The serum activities of 3 cytokines (TNF,IL-1 and IL-6) were observed in 23 patients admitted within 4 days of onset of acute pancreatitis (AP). The results showed that the serum level of 3 cytokines raised in all of the AP patients, significant difference between TNF and IL-1 was abserved at admission and IL-6 did after one week of admission, suggesting that proper cytokine criteria are useful in predicting severity of the disease but the relationship between cytokines and MOF had not established.
ObjectiveTo analyze the risk factors of acute pancreatitis (AP) associated with hepatic dysfunction. MethodsWe collected the clinical data of AP patients from June 2012 to December 2014. According to the hepatic function, patients were divided into normal or mildly abnormal group (A), moderately abnormal hepatic function group (group B) and hepatic failure group (group C). We comparatively analyzed the relationship of abnormal hepatic function with causes (biliary, alcoholic, hypertriglyceridemia, and the others), age, gender, abdominal CT findings, laboratory test results, Ranson scores and the severity of acute pancreatitis bedside index (BISAP). ResultsA total of 117 AP patients were included in the study, including 75 males and 42 females aged from 28 to 71 years with the mean age of (53.21±1.35) years. There were 73 patients with mild AP (MAP), 28 with moderately severe AP (MSAP) and 16 with severe AP (SAP). There were 64 patients in group A, 37 in group B, and 16 in group C, in whom 73 patients were with hepatic dysfunction. The ratio of SAP and MSAP in group C was 75.0%, and MAP was 25.0%. There were 52 patients with bilious AP, 39 with alcoholic AP, 19 with hypertriacylglycerolemia AP, and 7 with others; the difference in causes among the three groups were not significant (P > 0.05). The differences in serum amylase, prothrombin time, white blood cells count, serum creatinine, triglycerides, total cholesterol, hemoglobin, and blood urea nitrogen among the three groups were not significant (P > 0.05). ConclusionsAP associated with hepatic dysfunction or failure may be caused by a various of factors. Whether the changes of serum amylase, prothrombin time, white blood cell count, serum creatinine, triglycerides, total cholesterol, hemoglobin, blood urea nitrogen, and BISAP scores can be the indexes of the judgment of AP with hepatic dysfunction needs more researches. Proper assessment of the related risk factors helps to prevent serious hepatic dysfunction or even failure.
ObjectiveTo study the function of selectin in the pathogenesis and advancement of acute pancreatitis(AP), so as to guide further investigation and clinical treatment. MethodsCorrelative articles in recent years were reviewed. ResultsSelectins act as an indicator of the activation of endothelium. Their expression changes markedly during AP and is closely related to cytokines, oxygen free radicals and complements. Conclusion Selectin is a component which is engaged in the pathology of AP, the level of selectin is useful in guiding clinical observation and treatment.
ObjectiveTo explore the pathogenesis of acute pancreatitis during pregnancy, differential diagnosis, and standardized treatment. MethodsThe related literatures at home and abroad in recent years were reviewed, and the progress of pathogenesis and treatment of acute pancreatitis during pregnancy were summarized. ResultsThe common cause of acute pancreatitis during pregnancy include biliary system diseases, hyperlipidemia, hyperparathyroidism, the direct effect of pregnancy on the pancreas, etc. According to the different pathogenic factors of acute pancreatitis during pregnancy, the laparoscopic cholecystectomy (LC), endoscopic retrograde cholangiopancreatography (ERCP), low-fat diet combined with Omega-3 fatty acids, parathyroid adenoma resection, or terminal pregnancy could be use. ConclusionAcute pancreatitis during pregnancy is dangerous, the cause, general condition of patients, and the growth of fetus should be give full consideration, and the diagnosis and treatment are standardized.
