Possible mechanisms of normal amylase activity in hyperlipemic pancreatitis.

Lipemic serum from three patients with acute pancreatitis and type IV hyperlipemia was fractionated into very-low-density lipoproteins and clear serum. Amylase activity (determined by the Phadebas method) in the component fractions did not exceed that in the original lipemic serum. Addition of these fractions or VLDL and chylomicrons from asymptomatic patients with hyperlipemia to nonlipemic serum from patients with "routine acute pancreatitis" did not inhibit amylase activity or alter the electrophoretic mobility of amylase isoenzymes. Therefore the normal amylase activity often observed in hyperlipemic pancreatitis does not result from an inhibition of amylase activity by serum lipoproteins.     

急性胰腺炎患者腹腔镜胆囊切除术的时机研究

目的:探讨急性胰腺炎胆囊切除术的有效性及时机。方法:分别对患有急性胰腺炎而进行腹腔镜胆囊切除的38例患者的临床信息进行了研究。结果:首先对38例病人进行了3~15天非手术的保守治疗,当临床症状和表征基本消失,血、尿中的淀粉酶接近正常水平时,进行胆囊切除。手术时间为30分钟到90分钟(平均时间60分钟),手术中无转化和严重并发症症状发生。对这38例病人随访6到56周后无复发现象发生。结论:当临床症状和表征基本消失,血、尿中的淀粉酶接近正常水平时,急性胰腺炎胆囊切除术是有效且可行的。在中国患有急性胰腺炎的患者中,进行腹腔镜胆囊切除的占50%~70%[1]。胆结石治疗取决于患者胰腺炎的严重性,及患者是否患有梗阻性黄疸。对于非梗阻性胰腺炎的患者,早期是否要进行明确的手术治疗尚无定论。我院患有急性胰腺炎的38例患者进行腹腔镜胆囊切除术(2004年2月到2009年4月之间)后取得了满意的效果。详情如下。     

急性胰腺炎患者腹腔镜胆囊切除术的时机研究

目的：探讨急性胰腺炎胆囊切除术的有效性及时机。方法：分别对患有急性胰腺炎而进行腹腔镜胆囊切除的38例患者的临床信息进行了研究。结果：首先对38例病人进行了3-15天非手术的保守治疗,当临床症状和表征基本消失,血、尿中的淀粉酶接近正常水平时,进行胆囊切除。手术时间为30分钟到90分钟（平均时间60分钟）,手术中无转化和严重并发症症状发生。对这38例病人随访6到56周后无复发现象发生。结论：当临床症状和表征基本消失,血、尿中的淀粉酶接近正常水平时,急性胰腺炎胆囊切除术是有效且可行的。在中国患有急性胰腺炎的患者中,进行腹腔镜胆囊切除的占50％～70％。胆结石治疗取决于患者胰腺炎的严重性,及患者是否患有梗阻性黄疸。对于非梗阻性胰腺炎的患者,早期是否要进行明确的手术治疗尚无定论。我院患有急性胰腺炎的38例患者进行腹腔镜胆囊切除术（2004年2月到2009年4月之间）后取得了满意的效果。详情如下。     

Ftorafur therapy in acute pancreatitis

The authors tested Ftorafur (N1-2'-furanidyl-5-fluorouracyl) in patients with acute pancreatitis on the basis of experimental and clinical data. The daily dosage was 200 mg (3-4 mg/kg body weight). In the course of treatment the serum and urine levels of amylase and the changes in WBC were studied. The results were compared to that obtained in patients with acute pancreatitis but were not given Ftorafur. Urine amylase levels decreased significantly in response to Ftorafur treatment over three days. The decrease of serum amylase levels and WBC was not significant in either group. The advantages of Ftorafur treatment are as follows: levels of amylase in serum and urine are normalized earlier, the duration of treatment, hence costs are decreased, Ftorafur produced a cytoprotective effect due to the inhibition of protein synthesis in the pancreas.     

Cell-mediated immune response to mumps virus infection in man.

