乌司他丁治疗急性胰腺炎的临床疗效评价

目的: 观察乌司他丁(UTI)治疗各型急性胰腺炎(AP)的临床疗效。方法: 将102 例急性胰腺炎患者随机分成2 组,对照组51 例(轻症38 例、重症I 型13 例);治疗组51 例(轻症38 例、重症I 型13 例)。对照组采用综合基础治疗,治疗组在综合基础治疗的基础上加用乌司他丁。按痊愈、显效、有效和无效四级评定疗效。结果: 治疗组轻症有效率为92.1 %,重症I 型为84.6 %;对照组轻症有效率为71.1 %,重症I 型为38.5 %,两组有显著差异性(P<0.05),治疗组对腹痛、血尿淀粉酶、白细胞和TB等的恢复明显优于对照组(P<0.05)。结论: 乌司他丁用于治疗急性水肿型胰腺炎和重症I型均有较好疗效,不良反应较少。     

Ranson评分对中重度高脂血症性急性胰腺炎分型的预测价值

目的探讨Ranson评分对高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)分型的早期预测价值。方法回顾性收集2014年1月至2018年10月在北京协和医院急诊科就诊的中重度HLAP患者资料,包括年龄、性别、血脂水平、血糖、白细胞、乳酸脱氢酶(lactate dehydrogenase, LDH)、谷草转氨酶(aspartate aminotransferase,AST)以及入院48 h后的血细胞比容、尿素氮、血钙、碱缺乏、液体丢失量。按照疾病严重程度分为中度和重度HLAP,并计算每例患者的Ranson评分。采用t检验比较中度和重度HLAP组间Ranson评分的差异,运用受试者工作特征(receiver operating characteristic,ROC)曲线分析得出最佳界值,计算其敏感度和特异度,以卡方检验验证其一致性。结果共计99例符合入选和排除标准的HLAP患者进入本研究,其中中、重度HLAP分别为45例和54例。重度HLAP组的Ranson评分显著高于中度组,差异具有统计学意义(5. 19±1. 33比3. 09±1. 35,P<0. 01)。ROC曲线分析显示4为最佳临界值,敏感度为75. 9%,特异度为84. 4%;以4为临界值,Ranson评分3～4者符合中度HLAP的表现,Ranson评分>4符合重度HLAP表现,中度和重度组的Ranson评分与疾病分型一致(P<0. 01)。结论 Ranson评分可用于中度和重度HLAP分型早期预测,3～4分提示中度HLAP,>4分提示重度HLAP。     

Innate Lymphoid Cells: Emerging Players in Pancreatic Disease

Common pancreatic diseases have caused significant economic and social burdens worldwide. The interstitial microenvironment is involved in and plays a crucial part in the occurrence and progression of pancreatic diseases. Innate lymphoid cells (ILCs), an innate population of immune cells which have only gradually entered our visual field in the last 10 years, play an important role in maintaining tissue homeostasis, regulating metabolism, and participating in regeneration and repair. Recent evidence indicates that ILCs in the pancreas, as well as in other tissues, are also key players in pancreatic disease and health. Herein, we examined the possible functions of different ILC subsets in common pancreatic diseases, including diabetes mellitus, pancreatitis and pancreatic cancer, and discussed the potential practical implications of the relevant findings for future further treatment of these pancreatic diseases.     

Fentanyl but Not Morphine or Buprenorphine Improves the Severity of Necrotizing Acute Pancreatitis in Rats

Opioids are widely used for the pain management of acute pancreatitis (AP), but their impact on disease progression is unclear. Therefore, our aim was to study the effects of clinically relevant opioids on the severity of experimental AP. Various doses of fentanyl, morphine, or buprenorphine were administered as pre- and/or post-treatments in rats. Necrotizing AP was induced by the intraperitoneal injection of L-ornithine-HCl or intra-ductal injection of Na-taurocholate, while intraperitoneal caerulein administration caused edematous AP. Disease severity was determined by laboratory and histological measurements. Mu opioid receptor (MOR) expression and function was assessed in control and AP animals. MOR was expressed in both the pancreas and brain. The pancreatic expression and function of MOR were reduced in AP. Fentanyl post-treatment reduced necrotizing AP severity, whereas pre-treatment exacerbated it. Fentanyl did not affect the outcome of edematous AP. Morphine decreased vacuolization in edematous AP, while buprenorphine pre-treatment increased pancreatic edema during AP. The overall effects of morphine on disease severity were negligible. In conclusion, the type, dosing, administration route, and timing of opioid treatment can influence the effects of opioids on AP severity. Fentanyl post-treatment proved to be beneficial in AP. Clinical studies are needed to determine which opioids are best in AP.     

