Clinico-pathological Particularities And Animal Experiment Of Shock Related Pancreatic Damage

Background and Objectives: This study is to realize the content of serum amylase（SAMY）、urinary amylase（UAMY）、lipase and pancreatic histopathology score in shockfrom clinico-pathological analysis and animal study, to further understanding thepancreatic function changes between different types and phases of shock, to preliminarydiscussion the relationship between pancreatic dysfunction and multiple organ dysfunctionand the effects on progression and prognosis of disease.Methods: Clinical study:154shock cases who were admitted to our hospital fromJan.2009to Nov.2013were enrolled in the study. SAMY、UAMY and lipase were routinelyobserved during the shock day. Pathological study:64critical cases who were admitted toour hospital from Jan.2009to Oct.2012and processed systemic pancreatic function andautopsy were reviewed about their clinical data, laboratory results, pathologicalcharacteristics as well as pancreatic histopathology score. Animal study：24male SD ratswere randomly divided into3groups: sham operation group(LPS was substituted by samevolume of normal saline solution)、3h after Lipopolysaccharide（LPS）injection group(LPS3h) and24h after Lipopolysaccharide（LPS）injection group(LPS24h), each group wasincluded8rats. The model of LPS group was set up by injection of LPS at a dose of25mg/kg through right external carotid artery.24h,3h and24h after injection of normal salineor LPS, blood were taken for measuring the SAMY, UAMY and lipase. The pancreatictissue specimens were taken for histopathological examination.Results:1.Clinical study: There is no statistical difference of the content of lipase in septic shock,hypovolemic shock and cardiogenic shock. The content of SAMY and UAMY issignificantly higher in decompensate shock period than compensate shock period, the sameas in septic shock [SAMY:71.38(16.55~193.67) vs.26.51(8.80~61.50), P<0.05and UAMY159.87（32.07~537.10） vs.40.04（11.30~138.81）， P<0.001], but not inhypovolemic shock and cardiogenic shock. Compared with hypovolemic shock,cardiogenic shock and pancreatic enzyme normal group, the concentration of calcium issignificantly higher in septic shock and abnormal group patients. In condition of shock, asthe SAMY elevated, the serum creatinine concentration was higher, while there is nosignificant relationship between the content of SAMY and ALT、CK-MB、PaO2/FiO2、PLT、blood glucose. Compared with pancreatic enzyme normal group, the mortality indecompensate shock period was higher in pancreatic enzyme abnormal group.2.Pathological study: Compared with sepsis and non-sepsis children, the pancreaticpathology score and highest content of lipase during the first day of admission in septicshock group was significantly higher (P<0.05),which was also significantly higher indecompensate shock period than compensate shock perio（dP<0.05）; Compared with sepsisand non-sepsis children, the lowest content of serum calcium during the first day ofadmission in septic shock group was significantly reduced(P<0.05), which was alsonegatively related with pancreatic pathology score（r=-0.253，P=0.044）；In septic shock,as the pancreatic pathology score elevated, the serum creatinine concentration was higher（r=0.271，P=0.031）, while there is no significant relationship between the content ofSAMY and ALT、CK-MB、PaO2/FiO2、PLT、blood glucose. Compared with pancreatichistopathology2~3points and3~4points group, the time between develop MODS to deathwas significantly shorter in pancreatic histopathology6~7points group children (P<0.01).3.Animal study: The content of serum lipase in LPS3h group and LPS24h group wassignificantly increased than sham operation group, which was [（11.49±2.35） vs.（6.78±2.49），P<0.05] and [（9.55±3.01）vs.（6.78±2.49），P<0.01]. LPS injection grouprats presented hemorrhagic alteration of the pancreatic tissue.Conclusion There exist pancreatic function and histological damage in early shockperiod, while there is no difference between the different types of shock. Compared withcompensate shock phase, the function and histological changes of pancreatic is more severe. In condition of shock, ischemic injury to pancreas is similar to that of other organs,and is significantly related with kidney damage. In critically ill children with multipleorgan dysfunction, pancreatic damage suggests quickly disease development and highmortality.