【摘要】 目的观察中药清胰汤联合地塞米松对大鼠重型急性胰腺炎(SAP)早期全身炎症反应综合征(SIRS)的治疗作用。方法选用健康雄性SD大鼠100只,体重250~300 g,随机分为假手术组、SAP组、地塞米松治疗组(D组)、清胰汤治疗组(Q组)及地塞米松联合清胰汤组(D+Q组),每组20只。每组按照不同时间点分为2、6、12和24 h 4个小组,每组5只。假手术组、SAP组经阴茎背静脉给予生理盐水,D组经阴茎背静脉给予地塞米松,Q组鼻饲给予清胰汤,D+Q组联合应用地塞米松和清胰汤。用5%牛磺胆酸钠经胰胆管逆行注射制作大鼠SAP模型,检测血清TNFa(肿瘤坏死因子a)、IL-1(白介素-1)、IL-6(白介素-6)和AMY(淀粉酶)水平,计算胰腺脏器系数并观察大体及病理学改变。结果 SAP各组血清AMY、TNFa、IL-1、IL-6水平均明显升高,胰腺病理评分明显增加,腹水量亦明显增加,镜下可见胰腺水肿、出血、炎细胞浸润、点片状坏死。并随时间延长而增加。D组和Q组腹水量明显减少;除2 h组外胰腺病理改变明显减轻,胰腺病理评分减少(P<0.01);血清AMY、TNFa、IL-1、IL-6明显下降。两组之间上述各指标无明显差别。D+Q组与D组和Q组6、12和24 h小组相比血清AMY、TNFa、IL-1、IL-6下降更为明显(P<0.05)。结论血清AMY、TNFa、IL-1、IL-6在SAP早期SIRS阶段明显升高,清胰汤和地塞米松对大鼠SAP早期SIRS均有治疗作用,两者有协同作用。更多还原

【Abstract】 【Objective】 In order to study the effects of QingYi decoction combination with Dexamethasone on severe acute pancreatitis(SAP) with systemic inflammatory response symdrome(SIRS),Sodium taurocholate was injected into the rat’s bilio-pancreatic duct to make a classic hemorrhagic pancreatitis model.【Methods】 100 healthy SD rat were randomly divided into five groups: sham group,SAP group,Dexamethasone group(D group),QingYi decoction group(QY group) and Dexamethasone combination QingYi decoction group(D+QY group).Every group was divided into 4 small subgroups according the time point 2 h,6 h,12 h,24 h after the operation.Then the serum level of amylase(AMY),tumor necrosis factor alpha(TNFa) and interleukin 6(IL-6) were measured.In addition,pancreatic index and pancreas pathologic grade were determined.【Results】Comparison with Sham group,SAP group had a lot of red ascites in SAP group.The time longer SAP attacked,the volumn of ascites more.Pathomorphologic changes of pancreas appeared included edema,hyperemia,hemorrhage and necrosis in SAP groupsobserved with naked eyes.Microscopic pathology consisted of edema,hyperemia,hemorrhage and necrosis in acinusand interstitium of pancreas.Among the five groups,pancreas index and pathologic score of SAP group were highest,that of D+QY group lowest,and that of D group,QY group moderate.Level of AMY,TNFα,IL-1,IL-6 in SAP groupserum increase significantly comparing with that of sham group(P<0.05).The volumn of ascits decreased significantlyin D,QY,D+QY group.The change pathomorphology of pancreas improved significantly in D,QY group.Level ofTNFα,IL-1,IL-6 in D,QY group decreased significantly comparing with SAP(P<0.05).Level of TNFa,IL-1,IL-6in D+QY group decreased significantly comparing with D,QY group(P<0.05)and in D group decreased notsignificantly comparing with QY group(P>0.05).【Conclusions】TNFα,IL-1,IL-6 played important roles inpathogenesis of SAP compared with SIRS.QingYi decoction combination with Dexamethasone maybe had powerfulsynergism in the treatment of SAP with SIRS.更多还原