急性重症胰腺炎53例临床治疗分析

目的观察非手术治疗重症急性胰腺炎的临床疗效,以利于临床更好地推广应用。方法收集2005年1月至2008年12月间在我院住院治疗的重症胰腺炎病例53例临床资料,进行回顾性分析,早期使用广谱抗生素,抑制胰腺分泌,积极配合中药治疗,及时给予肠内营养等。结果53例患者经综合治疗治愈42例,治愈好转率为79.2%。结论非手术治疗重症急性胰腺炎有较好疗效,尤其是早期应用,可提高该病的早期治愈率及有效率。     

导丝引导插管对ERCP术后胰腺炎的影响

目的探讨内镜逆行胆胰管造影术（endoscopic retrograde cholangio-pancreatography, ERCP）中导丝进入胰管术后胰腺炎的发生率及置放胰管支架对术后胰腺炎的预防作用。方法回顾性分析2008年10月1日至2009年12月31日共计1217例次ERCP术[均行内镜下括约肌切开术（endoscopic sphincterotomy,EST）]的临床资料．比较导丝进入胰管组（24例）、导丝进入胰管且放置胰管支架组（64例）及导丝未进入胰管组（1079例）3组间ER—CP术后胰腺炎（post—ERCP pancreatitis,PEP）的发生率,分析导丝进入胰管对胰腺炎的影响及其支架对预防PEP的作用。结果导丝进入胰管组、导丝进入胰管且放置胰管支架组及导丝未进入胰管组PEP发生率分别为6．76％、6．25％、2．13％。导丝进入胰管组、导丝进人胰管且放置支架组PEP发生率显著高于导丝未进入胰管组（均P〈0．05）;导丝进入胰管组与导丝进入胰管且放置支架组PEP发生率比较差异无统计学意义（P〉0．05）。结论导丝进人胰管是诱发ERCP术后胰腺炎的因素,而导丝进入胰管后放置胰管支架不减少术后胰腺炎的发生率。     

近10年早期肠内外营养对急性胰腺炎预后的Meta分析

目的:分析2004—2014年早期肠内外营养对急性胰腺炎预后的影响及并发症。方法:应用计算机检索2004年1月—2014年1月国内外文献数据库,对急性胰腺炎进行肠内外营养支持治疗的预后对比。结果:对于急性胰腺炎,早期肠内营养较肠外营养可降低其病死率、减少感染率、缩短住院时间、减少并发症的发生。结论:对于急性胰腺炎患者,可尽早进行早期肠内营养进行营养支持治疗。     

Betulinic Acid Ameliorates the Severity of Acute Pancreatitis via Inhibition of the NF-κB Signaling Pathway in Mice

Acute pancreatitis (AP) is an inflammatory disorder, involving acinar cell death and the release of inflammatory cytokines. Currently, there are limited effective therapeutic agents for AP. Betulinic acid (BA) is a pentacyclic triterpenoid extracted from Betula platyphylla that has been shown to have anti-inflammatory effects. In this study, we aimed to investigate the effects of BA on AP and elucidate the potential underlying mechanisms. AP was induced in mice through six intraperitoneal injections of cerulein. After the last cerulein injection, the mice were sacrificed. Our results revealed that pre- and post-treatment with BA significantly reduced the severity of pancreatitis, as evidenced by a decrease in histological damage in the pancreas and lung, serum amylase and lipase activity and pancreatic myeloperoxidase activity. Furthermore, BA pretreatment reduced proinflammatory cytokine production, augmentation of chemokines, and infiltration of macrophages and neutrophils in the pancreas of AP mice. In addition, mice that were pretreated with BA showed a reduction in Iκ-Bα degradation and nuclear factor-kappa B (NF-κB) binding activity in the pancreas. Moreover, BA reduced the production of proinflammatory cytokines and NF-κB activation in pancreatic acinar cells (PACs). These findings suggest that BA may have prophylactic and therapeutic effects on AP via inhibition of the NF-κB signaling pathway.