CAJ | 학술논문

目的：探讨早期腹腔引流对重症急性胰腺炎（severe acute pancreatitis，SAP）大鼠肠粘膜免疫屏障功能损伤的影响及作用机制。方法将72只Wistar大鼠随机分为3组：SAP组（A组）、SAP引流组（B组）、假手术对照组（C组）。观察术后12、24 h大鼠死亡率，各时相点腹水量。分别于术后的第6、12、24 h采集血液、腹水、肠液、肠组织、胰腺标本，冻存以备检测。采用全自动生化分析仪检测血清及腹水淀粉酶活性，ELISA法测定血清及腹水IL-6、TNF-a浓度，胰腺组织冰冻切片HE染色观察病理变化，ELISA法检测肠液sIgA水平，肠组织作CD4＋T淋巴细胞免疫组化染色。结果分别于术后6、12、24 h，通过各项指标的检测，有以下发现：①术后同时相点A、B两组大鼠血清及腹水淀粉酶、IL-6、TNF-a水平均显著高于C组大鼠水平，且术后同时相点A、B两组大鼠胰腺组织水肿及出血坏死程度均较C组大鼠显著加重。②对肠液sIgA的检测发现，术后各时相点A、B两组大鼠均显著低于C组大鼠水平，且A、B两组大鼠肠组织中CD4＋T淋巴细胞浸润程度也均显著低于C组。③术后同时相点B组大鼠血清及腹水淀粉酶、IL-6、TNF-a水平均显著低于A组大鼠水平；B组大鼠胰腺组织水肿及出血坏死程度较A组明显减轻。④术后同时相点B组肠液sIgA水平显著高于A组水平；且B组肠组织中CD4＋T淋巴细胞浸润程度较A组显著增加。结论SAP发病早期，通过腹腔置管引流将富含诸如IL-6、TNF-a等炎性因子的腹水引流出体外，对肠粘膜免疫屏障功能起到显著的保护作用。
목적：탐토조기복강인류대중증급성이선염（severe acute pancreatitis，SAP）대서장점막면역병장공능손상적영향급작용궤제。방법장72지Wistar대서수궤분위3조：SAP조（A조）、SAP인류조（B조）、가수술대조조（C조）。관찰술후12、24 h대서사망솔，각시상점복수량。분별우술후적제6、12、24 h채집혈액、복수、장액、장조직、이선표본，동존이비검측。채용전자동생화분석의검측혈청급복수정분매활성，ELISA법측정혈청급복수IL-6、TNF-a농도，이선조직빙동절편HE염색관찰병리변화，ELISA법검측장액sIgA수평，장조직작CD4＋T림파세포면역조화염색。결과분별우술후6、12、24 h，통과각항지표적검측，유이하발현：①술후동시상점A、B량조대서혈청급복수정분매、IL-6、TNF-a수평균현저고우C조대서수평，차술후동시상점A、B량조대서이선조직수종급출혈배사정도균교C조대서현저가중。②대장액sIgA적검측발현，술후각시상점A、B량조대서균현저저우C조대서수평，차A、B량조대서장조직중CD4＋T림파세포침윤정도야균현저저우C조。③술후동시상점B조대서혈청급복수정분매、IL-6、TNF-a수평균현저저우A조대서수평；B조대서이선조직수종급출혈배사정도교A조명현감경。④술후동시상점B조장액sIgA수평현저고우A조수평；차B조장조직중CD4＋T림파세포침윤정도교A조현저증가。결론SAP발병조기，통과복강치관인류장부함제여IL-6、TNF-a등염성인자적복수인류출체외，대장점막면역병장공능기도현저적보호작용。
Objective To investigate the impact and mechanism of the catheter drainage on the rats with intestinal mucosal immune barrier in-jury by severe acute pancreatitis(SAP).Methods 72 wistar rats were randomly divided into three groups:SAP model group(A group),SAP drainage group (B group),the sham operation control group (C group).Observe the rats’mortality of 12、24 h after operation and volume of ascites at every phase.Blood,ascites,intestinal juice,intestinal tissue,pancreas tissue were collected at 6,12,24 h after operation,and stored in refrigerator for examination.The amylase of blood and ascites were detected by fully automatic biochemical analyzer.IL-6 ,TNF-a concen-tration of blood and ascites was evaluated by ELISA.Pancreatic pathological changes was observed using HE dyeing.The sIgA levels of intes-tinal juice detected by The ELISA.The CD4 +expression of intestinal detected by the immunohistochemistry.Results Testing the indicators in 6,12,24 h,we have the following findings:①Blood and ascites amylase,ascites amylase,IL-6 and TNF-a of group A and group B are sig-nificantly higher than group C at each time point.Compared with group C,the pancreatic edema and hemorrhagic necrosis are more serious in A and B groups.②The level of sIgA of group A and group B are significantly lower than group C at each time point,compared with group C, as the same of the expression of CD4+T .③Serum amylase,ascites amylase,IL-6 and TNF-a of Group B is significantly lower than group A at each time point.Compare with group B pathological changes was obviously in group A.④The level of sIgA and expression of CD4+T im-mune cell of intestinal tissue in Group B was significantly higher than group A at each time point.Conclusion In the early stage of SAP, drainaging ascites that contain inflammatory factors,such as IL-6 and TNF-a,by using abdominal cavity catheter drainage,play a significant role in protecting intestinal mucosal immune barrier function.