ObjectiveTo summarize progress of immune response in severe acute pancreatitis (SAP) and to provide a basis for appropriate immunotheraphy.MethodThe relevant literatures about the effect of immune response in the SAP with infectious complications in recent years were reviewed.ResultsThe inflammatory cascade reaction occurred in the early stage of SAP. Subsequently, the compensatory anti-inflammatory response syndrome (CARS) arised and immune response of the organism was suppressed. At this stage, the rate of infection was higher than before.ConclusionsCARS is one of major reasons in SAP with infectious complications. At present, fluid infusion, fasting, parenteral nutrition and like are major therapies in SAP. If corresponding immunotherapy could be carried out according to immune mechanism of SAP infection, that is, early appropriate immunosuppressive therapy and dynamic monitoring of body’s immune system state should be performed, when it is found that immunosuppression is present, appropriate immunostimulus therapy will be possible to reduce mortality of SAP and improve its prognosis.
ObjectiveTo explore the relationship between blood glucose variability index and persistent organ failure (POF) in acute pancreatitis (AP). MethodsWe prospectively included those patients who were diagnosed with AP with hyperglycemia and were hospitalized in the West China Center of Excellence for Pancreatitis of West China Hospital of Sichuan University from July 2019 to November 2021. The patients were given blood glucose monitoring at least 4 times a day for at least 3 consecutive days. The predictive value of blood glucose variability index for POF in patients with AP was analyzed. ResultsA total of 559 patients with AP were included, including 95 cases of POF. Comparing with those without POF, patients with AP complicated by POF had higher levels of admission glucose (11.0 mmol/L vs. 9.6 mmol/L), minimum blood glucose (6.8 mmol/L vs. 5.8 mmol/L), mean blood glucose (9.6 mmol/L vs. 8.7 mmol/L), and lower level of coefficient of variation of blood glucose (16.6 % vs. 19.0 %), P<0.05. Logistic regression analyses after adjustment for confounding factors showed that the risk of POF increased with the increase of admission glucose [OR=1.11, 95%CI (1.04, 1.19), P=0.002], minimum blood glucose [OR=1.28, 95%CI (1.10, 1.48), P=0.001] and mean blood glucose [OR=1.18, 95%CI (1.04, 1.33), P=0.010]; with the higher level of coefficient of variation of blood glucose [OR=0.95, 95%CI (0.92, 0.99), P=0.021], the risk of POF decreased. The results of area under the curve (AUC) of the receiver operator curves showed that AG [AUC=0.787, 95%CI (0.735, 0.840)] had the highest accuracy in predicting POF, with sensitivities of 60.0% and specificities of 84.7%. ConclusionHigh admission glucose, minimum blood glucose, mean blood glucose, and low coefficient of variation of blood glucose were risk factors for the development of POF in patients with hyperglycemic AP on admission.
摘要:目的: 探討重癥急性胰腺炎的臨床治療方法。 方法 :回顧性分析我院自19984～20067共收治的各類重癥急性胰腺炎患者56例。 結果 : 治療上采取在內科治療的基礎上,選擇適當手術干預,除2例并發多器官功能衰竭病死外,全部治愈出院。 結論 :重癥急性胰腺炎的處理要根據患者的具體情況,應首先采取非手術治療,并針對不同情況合理選擇外科手術治療。Abstract: Objective: To discussion the clinical treatments of the severe acute pancreatitis. Methods : Retrospective analysis all kinds of the severe acute pancreatitis from 1998420067 in our hospital. Results : The treatments are based on nonsurgical treatment and with the selection of appropriate surgical intervention, all patients have cured except tow cases who died in multiple organ failure. Conclusion : According to the specific circumstances of the patients, The treatments of severe acute pancreatitis should be adopted first nonsurgical treatment, and with a reasonable choice of the surgery for different circumstances.
