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目的探讨低分子量肝素(low molecular weight heparin,LMWH)对重症急性胰腺炎(severeacute pancreatitis,SAP)合并胰性脑病的治疗作用。方法SD大鼠随机分为3组:(1)假手术对照组(S组);(2)SAP组;(3)LMWH治疗组(LT组):SAP制模后4 h给予LMWH治疗。检测SAP组和S组制模术后24 h,LMWH治疗后24 h的血清淀粉酶,血清髓鞘碱性蛋白(MBP),IL-6,TNF-α,脑组织含水量,胰腺和脑组织形态学变化。结果(1)SAP组血清淀粉酶,TNF-α,IL-6水平显著高于S组和LT组(均P<0.001),SAP组MBP水平显著高于S组和LT组(P<0.01,P<0.05);LT组血清淀粉酶和IL-6水平显著高于S组(P<0.05,P<0.001),但TNF-α和MBP在LT组及S组间差异无统计学意义(P>0.05)。(2)SAP组的脑组织含水量显著高于S组和LT组(P<0.01,P<0.05)。(3)SAP组胰腺组织大片坏死、出血;LT组胰腺组织坏死、出血程度均较SAP组明显减轻。(4)SAP组的脑组织出现明显神经元细胞凋亡,线粒体空泡变性及有髓神经脱髓鞘改变;LT组的有髓神经脱髓鞘和线粒体水肿较SAP组明显减轻,未见神经元细胞凋亡。结论LMWH可减少胰酶的释放,抑制脑神经元细胞凋亡,同时下调炎症介质的产生,从而减少胰性脑病的发生。
Objective To investigate the therapeutic effect of low molecular weight heparin (LMWH) on pancreatic encephalopathy in patients with severe acute pancreatitis (SAP). Methods SD rats were randomly divided into three groups: (1) sham operation control group (S group); (2) SAP group; (3) LMWH treatment group (LT group): LMWH treatment was given 4 h after SAP model. Serum amylase, serum MBP, IL-6, TNF-α, brain water content, pancreatic and brain tissue were detected 24 h after model establishment in SAP group and S group 24 h after LMWH treatment. Morphological changes. Results The levels of serum amylase, TNF-α and IL-6 in SAP group were significantly higher than those in S group and LT group (all P <0.001). The levels of MBP in SAP group were significantly higher than those in S group and LT group (P <0.01, P <0.05). The levels of serum amylase and IL-6 in LT group were significantly higher than those in S group (P <0.05, P <0.001), but no difference was found between TNF-α and MBP in LT group and S group > 0.05). (2) The brain water content of SAP group was significantly higher than that of S group and LT group (P <0.01, P <0.05). (3) Large pancreatic tissue necrosis and hemorrhage in SAP group. The necrosis and hemorrhage of pancreatic tissue in LT group were significantly reduced compared with SAP group. (4) The brain tissue of SAP group showed obvious neuronal apoptosis, degeneration of mitochondria and demyelination of myelinated nerve. Myelinated demyelination and mitochondrial edema in LT group were significantly reduced compared with SAP group Cell apoptosis. Conclusion LMWH can reduce the release of pancreatic enzymes, inhibit neuronal apoptosis, reduce the production of inflammatory mediators and reduce the incidence of pancreatic encephalopathy.