| PurposeAcute pancreatitis ( AP) is a fatal disease whose mortalily is 7 - 11% , and even over 20% in severity acute pancreatitis (SAP) with pancreatic necrosis. One of the pathogenic mechanisms of pancreatic necrosis may be local vasospasm and intravascular coagulation as a. consequence of microcirculatory disorder, which also occur in other organs in case severe information reaction occurs. A-cute lung injury ( ALI) plays a major role in those patients'deaths with SAP in one week. This study is on the basis of rats'SAP models to detect the treatment effect of urokinase on lung injury by observing the dynamic changes of pulmonary blood flow and tumor necrosis factor a ( TNF - a ).Materials and methods1. Experimental animals and models preparation: 192 Wistar male rats ere divided randomly into three groups: normal control group ( C) , severe acute pancreatitis group ( P) and treatment group (T). Each of them was divided av-eragely into four groups according to 2 hours, 6 hours, 12 hours and 24 hours after models preparation with each group separating into A and B as follows: A was to detect pulmonary blood flow and B was to detect TNF - a activity by ra-dioimmunoassay method and observe pulmonary histologic changes. SAP models were established by retrograde injecting 5% sodium taurocholate into cholangio-pancreatic duct, and control group was by overturning duodenum only.2. Statistical management: SPSS 11. 5 statistical software was used.Results1. Pulmonary blood flow: Comparing with the pulmonary blood flow in C group, that in P group decreased markedly in all phases (P <0. 05) , whereas that in T group had no obvious changes (P >0.05). The pulmonary blood flow in P group decreased ( P < 0. 05 ) in all phases in comparision with that in T group (P<0.05).2. TNF - a level; TNF - a activity in P and T groups increased significantly in all phases in comparasion with that in C group ( P <0. 05 ). TNF - a activity was higherin all phases in P group than that in T group.3. Pathological changes. No remarkable pathological changes were observed in the lungs of the rats in C group. Pulmonary interstitial congestion, neutrophil infiltration, capillary stasis, alveolar cavity edema and alveolar cavity bleeding occurred in SAP group, and aggravated as time passed. Pulmonary pathological changes ameliorated obviously in T group comparing to that in SAP group ( P < 0. 05) , and it was minor in comparasion with that in C group (P > 0.05 ).4. Correlation analysis. Pearson correlation analysis showed that pulmonary blood flow was highly negatively correlated with serum TNF - a activity in P group (r = -0.612, P=0.000) ; Spearman correlation analysis discovered that pulmonary blood flow was highly negatively correlated with serum TNF - a activity and positively correlated with injury degree of lung in P group ( r = -0. 862, 0.573, P<0.01)DiscussionIn the earlier period (2h) of SAP, pulmonary blood flow markedly decreases and at the same time pulmonary damage occurs, and they are highly correlated negatively. Pulmonary blood flow increased and the injury degree alleviated after using urokinase, so we infered that ameliorating microcirculation can protect lung. In this experiment, the serum TNF - a. markedly decreased and the pulmonary pathological changes alleviated after using urokinase, but the level ofserum TNF - a was higher than normal value. So we can conclude that uroki-nase cannot affect the level of cell factors directly, but it can indirectly alleviate inflammation reaction of ALI, and the mechanism is that urokinase can dissolve microthrombi resulting in interrupting malignant circulation of " inflammation reaction - microthrombosis ?inflammation reaction" .Microthrombosis plays a baton role in MODS occurrence of SAP, which is because inflammation reaction imbalance as a consequence of preliminary strike factors and immune regulation energy abnormity and is also the direct reason of organs dysfunction, even failure. As a kind of fibrin - lysis agent, urokinase can direc...
|
PDF Full Text Request