重症急性胰腺炎大鼠肠粘膜免疫屏障功能损伤及早期腹腔引流对其影响的实验研究

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、24h大鼠死亡率，各时相点腹水量。分别予术后的第6、12、24h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CIM＋T淋巴细胞免疫组化染色。结果分别于术后6、12、24h，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-α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CIM＋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、TNBa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CIM＋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-α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。

Research of Intestinal Mucosal Immune Barrier Injury to Rats with Severe Acute Pancreatitis and Impact on It by Early Catheter Drainage

Objective To investigate the impact and mechanism of the catheter drainage on the rats with intestinal mucosal immune barrier injury 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 fufly automatic biochemical analyzer. IL-6 ,TNF-α concentration of blood and ascites was evaluated by ELISA. Pancreatic pathological changes was observed using HE dyeing. The sIgA levels of intestinal 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 aseites amylase, ascites amylase, IL-6 and TNF-a of group A and group B are significantly 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 slgA 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 CIM ＋ T. ③Serum amylase, ascites amylase, IL-6 and TNF-α 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 CIM ＋ 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-α, by using abdominal cavity catheter drainage, play a significant role in protecting intestinal mucosal immune barrier function.