLR (neutrophil lymphocyte ratio) and Ht (hematocrit) i.e., NLH=NLR+Ht. NLH was also compared with APACHE II score as a standard predictor of prognosis in acute pancreatitis.Results: Median NLH score among the severe group is significantly higher compared to mild and moderate group. NLH score significantly correlated with length of hospital stay and also had a statistically significant correlation with ICU stay. NLH scoring is comparable with APACHE II scoring system in predicting prognosis in acute pancreatitis.Conclusions: NLH score can be used as a predictor of severity of acute pancreatitis, right at the time of initial diagnosis. Further it may predict adverse outcomes, need for ICU care as well as the length of hospital stay. NLH score can be used as a tool to refer at risk patients to tertiary center needing ICU admission.

18.
Article | IMSEAR | ID: sea-213005

ABSTRACT

Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.

19.
Rev. chil. nutr ; 47(2): 292-298, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115501

ABSTRACT

La clasificación de la severidad de la pancreatitis aguda ha cambiado con la actualización de Atlanta del 2012. Las recomendaciones de terapia nutricional en los casos de pancreatitis aguda grave no están sustentadas en estudios con alto nivel de evidencia, en los estudios se incluyen pacientes con los diferentes grados de severidad, se usa la clasificación de Atlanta 2002 para definir la pancreatitis aguda grave y, en la mayoría de los estudios experimentales, los controles son pacientes con nutrición parenteral. Se realiza una revisión narrativa de la evidencia actual publicada, analizando las características clínico epidemiológica de los pacientes y los resultados obtenidos. Así, se proponen características que deben ser consideradas en estudios futuros sobre el tema.


The classification of the severity of acute pancreatitis has changed with respect to the Atlanta update of 2012. The recommendations for nutritional therapy in cases of severe acute pancreatitis are not supported by high-level studies, as studies contain a mix of patients with different degrees of severity. The Atlanta 2002 classification is used to define severe acute pancreatitis and, in most of experimental studies, controls are patients with parenteral nutrition. A narrative review of the current published evidence is carried out analyzing the clinical and epidemiological characteristics of the patients in these results and characteristics to be included in future studies are proposed.


Subject(s)
Humans , Pancreatitis/therapy , Nutrition Therapy/methods , Pancreatitis/complications , Pancreatitis/physiopathology , Severity of Illness Index , Acute Disease , Enteral Nutrition , Parenteral Nutrition
20.
Article in Chinese | WPRIM | ID: wpr-873286

ABSTRACT

Objective::To explore the effect of modified Qingyitang combined with continuous blood purification in the adjuvant treatment of severe acute pancreatitis (SAP) complicated with multiple organ dysfunction (MODS) caused by heat accumulation of viscera. Method::Totally 100 cases of patients of SAP complicated with MODS, who were diagnosed as heat accumulation of viscera by traditional Chinese medicine(TCM) and treated in ICU of the First Affiliated Hospital of Hunan University of Chinese Medicine during May 2015 and May 2019, were randomly divided into two groups, namely control group and observation group, with 50 cases in each group. The patients in control group were treated with fasting and abstinence, gastrointestinal decompression, inhibition of trypsin secretion, gastric mucosal protection, early jejunal nutrition, reduction of inflammatory reaction, continuous blood purification (CBP), mechanical ventilation and circulatory support. The patients in observation group were treated by nasojejunal tube according to syndrome differentiation in addition to routine comprehensive therapy. Modified Qingyitang was injected for 7 days. The remission time of abdominal pain and distention, the time of first exhaust and defecation, the time of ICU residence, the number of samples falling off, the cause of death and the number of cases were recorded. Relevant indexes were measured before treatment, on the 3rd and 7th day of treatment, including the evaluation indexes of pancreatitis: blood amylase (AMS), blood lipase (LPS), and modified computed tomography severity index (MCTSI), inflammatory response indexes were interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP). Organ function indexes included APACHE-Ⅱ, arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), glutamyltransferase (γ-GGT), urine volume, creatinine (CREA), urea nitrogen (UREA), glomerular filtration rate (GFR), creatine kinase (CK), creatine kinase isoenzymes (CKMB), lactate dehydrogenase (LDH), myoglobin (Mb). Tissue perfusion evaluation indexes included acute physiology and chronic health score, serum lactic acid (Lac) and central venous pressure (CVP). TCM treatment score was based on the syndrome score of acute pancreatitis with heat accumulation of viscera syndrome. Result::The total effective rate of TCM syndromes was 86.67%(39/45) in observation group and 73.91%(34/46) in control group (χ2 =13.524, P<0.01). On the 7th day of treatment, the symptoms and indicators of the two groups were improved. Compared with before treatment, AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT and AST were improved on the 3rd and 7th day after treatment in observation group and control group. The levels of AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT, AST, ALP, γ-GGT, urine volume were significantly improved (P<0.05). Compared with control group on the 3rd and 7th day, the levels of AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT, AST, ALP, γ-GGT, urine volume were significantly improved (P<0.05). CREA, UREA, GFR, CK, CKMB, LDH and Mb were significantly improved (P<0.05). Compared with control group, the abdominal pain, abdominal distension relief time, first exhaust/defecation time, ICU stay time in observation group were significantly shortened (P<0.05), and the mortality rate in observation group was significantly reduced (P<0.05). Conclusion::Patients of SAP accompanied with MODS can be treated with blood purification combined with modified Qingyitang by promoting pancreas repair, inhibiting inflammation and improving organ function. It plays an important role in improving symptoms, alleviating TCM syndromes, delaying progression of disease, reducing hospital stay and reducing mortality.

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