Objective To summarize the risk factors, diagnosis, and treatment experience of intra-abdominal bleeding following surgeries for severe acute pancreatitis. Methods A retrospective review was conducted of 347 patients underwent necrosectomy for severe acute pancreatitis between January 2011 and December 2015 at West China Hospital of Sichuan University. Results Of the 347 patients, thirty-eight patients had intra-abdominal bleeding after surgeries, including 5 patients who had twice bleeding. The bleeding positions including splenic vein (n=7), splenic artery (n=2), pancreatic and peripancreatic vessels (n=8), colonic mesangial vessels (n=6), other vessels (n=12), and extensive osmotic bleeding in abdominal cavity (n=7). Hemostatic modes: suture (n=20), compression hemostasis (n=18), transcatheteranerial embolism (n=2), suture and compression hemostasis (n=4), and conservative treatment (n=1). There were 19 dead patients of 38 bleeding patients. There were statistically significant differences between the hemorrhage group and the non-hemorrhage group on gender, acute physiology and chronic health evaluation (APACHEⅡ) scores and modified Marshall scores at admission, interval onset to surgery, surgical approaches, and morbidity (P<0.05). Compared with the non-hemorrhage group, there were more males, higher APACHE Ⅱ scores and modified Marshall scores, longer interval onset to surgery, and higher mortality in the hemorrhage group. Multivariable logistic regression analysis showed that male patients had higher risk of intra-abdominal bleeding (OR=3.980, P=0.004), as the grow of APACHEⅡ scores, the risk of intra-abdominal bleeding increased (OR=1.487, P<0.001). Conclusions We should pay more attention on the male SAP patients as well as patients with multiple organ dysfunction.
ObjectiveTo explore the protective effects of abdominal paracentesis drainage (APD) on pancreatitis-associated liver injury in the early phase of severe acute pancreatitis (SAP). MethodsOne hundred and fourteen consecutive patients with SAP, admitted to the General Hospital of Western Theater Command from January 2015 to January 2021, were included in this retrospective study. The patients were divided into the APD group (n=61) and the non-APD group (n=53) based on whether they underwent APD treatment within 72 h of admission. The variables including baseline data, liverfunction tests, inflammation indexes, severity scores and other variables of the two groups were statistically analyzed. ResultsThe hospital mortality in the APD group was lower than that in the non-APD group (8.2% vs. 22.6%, P=0.031). These severity scores (including APACHE Ⅱ score, Ranson score and modified Marshall score) and inflammation indexes (including C-reactive protein, interleukin-6, interleukin-1 and tumor necrosis factor-α) in the APD group were all lower than those in the non-APD group (P＜0.05). In terms of liver function related indexes, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and direct bilirubin (DBIL) after treatment in both two groups were significantly lower than those before treatment (P＜0.05). The levels of ALT, AST, TBIL and DBIL after treatment in the APD group were lower than those in the non-APD group (P＜0.05), and the levels of prealbumin and albumin after treatment in the APD group were higher than those in the non-APD group (P＜0.05), but there were no significant differences in the levels of alkaline phosphatase, GGT and 5′ -nucleotidase after treatment in the two group (P＞0.05). ConclusionFor SAP patients with ascitic fluid, application of APD can attenuate liver injury and improve liver function in the early stage of SAP.