The antibody and cell-mediated immune response to mumps virus infection was studied in groups of subjects after natrually acquired mumps virus infection, after parenteral immunization with live attenuated mumps vaccine, and in a population of mumps seronegative subjects. The technique of neutralization of tissue culture infectivity was utilized to study mumps specific antibody. The cell-mediated immunity (CMI) was detected by specific immune release (SIR) of radioactivity by purified lymphocytes after they were reacted with radioactive chromium (51Cr) labeled human conjunctival cell cultures chronically infected with mumps virus. No SIR activity was observed in lymphocytes obtained from cord blood and young individuals seronegative for antibody to mumps virus. Detectable SIR activity was observed in a few older seronegative subjects; however, immunization with mumps vaccine in such antibody negative subjects failed to result in the development of any antibody response in the serum. High SIR activity was observed in the lymphocytes of naturally infected and vaccinated subjects. Although all naturally infected or immunized subjects had varying levels of mumps specific antibody activity in the serum, no correlation existed between the levels of antibody and SIR activity. These observations suggest the development of mumps specific in vitro correlates of CMI after naturally acquired or vaccine-induced mumps virus infection.     

Effects of gabexate mesilate on serum inflammatory cytokines in rats with acute necrotizing pancreatitis

Gabexate mesilate is a synthetic protease inhibitor. The effectiveness of gabexate mesilate in patients with acute pancreatitis is controversial. Proinflammatory cytokines are associated with systemic inflammatory response syndrome (SIRS) in acute pancreatitis. A compensatory anti-inflammatory response occurs in parallel with SIRS. We investigated the effects of gabexate mesilate on acute necrotizing pancreatitis in rats, emphasizing the changes in serum levels of proinflammatory and anti-inflammatory cytokines. Acute necrotizing pancreatitis was induced by retrograde infusion of sodium taurodeoxycholate into the pancreatobiliary duct in rats. The rats were divided into three groups. Group I was given gabexate mesilate 2 mg/kg/h i.v. continuously 1 h before the induction of acute pancreatitis. Group II was given gabexate mesilate the same dose immediately after the induction of acute pancreatitis. Group III was given normal saline as the controls. Serum levels of amylase, lipase, tumor necrosis factor alpha, interleukin-6, and interleukin-10, pancreatic histopathology and hemodynamics were examined at 5h after the induction of acute pancreatitis. Gabexate mesilate significantly reduced serum levels of amylase, lipase, tumor necrosis factor alpha and interleukin-6 at 5 h. Serum levels of interleukin-10 significantly increased in Group I, as compared with Groups II and III. The severity of pancreatic histopathology, the reduction of mean arterial pressure, the volume of ascites and pancreatic wet weight/body weight ratios were also significantly improved by the administration of gabexate mesilate. The beneficial effects of gabexate mesilate on acute pancreatitis may be, in part, due to the modulation of inflammatory cytokine responses.     

清胰利胆颗粒对重症急性胰腺炎患者血清HMGB1, HSP70, HSP27,IL-8水平的影响

目的:研究清胰利胆颗粒对重症急性胰腺炎患者血清高迁移率族蛋白1(HMGB1)、热休克蛋白70(HSP70)、热休克蛋白27(HSP27)、白介素-8(IL-8)水平的影响。方法:选取2015年8月至2016年7月我院收治的84例重症急性胰腺炎患者,根据随机数字法分为观察组和对照组,42例每组。对照组采取常规方案完成治疗,观察组在此基础上使用清胰利胆颗粒治疗。比较两组患者临床疗效,血淀粉酶恢复至正常时间、白细胞恢复至正常时间、胃肠功能恢复至正常时间、腹痛缓解时间及血清HMGB1、HSP70、HSP72、IL-8水平。结果:治疗后,观察组临床总有效率显著高于对照组[92.86%(39/42)比71.43%(30/42)](P0.05)。观察组的血淀粉酶恢复至正常时间、白细胞恢复至正常时间、胃肠功能恢复至正常时间及腹痛缓解时间显著短于对照组(P0.05)。治疗前,两组患者HMGB1、HSP70、HSP72、IL-8水平比较无显著差异(P0.05),治疗后,两组患者HMGB1、HSP70、HSP72、IL-8水平和治疗前相比显著下降(P0.05),和对照组相比,观察组的HMGB1、HSP70、HSP72、IL-8水平较低(P0.05)。结论:清胰利胆颗粒能有效降低重症急性胰腺炎患者血清HMGB1、HSP70、HSP27、IL-8水平,且可提高临床疗效。     

Serum amylase values in callitrichids.

