RESUMO
Objective To investigate the effects of intestinal ischemia reperfusion (IIR) on the progression of inflammatory reaction in hemorrhagic necrosis pancreatitis (HNP).Methods Eighty rats were randomly divided into sham operation (SO) group,acute edematous pancreatitis (AEP) group,AEP + IIR group and HNP group according to the random number table.Erythrocyte velocity (EV),functional capillary density (FCD) and leukocyte adherence (LA) were observed at 0,1,2,3 and 6 hours after the models were completed.The serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected.All data were analyzed by using the analysis of variance or the t test.Results The level of EV in the AEP group significantly decreased at 1 hour,and got increased at 3 hours,while the level of EV in the AEP group was still significantly lower than that in the SO group ( t =9.60,P ＜ 0.05 ).The levels of EV in the AEP + IIR group and HNP group constantly decreased,and increased at 6 hours,but were continually lower than that in the AEP group ( t =6.03,6.12,P ＜0.05 ).The level of FCD in the AEP group was significantly lower than that in the SO group at 3 hours ( t =8.20,P＜0.05).The levels of FCD in the AEP + IIR group and HNP group were significantly lower than that in the AEP group at 3 hours (t =35.60,23.80,P ＜ 0.05 ).Compared with AEP group,the level of LA in the AEP group was significantly increased at 1 hour ( t =75.00,P ＜ 0.05 ) and reached peak at 3 hours.The levels of LA in the AEP + IIR group and HNP group were significantly higher than that in the AEP group at 1,2,3,6 hours (t =23.00,29.50,53.00,38.70,23.10,48.20,39.20,47.50,P＜0.05).Compared with SO group,the level of TNF-α in the AEP group significantly increased since l hour (t =77.00,P ＜ 0.05),and began to decrease at 3 hours; the levels of TNF-α in the AEP +IIR group and HNP group at 2 hours were significantly higher than that in the AEP group (t =23.50,18.10,P＜0.05).The levels of IL-6 in the AEP group at 1,2,3,6 hours were significantly higher than those in the SO group ( t =93.50,146.00,243.60,209.20,P ＜ 0.05 ).The levels of IL-6 in the AEP + IIR group and HNP group at 1 hour were not significantly different from that in the AEP group ( t =2.30,2.03,P ＞ 0.05),while the levels of IL-6 in the AEP + IIR group and HNP group at 2 hours were significantly higher than that in the AEP group (t =35.63,29.80,P ＜ 0.05 ).Conclusion IIR may enhance the inflammatory reaction of AEP and IIR might be one of the factors to exaggerate the inflammatory reaction of HNP.
RESUMO
Objective To explore the therapeutic effect of immune regulating nutrition on severe acute pancreatitis (SAP). Methods The clinical data of 80 patients with SAP who were admitted to the Union Hospital of Huazhong University of Science and Technology from February 2008 to October 2009 were prospectively analyzed. The 80 patients were equally divided into conventional nutrition (CN) group and immune regulating nutrition (IRN) group. Patients in the CN group received CN support, while patients in the IRN group were supplemented with ω-3 polyunsaturated fatty acid (ω-3 PUFA ) and glutamine at the basis of CN support.APACHE Ⅱ scores were evaluated at day 1, 4, 7, 10, 14 in the course of treatment. The differences in the incidence of pulmonary and abdominal infection, sepsis, and other clinical parameters including operation intervention, mortality, length of ICU and hospital stay between the two groups were compared. All data were analyzed using the t test and chi-square test. Results The APACHE Ⅱ scores of patients in the IRN group were 15.3 ± 1.8 and 9.0 ± 1.8 at day 4 and 7, which were significantly lower than 20.0 ± 2.7 and 13.3 ± 2.4 in the CN group, respectively (t = 3.3, 2. 8, P < 0.05). The APACHE Ⅱ scores of patients in the IRN group at day 10and 14 were also lower than those in the CN group, while there was no significant difference (t =0. 7, 0. 6, P>0.05). The incidences of pulmonary and abdominal infection and surgical intervention rate in the IRN group were 18% (7/40), 13% (5/40) and 5% (2/40), which were significantly lower than 38% (15/40), 33% (13/40)and 20% (8/40) in the CN group, respectively (χ2 =4.0, 4.6, 4.1, P<0.05). The incidence of sepsis in the IRN group was 5% (2/40), which was lower than 8% (3/40) of the CN group, while there was no significant difference between the two groups ( χ2 =0.0, P >0.05 ). The average lengths of ICU and hospital stay in the IRN group were (5.4 ± 1.6 ) days and ( 38.6 ± 9.3 ) days, which were significantly lower than ( 7.8 ± 2.8 ) days and (43.1 ± 1 1.6) days in the CN group, respectively ( t = 2. 7, 3. 7, P < 0.05 ). The morality was 5% (2/40) in the IRN group and 8% (3/40) in the CN group, with no significant difference between the two groups (χ2 =0.0,P >0.05). Conclusion CN support supplemented with ω-3 PUFA and glutamine can adjust the inflammation reaction of SAP and sustain the normal immune function, which is helpful in decreasing the incidence of severe infection.