Objective To explore the protective effect of rapamycin on brain tissues injury in severe acute pancreatitis (SAP) and its possible mechanism in experimental rats. Methods Ninety SPF males SD rats were randomly divided into 3 groups by random envelope opening method: sham operation group (SO group), SAP group, and rapamycin group (RAPA group), then the rats of each group were divided into 24 h, 36 h, and 48 h 3 subgroups by random number table method. Rats in each group underwent laparotomy, the model was prepared by retrograde injection of solutions into biliopancreatic duct, rat of the SO group was injected with 0.9% normal saline (2 mL/kg), rats of the SAP group and the RAPA group were injected with 5% sodium taurocholate solution (2 mL/kg), but rat of the RAPA group was injected with rapamycin (1 mg/kg) at 30 min before narcosis. All survival rats in each subgroup were killed at 24 h, 36 h, and 48 h respectively, then the pancreas and brain tissues of rats were collected, pancreas and brain tissues were stained by hematoxylin-eosin staining, brain tissues were stained by Luxol fast blue additionally, pathological changes of brain tissues were scored under light microscope. The protective effect of rapamycin on brain tissues injury was determined by comparing the differences in the degree of brain tissues among 3 groups. The phosphorylated mammaliantarget of rapamycin (p-mTOR) and phosphorylated ribosomal 40S small subunitS6 protein kinase (p-S6K1) expression levels in brain tissues were detected by Western blot. In addition, the correlations between the expression levels of p-mTOR and p-S6K1 in brain tissues and the degree of brain tissues injury were analyzed to further explore the possible mechanism of rapamycin’s protective effect on brain tissues injury in SAP. Results① At the point of 24 h, 36 h, and 48 h, the order of the relative expression levels of p-mTOR and p-S6K1 in brain tissues of three groups were all as follows: the SO group < the RAPA group < the SAP group (P<0.05). ② At the point of 24 h, 36 h, and 48 h, the order of brain histological score in three groups were all as follows: the SO group < the RAPA group < the SAP group (P<0.05). ③ The relative expression levels of p-mTOR and p-S6K1 in brain tissues were positively correlated with pathological scores of brain tissues (r=0.99, P<0.01; r=0.97, P<0.01). ConclusionRapamycin plays a protective role in pancreatic brain tissues injure by down-regulating the expression levels of p-mTOR and p-S6K1 in mTOR signaling pathway.
ObjectiveTo determine the effectiveness of Yidantong recipe retained enema combined with external application of Jinhuang powder on non-severe acute pancreatitis (NSAP). MethodsA total of 134 patients with NSAP, admitted to the Third People’s Hospital of Chengdu from September 2019 to August 2022 were included in this retrospective cohort study. All patients received routine Western medicine treatment, and they were divided into a observation group (n=66) and a control group (n=68) based on whether they underwent treatment of Yidantong recipe retained enema combined with external application of Jinhuang powder. The variables including incidence of adverse clinical outcome events, severity scores after treatment, the recovery time of flatus and bowel movement, duration of fasting food and water, scores of traditional Chinese medicine (TCM) syndromes and numerical value of blood indices before and after treatment, and the treatment effect of the two groups were statistically analyzed. ResultsCompared with that of the control group, the incidence of multiple organ dysfunction syndrome (MODS) and severe acute pancreatitis (SAP) of the observation group was lower (P<0.05), and the reduction before and after treatment of APACHEⅡ score, BISAP score and Ranson score in the observation group was more than those in the control group (P<0.05). Compared with that of the control group, the recovery time of flatus and bowel movement and duration of fasting food and water of the observation group was shorter (P<0.05). The reduction before and after treatment of the scores of TCM syndromes (abdominal pain, abdominal distention, nausea and vomiting, dry mouth and bitter taste) and numerical value of blood amylase (AMY), alanine aminotransferase (ALT), alanine aminotransferase (AST) and C-reactive protein (CRP) in the observation group were more than those in the control group (P<0.05). Compared with that of the control group (83.33%), the total effective rate of the scores of TCM syndromes (95.59%) of the observation group was higher (P<0.05).ConclusionYidantong recipe retained enema combined with external application of Jinhuang powder in the treatment of NSAP is effective by combining with routine Western medicine.