Objective To investigate the change of the platelet parameter and to study the therapeutic effects of ulinastatin (UTI) on platelet parameter in patients with acute pancreatitis (AP). Methods The data of 80 patients with AP were analyzed retrospectively. All patients were divided into two groups: mild acute pancreatitis (MAP, n=43) and severe acute pancreatitis (SAP, n=37). Thirty people who took the medical examination and whose results were normal were included as control group. The autocytometer was used to test PLT, PCT, MPV and PDW in different periods of SAP. Results On admission, there were no significant differences of PLT, PCT between MAP group and control group (Pgt;0.05), but MPV and PDW in MAP group were higher than those of control group (plt;0.05). Compared with MAP group, PLT and PCT decreased markedly in SAP group (plt;0.01), while MPV and PDW significantly increased (plt;0.05). After 1-week treatment of UTI, PLT and PCT in MAP group didn’t change dramatically, while MPV and PDW decreased significantly (plt;0.05). While in SAP group, PLT and PCT increased significantly (plt;0.05, plt;0.01), and MPV and PDW decreased significantly (plt;0.01, plt;0.05). Compared with conventional treatment， PLT and PCT in MAP group increased significantly in UTI treatment group （plt;0.05）, but there was no statistical difference in terms of MPV and PDW （Pgt;0.05）. However, SAP group showed significant increase of PLT and PCT （plt;0.01， plt;0.05） and decrease of MPV and PDW in UTI treatment group compared with patients treated by conventional methods （plt;0.01）. Conclusion The platelet parameter changes in patients with acute pancreatitis, and the changes of SAP patients are more mark than those of MAP patients. UTI can significantly increase PLT and PCT, and significantly decrease the activity of the platelet. Therefore, UTI may take a role in the treatment and prevention for SAP.
ObjectiveTo determine the characters of symptomatic pancreatic pseudocyst due to acute pancreatitis and effects of surgical treatment with two kinds of procedure （internal drainage or external drainage）. MethodsOne hundred and fifteen cases hospitalized during recent ten years were retrospectively analyzed.ResultsWe found that necrotic tissue existed in the pseudocyst in most cases and infection might occur in these pseudocyst. Although effect of two kinds of surgery was similar, the clinical course was different. The complications after surgery were fewer in patients underwent internal drainage than that with procedure of external drainage, and average hospital day was 7d in cases with internal drainage and 11d in cases with external one respectively. Surgery of internal drainage used in treatment was not only successful in noninfectious and single pseudocyst, but in infectious or multiple seudocyst.ConclusionInternal drainage should be used in most cases and considered as the first selection in surgery of pseudocyst due to acute pancreatitis.
Objective To evaluate the activity of the pancreatic tissue phospholipase A2 (PLA2) in acute pancreatitis (AP) and the therapeutic effects of verapamil in rats. MethodsThe model of rat AP induced by a closed duodenal loop technique was established to observe the changes of PLA2 activity in AP group and treated group. The pancreatic histology was examined by light and electron microscopy. Results At 16 and 24 hours after induction of AP in rats, significant inhibition of the pancreatic tissue PLA2 activity was shown in the treated group as compared with AP group, with 32.34±3.87u, 35.26±4.52u and 44.83±5.31u, 47.77±5.86u respectively. The treated animals also showed a decrease in the severity of pancreatic hemorrhage, necrosis and damage to the cellular ultrastructures. Conclusion There exists high activity of PLA2 in rats AP. Calcium channel blocker, verapamil might take therapeutic effects on AP by inhibiting activity of PLA2.
