国际麻醉学与复苏杂志   2011, Issue (2): 0-0
    
静脉内谷氨酰胺支持下调牛磺胆酸钠诱导ASP猪血浆内毒素水平及PLA2和NE活性
屠伟峰, 郄文斌1()
1.广州军区总医院全军临床麻醉中心
Intravenous glutamine support downmodulated the release of plasma LPS and the activities of PLA2 and neutrophis elastase in taurocholate-induced acute severe pancreatitis in the pigs.
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摘要:

目的 观察静脉内滴注谷氨酰胺(Gln)对牛磺胆酸钠混合液诱导的急性重症胰腺炎(ASP)猪血浆内毒素及磷酯酶A2(PLA2)和弹性蛋白酶(NE)活性的影响。方法 选健康长白种猪21头,体重16~22kg,雌雄不限,随机分为4组。假手术对照组(Sham组,n=5)、ASP 对照组(ASP 组,n=5)、ASP+甘氨酸)组(Gln对照组,n=5)、ASP+Gln组(Gln组,n=6)。在麻醉状态下,进腹向胰总管内注入1ml/kg 5%牛磺胆酸钠混合液(内含8000~10000 BAEE单位胰蛋白酶/ml,pH7.6)诱导ASP。以0.9%NaCl磷酸盐缓冲液取代5%牛磺胆酸钠混合液即为Sham组。分别于ASP诱导前30min、ASP诱导后6、24、48、72h采集腔静脉血样本以测定血浆内毒素、Gln水平、PLA2、弹性蛋白酶。凡涉及内毒素采样、保存和测定过程中所有物品都须进行去热原和无菌处理。结果 静脉内Gln支持不仅可显著增加血浆Gln浓度,与Sham组和Gly组比较差别有显著统计学意义(P均<0.01),还可明显降低血浆内毒素、PLA2和弹性蛋白酶水平。结论 结果提示保持高水平血浆Gln可下调ASP后血浆内毒素水平及PLA2和弹性蛋白酶活性,有利于减轻这些促炎介质促发的瀑布样炎性反应及胰腺外器官功能损害。

关键词: 急性胰腺炎;谷氨酰胺;内毒素;弹性蛋白酶;磷酯酶A2
Abstract:

Objective To observe the effects of intravenous glutamine(Gln) support on plasma lipopolysaccharide(LPS, endotoxin) and the acitvities of phospholipase A2(PLA2) and neutrophil elastase(NE) in the taurocholate-induced acute severe pancreatitis(ASP) in the pigs. Methods There were twenty-one pigs weighing 16~22kg, which were divided into four groups, including sham-controlled group(Group Sham, n=5), ASP-controlled group(Group ASP, n=5), ASP+glycine controlled group(Group Gly, n=5) and ASP+Gln supported group(Group Gln, n=6). Anesthesized pigs were subjected to ASP induced by injecting 1 ml/kg of mixed solution of 5% sodium taurocholate and 8000~10000 BAEE units trypsin/ml into pancreas via pancreatic duct, which was replaced by 0.9% sodium chloride phosphate buffer to be taken as Group Sham. Blood samples from caval vein was collected for the determinations of Gln, LPS, NE and PLA2. Plasma glutamine were measured by the high performance liquid-phase technique(the product of Waters, U.S.). Systemic plasma endotoxin levels was quantified by the chromogenic limulus amebocyte lysate(LAL) technique. All pigs were intravenously sacrificed by injecting 20 ml of 10%KCl. Anything involved in the processes of the sampling, preserving, measuring and so on had to be depyrogenated and to be asepsis. Results Intravenous glutamine support could effectively prevent the decrease of systemic plasma glutamine levels(P<0.001), and reduced significantly the higher levels of systemic plasma LPS and the activities of plasma NE and PLA2 followed by acute severe pancreatitis induced by the mixed solusion of 5% sodium taurocholate and trypsin in pigs(P<0.001, 0.001 and 0.001, respectively). Conclusions It is suggested that keeping higher plasma glutamine could downregulate the levels of plasma LPS and the activities of plasma PLA2 and NE, which is beneficial to lessen the cascade inflammatory responses irritated by thses proinflammatory mediators and extro-pancreas’ organ functional lesion in pigs with ASP.

Key words: acute pancreatitis; glutamine; lipopolysaccharide; neutrophil elastase; PLA2