ObjectiveThis study aimed to develop early mortality risk prediction models for patients with severe acute pancreatitis (SAP) based on eight machine learning algorithms, and to identify the major risk factors. MethodsClinical data of SAP patients diagnosed at West China Hospital of Sichuan University between January 2020 and August 2023, were retrospectively collected and randomly divided into a training set (n=878) and a validation set (n=376) in a 7∶3 ratio. Eight machine learning algorithms, including random forest, logistic regression, support vector machine, multilayer perceptron, XGBoost, Gaussian naive Bayes, CatBoost, and AdaBoost, were applied to construct early mortality prediction models for SAP. The models were evaluated using the area under curve (AUC), decision curve analysis (DCA), Shapley additive explanations (SHAP), and other indexes. ResultsA total of 1 254 SAP patients were finally included in this study, with an early mortality rate of 15.8% (198/1 254). The random forest algorithm demonstrated the best predictive performance in both the training and validation sets, with AUCs of 0.913 and 0.844, respectively. In the DCA, random forest also yielded the greatest net benefit. SHAP analysis ranked seven key predictors of early mortality in SAP by importance: age, body mass index, heart rate, need for assisted ventilation, hemoglobin, interleukin-6, and lactate dehydrogenase, with the need for assisted ventilation being the most critical predictor.ConclusionThe random forest model developed in this study can assist clinicians in more accurately identifying high-risk SAP patients at an early stage, thereby enabling timely interventions to reduce early mortality.
Objective To study value of severe acute pancreatitis (SAP) rat model induced by retrograde pancreaticobiliary duct infusion of methylene blue in combination with sodium taurocholate. Methods The SPF 90 SD rats, 45 male rats and 45 female rats of them, were randomly divided into control group (C group), sodium taurocholate group (ST group) and methylene blue in combination with sodium taurocholate group (MBST group), which were retrogradely infused with the 0.9% normal saline, sodium taurocholate plus DAPI, and methylene blue plus sodium taurocholate plus DAPI respectively into the pancreaticobiliary duct. The success rate of puncture, degree necrosis of pancreas tissue, range of pancreatic lesions, and the incidence of bile or intestinal leakage were compared among the three groups. Results ① The success rate of puncture in the MBST group was significantly higher than that in the ST group (P=0.003) and the C group (P=0.006), which had no significant difference between the ST group and the C group (P=0.782). ② The necrosis degree of pancreas tissues in the MBST group and ST group became more and more severe with the extension of time (P<0.050), which in the MBST group was more serious than that in the ST group (P<0.050). ③ The point of pancreatic lesions range in the MBST group was significantly higher than that in the ST group (P=0.003). ④ The incidence of bile or intestinal leakage in the MBST group was significantly lower than that in the C group (P=0.008) and the ST group (P=0.004). Conclusions Retrograde pancreaticobiliary duct infusion of methylene blue in combination with sodium taurocholate can improve success rate of puncture, aggravate necrosis degree of pancreatic tissue, increase lesion scope of pancreatic tissue, and reduce rate of bile or intestinal leakage, which can provide a stable animal model for basic research of SAP.
Objective To perform a systematic review and meta-analysis to evaluate the efficacy and safety of prophylactic use of antibiotics in preventing severe acute pancreatitis. Methods Randomized control trials (RCTs) of prophylactic use of antibiotics were identified from PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wangfang Database, and handly searched related literatures. The retrieval time was from inception to Dec. 2017. All the data would be analysis with the software RevMan 5.3. Results Eventually 16 RCTs of 999 participants were involved, the patients were divided into two groups: the intervention group (prophylactic use of antibiotics, n=501) and the control group (n=498). The result of meta-analysis showed that, the incidence rate of pancreatitis infectious disease and the incidence rate of peripancreatitis infectious were significant lower in the intervention group than the control group, whose OR were amount to 0.68 ［95% CI was (0.50, 0.93), P=0.02］ and 0.63 ［95% CI was (0.45, 0.88), P=0.007］ respectively. Meanwhile, concerning the rate of surgery intervention ［OR=0.79, 95% CI was (0.57, 1.08), P=0.14］ and in mortality rate ［OR=0.81, 95% CI was (0.56, 1.15), P=0.24］, there was no statistically significant. Conclusion Prophylactic antibiotic treatment can do benefit to reduce the incidence rate of pancreatitis infectious and the rate of peripancreatitis infectious disease, but can not reduce mortality in patients with severe acute pancreatitis and had no significant protective effect in patients in reducing the rate of surgery intervention and mortality rate.