bjectiveTo observe the effecacy of immunosuppressive agents on modulation of the disorders of inflammatory and antiinflammatory cytokines in acute pancreatitis, and to investigate the mechanism of treatment of acute pancreatitis with immunosuppressive agents. MethodsSD male rats were divided into 6 groups: group 1, the normal control group (n=6); group 2, acute pancreatitis induced by ductual injection of 5%sodium cholate sulfur at the volume of 1.0 ml/kg without treatment (n=8). After the pancreatitis were induced, the rest rats were injected intravenously with 5Fu 40 mg/kg (group 3, n=6); or methylprednisolone 30 mg/kg (group 4, n=6); or cyclophosphamide 20 mg/kg (group 5, n=6); or methotrexate 1.2 mg/kg (group 6, n=6). Twentyfour hours afteroperation, the animals were killed, the blood samples were taken for measurement of TNFα, IL1, IL6 (by bioassay), and IL10, TGFβ (by ELISA) as well as amylase. ResultsThe inflammatory cytokines (TNFα,IL1,IL6 ) and the antiinflammatory cytokines (IL10 and TGFβ), in blood of acute pancreatitis were increased significantly. After treated with immunosuppressive agents, both the inflammatory and antiinflammatory cytokines were decreased in different degrees. Some indexes of the severity of acute pancreatitis, such as amylase and pancreatic weight were improved obviously.ConclusionImmunosuppressive agents can regulate inflammatoryassociated cytokines increased remarkably in the acute pancreatitis. Therefore, improvement of acute pancreatitis can be achieved through rectifying the abnormal immunity and relieving the pathophysiological disorders of the acute pancreatitis by immunosuppressive agents.
Objective To summarize the role of inflammatory cytokines in the pathogenesis of acute pancreatitis (AP) and gut barrier dysfunction in recent years. Methods Literatures on cytokines and experimental pancreatitis as well as clinical pancreatitis were collected and reviewed. Results Tumor necrosis factor-α and other inflammatory cytokines were elevated significantly during pancreatitis in many tissues, especially in pancreas and alimentary tract, in a fashion independent of the animal model used. Anti-cytokine therapy could decrease the concentration of the cytokines in experimental animal. Conclusion Inflammatory cytokines are believed to be primarily responsible for the pathogenesis of acute pancreatitis and its associated distant organ dysfunction. Further study of the nature of these cytokines may provide a new approach to treating this disease.
ObjectiveTo explore the correlation of serum lipocalin-2 (LCN2) with inflammation and the predictive value of LCN2 for detecting acute kidney injury (AKI) in acute pancreatitis (AP).MethodsNighty-one patients with AP, who were admitted to Bazhong Municipal Hospital of Traditional Chinese Medicine between June 2016 and June 2018, were enrolled in the present study. Clinical paramaters were analyzed between patients with AKI (n=29) and patients without AKI (n=62). The correlation of serum LCN2 with inflammation was assessed with Pearson’s correlation analysis. The area under the receiver operating characteristic curve (ROC AUC) for serum LCN2 predicting AKI in AP patients was assessed.ResultsCompared with the patients without AKI, the patients with AKI showed increased serum levels of C-reactive protein [(64.8±10.5) vs. (148.3±21.6) mg/L], procalcitonin [(3.5±2.3) vs. (4.8±3.9) μg/L], urea nitrogen [(5.5±2.1) vs. (6.6±2.8) mmol/L], creatinine [(80.3±28.1) vs. (107.3±30.8) μmol/L], interleukin-6 [(10.1±3.7) vs. (16.2±4.6) pg/mL], and LCN2 [(155.0±37.6) vs. (394.8±53.1) mg/mL], as well as decreased level of calcium [(2.6±1.3) vs. (2.0±1.0) mmol/L], the differences were all statistically significant (P<0.05). The serum level of LCN2 was correlated with C-reactive protein (r=0.694, P<0.05), interleukin-6 (r=0.762, P<0.05), and procalcitonin (r=0.555, P<0.05) in patients with AP. The ROC AUC of LCN2 for predicting AKI was 0.844 (P<0.05) , with a sensitivity of 81.3% and a specificity of 81.4% when the cut-off value was 210.2 ng/mL.ConclusionsSerum LCN2 concentration is elevated in patients with AKI. In patients with AP, serum LCN2 level is positively correlated with C-reactive protein, interleukin-6, and procalcitonin. It can be regarded as a reliable indicator for predicting AKI.