摘要目的 比较清胰活血汤和Infliximab单抗治疗大鼠急性坏死性胰腺炎(ANP)并发多器官功能衰竭(MOOS)的疗效.方法 采用胰管内逆行注射4.5%牛磺胆酸钠1 ml/kg体重的方法诱导大鼠ANP模型.按数字表法随机分为ANP组、清胰活血汤组(Q组)和Infliximab单抗组(Ⅰ组).Ⅰ组于建模后6 h尾静脉注射Infliximab单抗(8 mg/kg体重),ANP组和Q组于建模前4 h和建模后3、9 h分别给予生理盐水和清胰活血汤灌胃(20 ml/kg体重).24 h后处死大鼠,检测血清淀粉酶、总胆红素(TBil)、肌酐(Cr)、TNF-α、二胺氧化酶(DAO)水平,测腹腔内压,计算小肠碳末推进率,行胰腺组织病理学检查.结果 ANP组、Q组、Ⅰ组的胰腺病理评分分别为13.8±0.8、6.1±0.4、3.9±0.6,各组间差异均有统计学意义(P值均<0.05),血清淀粉酶、TBil、Cr及TNF-α水平亦依次显著降低.ANP组、Q组、ΒⅠ组血DAO水平分别为(186.3±10.2)、(134.6±14.3)、(149.1±16.3)U/L;小肠碳末推进率为(53±0.1)%、(89±0.1)%、(61±0.1)%;腹内压为(11.8±1.5)、(4.1±0.8)、(5.8±1.2)mmHg(1 mmHg=0.133 kPa).Q组及Ⅰ组的DAO和腹内压均较ANP组显著降低,而小肠碳末推进率均高于ANP组(P值均<0.05),且Q组小肠碳末推进率高于Ⅰ组,腹内压和DAO浓度低于Ⅰ组,两组的差异具有统计学意义(P值均<0.05).结论 清胰活血汤与Infliximab单抗治疗ANP并MODS大鼠均具显效,其中清胰活血汤在促胃肠动力、降腹内压和改善肠屏障功能方面疗效更显著.

abstractsObjective To compare the treatment effects of Qingyi Huoxue decoction and infliximab on acute necrosis pancreatitis ( ANP) complicated with MODS in a rat model. Methods 4.5% sodium taurocholate was injected into the pancreatic duct to induce the ANP complicated with MODS model. The ANP rats were randomly divided into 3 groups, ANP group (ANP), Qingyi Huoxue decoction treatment group ( QG) , infliximab treatment group (IG). Rats in infliximab group received infliximab injection at a dose of 8 mg/kg body weight via tail vein 6 h after the ANP induction. The ANP and QG received normal saline and Qingyi Huoxue decoction (20 ml/kg) via gastric lavage 4 h before and 3 h, 9 h after ANP induction. After 24 h, all rats were sacrificed, the serum levels of amylase, total bilirubin, Cr, TNF-α, diamine oxidase ( DAO) , intra-abdominal pressure (IAP) and the rate of carbon propelling rate in ileum were measured. The pancreas samples were collected for pathological examination. The pathological score of pancreas was calculated. Results The pathological scores in ANP, QG, IG were 13.8 ±0.8, 6.1 ±0.4, 3.9 ±0.6, and the difference was statistically significant (P <0.05). The serum levels of amylase, total bilirubin, Cr, TNF-α were significantly decreased. In ANP, QG, IG the serum levels of DAO were (186.3 ± 10.2 ) , ( 134.6 ± 14.3 ) , ( 149.1 ± 16.3) U/L; the carbon propelling rates in ileum were (53 ±0.1)% , (89 ±0.1)% , (61 ±0.1)% ; the IAPs were (11.8 ±1.5), (4.1±0.8), (5.8 ±1.2) mmHg(1 mmHg=0.133 kPa). The DAO and IAP in AG, IG were significantly decreased when compared with that in ANP group, but the carbon propelling rates in ileum was significantly higher than that in ANP group, and the difference was statistically significant ( P < 0.05). In addition, the carbon propelling rates in ileum in QG were higher than that in IG, and IAP and DAO levels were lower than that in IG, and the difference was statistically significant (P <0.05). Conclusions The Qingyi Huoxue decoction and infliximab were significantly effective in the treatment of ANP rats complicated with MODS. But the effects of Qinyi Huoxue decoction on promoting gastrointestinal motility, reducing the IAP and improving the intestinal barrier function were better than those of the infliximab.