We determined the amylase levels in serum samples from six callitrichid species. The normal serum amylase values for all of these species was within or higher than the normal human range. Amylase values higher than the normal range occurred not only in association with pancreatitis but also pyometra, bone fracture, abscesses, diabetes mellitus and gastrointestinal conditions leading to diarrhea. We concluded that although serum amylase activity may be helpful in diagnosing pancreatitis, it is, as in humans, not specific for this condition in callitrichids.     

乌司他丁治疗急性胰腺炎的临床疗效及机制研究

目的:探讨乌司他丁对急性胰腺炎患者的临床疗效及可能机制。方法:收集我院收治的重症急性胰腺炎患者66例,随机分为实验组和对照组。所有患者均给予禁食水、充分补液、纠正电解质紊乱等常规支持对症治疗。对照组予奥曲肽,实验组予乌司他丁,共治疗7天。测定两组患者治疗前、后各血清白介素-6(IL-6)、白介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)水平;治疗前、治疗第1、3天及治疗后进行血常规检测,观察白细胞计数(WBC),并进行血淀粉酶(AMS)、尿淀粉酶(UAMY)测定;分别记录两组患者临床症状及体征恢复时间,判定临床疗效。结果:1治疗后,两组患者血清IL-6、IL-8及TNF-α水平均较治疗前显著下降,且实验组较对照组下降更明显(P0.05);2治疗后,两组患者白细胞计数及血、尿淀粉酶水平均较治疗前明显下降,且实验组较对照组下降更明显(P0.05);3治疗后,实验组各项临床症状及体征消失时间均明显短于对照组(P0.05)。结论:乌司他丁可有效改善急性胰腺胰腺炎患者的各项临床症状,这可能与其显著降低其血清IL-6、IL-8、TNF-α、淀粉酶水平、白细胞计数及尿淀粉酶水平有关。     

Activity of "nonspecific pancreatic carboxylesterase" in rat serum in experimentally induced acute pancreatitis (preliminary results)

The aim of this study was to obtain more information on the serum level of "nonspecific pancreatic carboxylesterase" (PCE) in experimentally induced acute pancreatitis in rats. The effects of caerulein stimulation, hepatic duct ligation, bile-pancreatic duct ligation or the effect of retrograde injection of saline, 5% taurocholate and sunflower oil were investigated. The activity of PCE and amylase was measured in the serum, pancreatic tissue, pancreatic juice and ascitic fluid. The changes in PCE activity were greater (both in directions to increase or decrease) than that of amylase, produced by different experimental procedures. The results confirm the thesis that the serum activity of PCE is a more sensitive diagnostic method than that of amylase to detect the inflammatory process in the pancreas or the effect of obstruction of the pancreatic duct.     

Effects of the S2-serotonergic receptor antagonist, ketanserin, on cerulein-induced pancreatitis in the rat.

We investigated the effects of ketanserin, a S 2 (5-hydroxytryptamine 2; 5-HT 2)-serotonergic receptor antagonist, on cerulein-induced pancreatitis in the rat. Large pharmacological doses of cerulein induced acute pancreatitis in the rat. Ketanserin reduced the cerulein-induced increase in serum amylase concentration in a dose-dependent manner. Treatment with 10 mg/kg of ketanserin per os markedly improved cerulein-induced pancreatitis and was associated with a significant reduction of the increase in serum amylase concentration. In addition, a very specific serotonin S 2 antagonist, ritanserin which has no antihypertensive effect, also reduced the cerulein-induced increase in the serum amylase concentration. These results suggest that S 2 (5-HT 2) may play a role in pathophysiology of cerulein-induced pancreatitis in the rat.     

乳酸杆菌对实验性急性胰腺炎损伤的治疗价值

目的探讨乳酸杆菌对急性胰腺炎的治疗作用。方法采用家兔急性胰腺炎模型,其中实验组给予乳酸杆菌干预,检测实验组、对照组血清淀粉酶、血清钙和血糖3项指标。结果实验组血清淀粉酶水平低于对照组(P<0.01)。结论乳酸杆菌对实验性急性胰腺损伤有修复作用。     

Acute Pancreatitis and Diabetic Ketoacidosis in Accidental Hypothermia and Hypothermic Myxoedema

Serial serum amylase and blood glucose levels were measured in 68 hypothermic (rectal temperature 35°C or less) patients, including 15 who had hypothermic myxoedema (serum protein bound iodine 3·5 μg/100 ml or less). Raised amylase levels were found in 34 patients and probably reflected a mild acute pancreatitis. The high amylase levels correlated with low arterial PO₂ levels and significantly with high arterial PCO₂ levels and the base deficit but not with the severity or duration of the hypothermia. The acute pancreatitis does not explain why hypothermic patients with myxoedema have a poorer prognosis than those who are euthyroid. The pancreatitis occasionally contributed to the development, sometimes delayed, of diabetic ketoacidosis, blood glucose levels of over 120 mg/100 ml being found in 20 patients. There was a significant correlation between the raised serum amylase levels and the hyperglycaemia. Hypoglycaemia, sometimes profound, was found in 12 patients.     

