Expression Of Nrf2 In Pancreatic Tissue In Pediatric Patients Diagnosed As Sepsis

Objective:Sepsis is a common disease in Pediatric Intensive Care Unit and severe sepsis can aggravate multiple organ dysfunction and shock.Pancreas involve in the pathological process of multiple organ dysfunction by related inflammatory reaction and oxidative stress.Nuclear factor–E2-related factor 2(Nrf2),a member of cap‘n'collar(CNC)family of transcription factors,involve in cytoprotective effect including regulating the inflammatory response,oxidative stress,improving mitochondrial function and decreased toxic protein aggregation.The mechanism of pancreatic damage caused by sepsis also including the above process,however,the expression of Nrf2 in pediatric patients diagnosed with sepsis are yet reported.Thus,we compared the expression of Nrf2 in different pancreas injury group for the purpose to find the target to prevent pancreatic injury in sepsis.Methods:69 specimens were retrospectively collected from pediatric patientswith sepsis diagnosed between 2011 and 2012 that were presented at Hunan Children's Hospital.The 69 cases were classified as sepsis and septic shock.Diagnostic criteria of sepsis is according to SSC pediatric guidelines published by the Society of Critical Care Medicine(SCCM)and the European Society of Intensive Care Medicine(ESICM).We firstly assessed pancreatic damage by tissue hematoxylin and eosin(HE)stain.Pathologic scoring of pancreatic damage was based on numeric scores including pancreatic edema,acinar necrosis,hemorrhage,inflammation and perivascular infiltrate based on their extent and severity.And,we define lower pancreas injury group and high pancreas injury group whose pathologic score were less than median score and more than median score,respectively.Then,Nrf2 expression was also analyzed by immunohistochemistry which was observed and photographed with a microscope(400× magnification)and were semi-quantified by Image-Pro Plus 6.0 software.The results of Nrf2 expression are represented as AIOD(Average Integral Optical Density).We compared Nrf2 expression in lower and higher pancreatic damage group.Results:All pediatric patients were classified as sepsis(n=45)and septic shock(n=24)group.The pathological score of pancreas damage was 7.45± 2.03.And the pathological score of pancreas damage in the sepsis group,and septic shock was 7.04 ± 2.07 and 8.21 ± 1.74,respectively.Theproportion of lower pancreas injury in sepsis group was more than septic shock group.There were no statistically significant correlations were observed between the expression of Nrf2 and age,gender(P>0.05).The AIOD value,in lower pancreas injury and higher pancreas injury group were 0.38±0.33,0.14±0.23(P=0.001),respectively.Conclusions:The expression of Nrf2 was reversely related with pancreatic damage.It also demonstrated Nrf2 may fight against pancreatic damage in pediatric patients with sepsis which need further verified.