摘要
Objective To investigate the effect of abdominal paracentesis drainage (APD) on pancreatic cell apoptosis in severe acute pancreatitis. Methods Male adult SD rats were randomized into the sham operation (SO) group, SAP group, and APD group, with 18 rats in each group. In the SAP group, 5% sodium sulfonate was pumped into the retrograde pancreatic bile duct to prepare the SAP model. On this basis, a gastric tube was introduced into the right lower abdomen for drainage, namely the APD group. Blood from the abdominal aorta and pancreatic tissues were collected at 6, 12, and 24 h time points in each group. The changes of serum amylase, inflammatory factor, and endotoxin were detected by ELISA. The HE staining was used to evaluate the pancreatic tissue injury. The apoptosis of pancreatic tissue was detected by TUNEL. Western blot and immunohistochemistry were used to detect the expression of apoptosis-related proteins and PI3K/AKT signaling pathway. Results Pancreatic tissue necrosis and edema were significantly lower in the APD group than in the SAP group, and the pathological score was decreased (P<0.05). Serum amylase, TNF-α, IL-1β, IL-6, and endotoxin levels in the APD group were significantly lower than those in the SAP group (P<0.05). The number of pancreatic cell apoptosis in the APD group was significantly higher than that in the SAP group (P<0.05), and the expression levels of pancreatic apoptotic proteins cleaved-caspase-3 and Bax were significantly increased in the APD group, while the expression levels of anti-apoptotic protein Bcl-2 were significantly decreased (P<0.05). Compared with the SAP group, the expression levels of PI3K/AKT signaling pathway key molecules p-PI3K, p-AKT, and NF-kB p65 were significantly decreased in the APD group (P<0.05). Conclusions Our data indicate that APD attenuates the severity of SAP by enhancing cell apoptosis via suppressing PI3K/AKT signaling pathway. This study provides a new theoretical basis for the treatment of severe acute pancreatitis with APD technology.
摘要
Objective To study the impact of early abdominal paracentesis drainage (APD) on the clinical course in patients with severe acute pancreatitis and massive peritoneal effusion.Methods From January 2012 to January 2017,107 patients with severe acute pancreatitis treated at the Chengdu Military General Hospital were retrospective studied.According to whether the patients underwent abdominal paracentesis drainage within a week of hospital admission,they were divided into the APD group (n=66) and the Non-APD group (n=41).The APD group was further subgrouped into the 0-2 d (within 48 h),3-5 d and 6 -7 d subgroups.The mortality rates,progression rates,length of stay,cost of stay,organ failure rates and inflammatory state of each subgroup of the APD were statistically analyzed and compared.Results 22 patients in the Non-APD group progressed in four weeks to require percutaneous catheter drainage (PCD).The rate of progression was 53.7％,and the mortality rate was 22％.In the APD group,21 patients underwent PCD treatment within 4 weeks.The rate of progression was 31.8％ and the mortality rate was 9.1％.In the APD group,the progression rate for the patients in the 0-2 d subgroup was 6.9％,and the in-hospital mortality rate was O.When compared with the other subgroups,the 0 to 2 d subgroup of patients had significantly lower progression and in-hospital mortality rates,lower hospitalization duration and hospitalization costs.These patients at 1 week after hospitalization also had significantly better inflammatory indexes,less incidence of organ failure and better disease severity scores (P＜0.05).Conclusions The results confirmed the effectiveness of APD in treating patients with severe acute pancreatitis with significant peritoneal effusion.Puncture treatment within 48 hours significantly improved prognosis of patients.The best time window of APD treatment for patients with severe acute pancreatitis with massive abdominal fluid is within 48 hours of hospitalization.