Effect of secretin on pancreatic juice proteins in caerulein-induced acute pancreatitis in the rat

Nine hours after the start of treatment with caerulein in rats, an increase in the weight of the pancreas and an increase in serum amylase levels were observed. Likewise, a significant increase in endogenous secretin occurred in rats with acute pancreatitis. A dramatic reduction in the secretion of total protein and amylase was also observed. A partial recovery of this latter effect was achieved after an infusion of high doses of secretin. Under our experimental conditions, the volume of secretion did not vary in caerulein-treated rats wtih respect to controls, either in resting conditions or under secretin stimulation, which indicates that the ductular cells were not significantly affected. Isoelectrofocusing (IEF) and crossed-immunoelectrophoresis (CIE) studies revealed important alterations in the proteins of the pancreatic juice of rats with caerulein-induced acute pancreatitis. Trypsinogen appeared to be particularly affected, showing an increase in the T2 acidic form with an IEP of 4.4 and a decrease in the basic form T3 with an IEP of 8.0, which splits in other forms with a clear antigenic community. A hydrolase was also observed with an IEP of 6.2. In this sense, secretin administration may also be said to induce a significant improvement in established acute pancreatitis, since it tended to normalize the structure and proportion of the proteins secreted.     

The influence of sensory nerves and CGRP on the pancreatic regeneration after repeated episodes of acute pancreatitis in rats.

Stimulation of capsaicin sensitive nerves or administration of calcitonin gene-related peptide (CGRP) before induction of acute pancreatitis (AP) attenuates pancreatic damage, whereas CGRP administration after development of AP aggravates lesion of pancreatic tissue. The aim of this study was to determine the effect of prolonged activity of sensory nerves or CGRP administration on the pancreatic repair after repeated episodes of AP. Five episodes of acute caerulein-induced pancreatitis (10 microg/kg/h for 5 h s.c.) were performed at weekly intervals in rats receiving either vehicle or capsaicin at the sensory nerve stimulatory dose (0.5 mg/kg, 3 times daily), or CGRP (10 microg/kg, 3 times daily). Two weeks after the last induction of AP morphological signs of pancreatic damage, pancreatic blood flow (PBF), serum and pancreatic amylase activity, fecal chymotrypsin activity, pancreatic weight, pancreatic RNA and DNA content, as well as, serum interleukin-1beta (Il-1beta ) were assessed. Pancreata of animals receiving vehicle alone showed almost full recovery within two weeks after last episode of pancreatitis induction. In capsaicin-treated group of rats, we observed the increase in PBF by 44% and in serum Il-1beta concentration by 91%. The pancreatic amylase activity, fecal activity of chymotrypsin, pancreatic nucleic acids content and DNA synthesis were decreased. In rats treated with CGRP the alterations in PBF, serum Il-1beta concentration, as well as, in pancreatic and fecal activity of enzymes were similar to capsaicin treated group but less pronounced. We conclude that prolonged activity of capsaicin-sensitive sensory nerves and the presence of their main mediator-CGRP during pancreatic regeneration after AP leads to pancreatic functional insufficiency typical for chronic pancreatitis.     

The effect of hyperbaric oxygen treatment on oxidative stress in experimental acute necrotizing pancreatitis

Various protocols may be used for acute pancreatitis treatment. Recently, the benefit of hyperbaric oxygen (HBO) has been demonstrated. To clarify the mechanism of HBO on the process of the acute pancreatitis, we determined the levels of antioxidant enzymes in an acute pancreatitis model. Forty-five Sprague-Dawley rats were randomly divided into three groups: Group I: sham group (n=15), Group II: pancreatitis group (n=15), Group III: pancreatitis group undergoing HBO therapy (n=15). HBO was applied postoperatively for 5 days, two sessions per day at 2.5 fold absolute atmospheric pressure (ATA) for 90 min. Superoxide dismutase (Cu/Zn-SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH Px) activity were measured in pancreatic tissue and erythrocyte lysate. MDA and GSH Px were also determined in plasma. In addition, amylase levels were measured in the serum. While serum amylase levels and MDA values in erythrocyte, plasma and pancreatic tissue were decreased, the levels of GSH Px and SOD were found to be significantly increased in the Group III as compared to those of the Group II. The findings of our study suggest that HBO has beneficial effects on the course of acute pancreatitis and this effect may occur through the antioxidant systems.     

