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目的:观察重症急性胰腺炎(SAP)大鼠的脑损伤以及血脑屏障在SAP大鼠脑损伤中的作用。方法:经胰胆管逆行注射3 .5 %牛磺胆酸钠(2 .5mL·kg-1)建立大鼠SAP模型,观察经生长激素和生长抑素不同处理各组动物的血清炎性介质、内毒素和磷脂酶A2的变化,分析各组脑水肿、血脑屏障和脑细胞凋亡与胰腺病理评分的相关性。结果:SAP组动物血清炎性介质、内毒素、磷脂酶A2 表达水平、胰腺病理评分和脑损伤程度较假手术组呈显著性升高(P <0 .0 1)。生长抑素和生长激素联合治疗SAP组动物血清各项指标、胰腺病理评分和脑损伤程度与SAP组相比有显著性减轻。应用多元回归分析显示脑水肿、血脑屏障和脑细胞凋亡与胰腺病理评分有相关性;发现血脑屏障是脑损伤指标中最重要的指标。结论:SAP时脑损伤主要影响血脑屏障,继而引起脑水肿和脑细胞的凋亡。胰腺病理评分与脑损伤程度呈正相关。生长激素和生长抑素联合治疗能显著降低SAP大鼠胰腺病理评分和脑损伤程度。
Objective: To observe the effects of brain injury and blood-brain barrier on brain injury in SAP rats with severe acute pancreatitis (SAP). Methods: The model of SAP was established by retrograde injection of 3.5% sodium taurocholate (2.5mL · kg-1) into the pancreatic duct through the pancreaticobiliary duct. The serum inflammatory mediators of the animals treated with different concentrations of somatotropin and somatostatin were observed, Endotoxin and phospholipase A2 changes in each group of brain edema, blood-brain barrier and brain cell apoptosis and pancreatic pathological score correlation. Results: The levels of serum inflammatory mediators, endotoxin, phospholipase A2, pancreatic pathological score and brain injury in SAP group were significantly higher than those in sham operation group (P <0.01). Somatostatin and growth hormone combined treatment of SAP serum animal indicators, pancreatic pathological score and degree of brain injury compared with the SAP group were significantly reduced. Multivariate regression analysis showed that cerebral edema, blood-brain barrier and apoptosis of brain cells were correlated with pancreatic pathological score. Blood-brain barrier was the most important indicator of brain injury. Conclusion: Brain injury in SAP mainly affects the blood-brain barrier and subsequently leads to brain edema and brain cell apoptosis. Pancreatic pathological score was positively correlated with the degree of brain injury. The combination of growth hormone and somatostatin can significantly reduce the pancreatic pathological score and brain injury in SAP rats.