【摘要】 目的:观察低分子肝素(LMWH)区域动脉灌注(LAI)对家兔重症急性胰腺炎(SAP)的疗效及对血浆TNF-α,IL-6,IL-10的影响。方法:24只健康成年家兔随机均分为假手术组,SAP组,SAP+LMWH静脉输注组(IV组),SAP+LMWH LAI组(LAI组)。以5%牛磺胆酸钠胰腺被膜下注射诱导SAP模型,造模30 min后,2个治疗组分别以静脉输注和LAI的方式给予LMWH(300 IU/kg),分别在术后0.5,3,6,12 h检测各组家兔静脉血浆TNF-α,IL-6和IL-10水平,并观察胰腺病理学改变。结果:假手术组术后血浆TNF-α和IL-6水平呈缓慢升高,其余各组血浆TNF-α和IL-6水平均在术后0.5~6 h内明显升高,与假手术组比较差异均有统计学意义(P<0.05或P<0.01),随后逐渐降低,其中IV组和LAI组血浆TNF-α和IL-6水平在各时点均低于SAP组(P<0.05或P<0.01),且LAI组两者降低程度大于IV组(P<0.05或P<0.01);假手术组术后IL-10水平在各时点无明显变化,SAP组IL-10水平在术后6 h各时点明显降低,与假手术组比较差异有统计学意义(均P<0.01),IV组和LAI组IL-10水平明显升高,与SAP组比较差异均有统计学意义(P<0.05或P<0.01),且LAI组升高程度明显大于IV组(P<0.01);除假手术组外,其余各组均为轻重不同的SAP特征性病理表现,以SAP组最重,IV组次之,LAI组最轻。结论:LMWH能降低SAP家兔TNF-α和IL-6的水平,提高IL-10的水平,对SAP具有治疗作用,且LAI优于静脉给药。更多还原

【Abstract】 Objective: To investigate the therapeutic effect of local arterial infusion(LAI) with low molecular weight heparin(LMWH) on severe acute pancreatitis in rabbits and its effect on the serum levels of TNF-α,IL-6 and IL-10. Methods: Twenty-four healthy adult rabbits were randomized into the sham operation group,SAP model group,SAP plus LMWH intravenous injection group(IV group) and SAP plus LMWH LAI group(LAI group).SAP model was established by injection with 5% sodium taurocholate under pancreatic capsule,and the rabbits of the two treatment groups were given LMWH(300 IU/kg) by intravenous injection or LAI,respectively.The serum levels of TNF-α,IL-6 and IL-10 in rabbits of each group were detected at 0.5,3,6 and 12 h after surgery and the pathological changes of pancreatic tissues were also assessed. Results: After surgery,the serum levels of TNF-α and IL-6 of the sham operation group were slowly elevated,while those of the remaining groups were markedly increased within 0.5 to 6 h,that all had statistical differences compared with the sham operation group(P<0.05 or P<0.01),and then gradually declined.The serum levels of TNF-α and IL-6 of the IV group and LAI group were all significantly lower than those of the SAP group at each observation time point(P<0.05 or P<0.01) and,further,the decreasing degrees of the two factors in the LAI group were more pronounced than those in the IV group(P<0.05 or P<0.01).The level of IL-10 of the sham operation group had no obvious alteration over the observation period after surgery,while it was markedly decreased in the SAP group at each time point after 6 h and all had statistical differences compared with the sham operation group(all P<0.01).The level of IL-10 of the IV and LAI group markedly increased with statistical differences compared with the SAP group(P<0.05 or P<0.01) and,furthermore,its increasing degree in the LAI group was more pronounced than that in the IV group(P<0.01).Except for the sham operation group,all the pancreatic tissues of the other groups exhibited pathological characteristics of SAP with varying degrees,among which the most severe was in the SAP group,less in the IV group,and least in the LAI group. Conclusion: LMWH can decrease the TNF-α and IL-6 levels,and increase the IL-10 level in rabbits with SAP.LMWH has therapeutic effect on SAP and its local arterial injection is more effective than intravenous injection.更多还原