The Significance Of The Serum Endotoxin, D-lactate, TNF-a In The Development And Outcome Of Acute Pancreatitis

ObjectiveDiscuss the mechanism of intestinal barrier dysfunction in acute pancreatitis (AP) patients; Research the dynamic changes at different time points of serum endotoxin, D-lactate, tumor necrosis factor-a (TNF-a) in AP patients before and after treatment, and to further explore the clinical significance of these three indicators in order for the AP condition monitoring and prognosis providing a new perspective, for the early diagnosis and treatment of SAP providing certain basis.MethodsSelect 30 cases of healthy volunteers as the control group,46 AP patients as experimental group; experimental group were divided into mild acute pancreatitis (MAP) group of 30 cases and severe acute pancreatitis (SAP)group of 16 cases; two groups were given to comprehensive medical treatment, such as Oxygen, ECG, fasting, gastrointestinal decompression, liquid therapy, nutritional support, correction of electrolyte and acid-base balance disorders, infection control, inhibition of pancreatic secretion, traditional Chinese medicine preparation and symptomatic treatment etc. Compared the differences of serum endotoxin, D-lactate, TNF-a in the MAP group, SAP group and the healthy control group berore treatment; compared the difference of these three indicators in the MAP group and SAP group after treatment on 3rd,7th and 14th day.Results1 The levels of serum endotoxin in MAP group and SAP group before treatment were significantly higher than healthy control group (P<0.05), of which SAP group was significantly higher than the MAP group (P<0.05). After treatment, the levels of serum endotoxin in MAP group decreased significantly, and had no significant difference with the healthy control group on 3rd day; the levels of serum endotoxin in SAP group declined, but had no significant difference with pretreatment, the levels of which were significantly higher than the control group (P<0.05) on 3rd and 7th day, and the levals on 7th day was significantly lower than on the 3rd day(P<0.05), after treatment on 14th day, the levels of serum endotoxin in SAP group and healthy control group, showed no statistical significance.2 The levels of serum D-lactate in MAP group and SAP group before treatment were significantly higher than the control group (P<05), of which SAP group was significantly higher than the MAP group (P<0.05). After treatment on 3rd day, the levels of serum D-lactic acid in MAP group and the healthy control group is of no significant difference; the levels of serum D-lactate in SAP group decreased, but had no significant differences with pretreatment, the levels of serum D-lactate on 3rd and 7th day were still higher than the healthy control group (P<0.05), the levals on 7th day was significantly lower than on 3rd day (P<0.05), after treatment on 14th day, the levels of serum D-Lactic acid between SAP group and healthy control group showed no statistical significance.3 The levels of serum TNF-a in MAP group and SAP group before treatment were significantly higher than the control group (P<0.05), of which SAP group was predominantly higher than the MAP group (P<0.05). After treatment on 3rd day, the levels of serum TNF-a between MAP group and the healthy control group was of no significantly difference,which in SAP group had downward trend after treatment on 3rd day, but significantly higher than the control group (P<0.05), and had no significant difference compared with pretreatment; after treatment on 7th and 14th day, the levels of serum TNF-a in SAP group had no significant difference with healthy control group.ConclusionAcute pancreatitis patients had different degrees of intestinal barrier dysfunction in early stage. The Serum endotoxin, D-lactic and TNF-a might reflect the intestinal barrier dysfunction of AP respectively, and its dynamic change consistented with the severity of the patient's conditions and trends, so which could provide a new perspective in monitoring the conditions and prognosis of AP patients, provide a theoretical basis on early clinical diagnosis of SAP and assessing treatment and prognosis.