Action Of Cholecystokinin In The Pathogenesis Of Biliary Pancreatitis

PrefaceThe pancreatitis is a familiar acute abdomen of surgery, usually episode in Europe and Asia. In recent years, the incidence rate was up - trend. The pathogenesis of pancreatitis is complicated, and has various factors to participate, the accurate pathogenesis is still not quite clear. The biliary pancreatitis ( BP) is most frequently in our country, generally consider that the pathogenesis of BP is one open mouth of pancreatic duct and bile duct ( Vater ampulla) ,and obstruction of Vater ampulla by calculus or inflammation etc cause the gall and pancreatic juice reflux, activate pancreatic enzyme to arose self digestion, evoke pancreatitis. But in clinic Bile Duct calculus patient without biliary obstruction or any clinical symptom often have the occurrence of pancreatitis. The pancreatitis incidence rate of gallbladder calculus patient is 20 times higher than lhepatic duct calculus patient, that cant explain with the common passage theory of the pancreatic duct and bile duct.Cholecystokinin(CCK) is a kind braingut petide which extensively distribution in digestive apparatus and nervous system. It regulates stomach and intestines peristalsis, digestive juice excretion, absorbs, behavior, emotion, remember etc, various physiology actions . The CCK in the plasma almost comes from the endocrine I cell of the small intestine, mainly action of CCK is contraction gallbladder, relaxing Oddi sphincter and promoting pancreas excretion and grow etc. In recent , animal experiment testify that CCK - R agitation or high dosage CCK can evoke pancreatitis , and internal CCK and receptor play a important action in multi - way ( L - Arginine injection,bile duct deligation, sodium tauro-cholate injection ) evoke pancreatitis , that will be important significance to the investigation of pancreatitis pathogenesis.ObjectiveTo find out the action of Cholecystokinin in the pathogenesis of biliary pancreatitis and the reason of pancreatitis incidence rate of gallbladder calculus patient is higher than lhepatic duct calculus patient.Materials and Method163 cases, without liver ,gall, pancreas surgical operation history, jaundice disease history( include this time to hospitalize) and diabetes mellitus, other depletion chronic disease histories, were selected in Liaoning Province People Hospital surgery from 2003. 10 to 2004. 10. The age and sex are unlimited. The cases are divided in four groups: â‘ Control group : Total 30, without alimentary canal disease history and surgical operation history; â‘¡Gallbladder calculus group: Total 78, without pancreatitis disease history and confirmation by ultrasound; â‘¢Lhepatic duct calculus group:Total 24, without pancreatitis disease history and confirmation by ultrasound; â‘£BP group:Total 31, without pancreatitis disease history and jaundice disease history.ResultThe CCK concentration of BP group is obviously higher than other groups ( P < 0. 01) ; the CCK concentration of gallbladder calculus group is obviously higher than control group and lhepatic duct calculus group ( P < 0. 01) ; control group and lhepatic duct calculus group have no obvious difference. The cases according to the ratings of CCK concentration are divided, and compute the relative risk ( OR value) of each levels. The cases of each levels compute by Chi -squared test , x2 = 11. 76, P < 0. 01, explaining that control group and case group have statisticses difference between each levels of CCK concentration. ItsOR value is to pass to increase with the increment of CCK concentration, namely , the incidence rate of pancreatitis increase along with the increment of CCK concentration.DiscussionAccording to the common passage theory, lhepatic duct calculus will alter to induct the pancreatitis easily . But in fact the pancreatitis incidence rate of gallbladder calculus patient is observably higher than lhepatic duct calculus patient by clinical research, the concrete reason is still not clear . This experiment confirm that gallbladder calculus group and lhepatic duct calculus group exist difference in plasma CCK concentration, the plasma CCK concentration of gallbladder calculus group is obviously higher than lhepatic duct calculus group , this maybe the reason of the high pancreatitis incidence rate in gallbladder calculus patient. The high level of CCK in the gallbladder calculus group probably relate to cholesterol concentration going up and the cholecystokinin receptor ( CCK - R) in gallbladder expression descending adjust, or CCK - R structure injury in gallbladder wall tissue, its feedback promotes CCK release peptide and CCK excretion increment .This experiment also confirmed that the CCK concentration of BP group is obviously higher than other groups , and the OR value of each levels cases according to the ratings of CCK concentration have obviously statisticses difference. Its OR value is to pass to increase with the increment of CCK concentration , namely , the incidence rate of pancreatitis increase along with the increment of CCK concentration . Because of the sample quantity restriction, it cant make sure the effect relation between CCK and BP,namely,CCK is the etiological factor of BP, but CCK concentration still interpretablely correlat with the pathogenesis of BP, may be one of the etiological factor of BP.ConclusionThe plasma CCK concentration of gallbladder calculus group is obviously...