Treatment with antileukinate, a CXCR2 chemokine receptor antagonist, protects mice against acute pancreatitis and associated lung injury

Acute pancreatitis is a common, and as yet incurable, clinical condition, the incidence of which has been increasing over recent years. Chemokines are believed to play a key role in the pathogenesis of acute pancreatitis. We have earlier shown that treatment with a neutralizing antibody against CINC, a CXC chemokine, protects rats against acute pancreatitis-associated lung injury. The hexapeptide antileukinate (Ac-RRWWCR-NH2) is a potent inhibitor of binding of CXC chemokines to the receptors (CXCR2). This study aims to evaluate the effect of treatment with antileukinate on acute pancreatitis and the associated lung injury in mice. Acute pancreatitis was induced in adult male Swiss mice by hourly intra-peritoneal injections of caerulein (50 microg/kg/h) for 10 h. Antileukinate (52.63 mg/kg, s.c.) was administered to mice either 30 min before or 1 h after starting caerulein injections. Severity of acute pancreatitis was determined by measuring plasma amylase, pancreatic water content, pancreatic myeloperoxidase (MPO) activity, pancreatic macrophage inflammatory protein-2 (MIP-2) levels and histological examination of sections of pancreas. A rise in lung MPO activity and histological evidence of lung injury in lung sections was used as criteria for pancreatitis-associated lung injury. Treatment with antileukinate protected mice against acute pancreatitis and associated lung injury, showing thereby that anti-chemokine therapy may be of value in this condition.     

Involvement of thrombopoietin in acinar cell necrosis in l-arginine-induced acute pancreatitis in mice

Thrombopoietin (TPO) plays an important role in injuries of different tissues. However, the role of TPO in acute pancreatitis (AP) is not yet known. The aim of the study was to determine the involvement of TPO in AP. Serum TPO was assayed in necrotizing pancreatitis induced by l-arginine in mice. Recombinant TPO and anti-TPO antibody were given to mice with necrotizing pancreatitis. Amylase, lipase, lactate dehydrogenase, myeloperoxidase activity and pancreatic water content were assayed in serum and tissue samples. Pancreas and lung tissue samples were also collected for histological evaluation. Immunohistochemistry of amylase α and PCNA were applied for the study of acinar regeneration and TUNEL assay for the detection of apoptosis in the pancreas. Increased levels of serum TPO were found in necrotizing pancreatitis. After TPO administration, more severe acinar necrosis was found and blockade of TPO reduced the acinar necrosis in this AP model. Acinar regeneration and apoptosis in the pancreas were affected by TPO and antibody treatment in necrotizing pancreatitis. The severity of pancreatitis-associated lung injury was worsened after TPO treatment, but attenuated after Anti-TPO antibody treatment. In conclusion, serum TPO is up-regulated in the necrotizing pancreatitis induced by l-arginine in mice and may be a risk factor for the pancreatic acinar necrosis in AP. As a pro-necrotic factor, blockade of TPO can attenuate the acinar necrosis in AP and may be a possible therapeutic intervention for AP.     

连续性血液净化在重症急性胰腺炎患者中应用的临床疗效观察

目的：观察连续性血液净化（CBP）在重症急性胰腺炎（SAP）患者中应用的临床疗效,探讨提高SAP临床疗效的治疗措施方法：选择在我科就诊的SAP患者64例,根据患者自愿的原则,分为常规组和CBP组,常规组采用内科常规治疗措施,CBP组在常规治疗的基础上加行CBP治疗,比较两组患者治疗中血清淀粉酶的动态改变、治疗第5天各项生化指标及APACHEII评分、病情稳定时间等临床一般情况。结果：两组患者在上述方面比较,差异均具有统计学意义（P〈O．05）,CBP组优于常规组。结论：在治疗SAP患者的过程中,应积极加行CBP治疗措施,可提高临床疗效,改善患者预后。