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目的:观察低分子肝素(LMWH)区域动脉灌注(LAI)对家兔重症急性胰腺炎(SAP)的疗效及对血浆TNF-α,IL-6,IL-10的影响。方法:24只健康成年家兔随机均分为假手术组,SAP组,SAP+LMWH静脉输注组(IV组),SAP+LMWH LAI组(LAI组)。以5%牛磺胆酸钠胰腺被膜下注射诱导SAP模型,造模30 min后,2个治疗组分别以静脉输注和LAI的方式给予LMWH(300 IU/kg),分别在术后0.5,3,6,12 h检测各组家兔静脉血浆TNF-α,IL-6和IL-10水平,并观察胰腺病理学改变。结果:假手术组术后血浆TNF-α和IL-6水平呈缓慢升高,其余各组血浆TNF-α和IL-6水平均在术后0.5~6 h内明显升高,与假手术组比较差异均有统计学意义(P<0.05或P<0.01),随后逐渐降低,其中IV组和LAI组血浆TNF-α和IL-6水平在各时点均低于SAP组(P<0.05或P<0.01),且LAI组两者降低程度大于IV组(P<0.05或P<0.01);假手术组术后IL-10水平在各时点无明显变化,SAP组IL-10水平在术后6 h各时点明显降低,与假手术组比较差异有统计学意义(均P<0.01),IV组和LAI组IL-10水平明显升高,与SAP组比较差异均有统计学意义(P<0.05或P<0.01),且LAI组升高程度明显大于IV组(P<0.01);除假手术组外,其余各组均为轻重不同的SAP特征性病理表现,以SAP组最重,IV组次之,LAI组最轻。结论:LMWH能降低SAP家兔TNF-α和IL-6的水平,提高IL-10的水平,对SAP具有治疗作用,且LAI优于静脉给药。
Objective: To observe the effect of low molecular weight heparin (LMWH) arterial infusion (LAI) on acute pancreatitis (SAP) in rabbits and its effect on plasma TNF-α, IL-6 and IL-10. Methods: Twenty-four healthy adult rabbits were randomly divided into sham operation group, SAP group, SAP + LMWH intravenous infusion group (IV) and SAP + LMWH LAI group (LAI group). The SAP model was induced by 5% sodium taurocholate subconjunctival injection. After 30 min of modeling, LMWH (300 IU / kg) was administered to the two treatment groups by intravenous infusion and LAI respectively. After 0.5, The levels of TNF-α, IL-6 and IL-10 in rabbits at 3, 6 and 12 h were measured, and pathological changes of pancreas were observed. Results: The plasma levels of TNF-α and IL-6 in sham operation group increased slowly, and the levels of TNF-α and IL-6 in other groups were significantly increased within 0.5-6 h after operation. Compared with sham operation group (P <0.05 or P <0.01), and then gradually decreased. The levels of plasma TNF-α and IL-6 in IV and LAI groups were lower than those in SAP group at each time point (P <0.05 or P <0.01) P <0.01). The reduction of IL-10 in LAI group was more than that in IV group (P <0.05 or P <0.01) (P <0.01). The level of IL-10 in IV group and LAI group was significantly higher than that in SAP group (P <0.01), the difference was statistically significant (P < P <0.05 or P <0.01), and the elevation in LAI group was significantly greater than that in IV group (P <0.01). Except for the sham-operation group, all the other groups were characterized by different severity of SAP. , Followed by IV, the lightest in LAI group. Conclusion: LMWH can reduce the levels of TNF-α and IL-6 in rabbits and increase the level of IL-10 in SAP rabbits, which is superior to SAP in intravenous administration.