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Apoptosis of T-lymphocytes and the Activation of NF-kB in Severe Acute Pancreatitis

SYLLA MOMO  
【摘要】:Background:There is clear evidence that, because of the development of humantechnology, and changes of the food intake (Hyperlipidemia,Hypercalcemia, alcohol abuse); Severe Acute Pancreatitis (SAP) isbecoming common in the countries world wide.SAP is also becoming a serious disease in intensive care unit (ICU)and in the department of surgery causing high morbidity and mortality.Objectives:The purpose of this study was to investigate theimmunopathological changes, the involvement of the multipleorgan dysfunction syndromes (MODS) and the relationship withthe activation of the NF-kB in SAP.Methods and results:86 rats were used, 22 were sham operated group and 64 were dividedinto SAP models group and treatment group.The 86 animals study allowed us to evaluate the immunopathologicalchanges; the involvement of distant organs and the effect of NF-kBactivation in severe acute pancreatitis (SAP). In the sham operated animals, there was no death, both the pancreas and the lungs Structure were normal. The percentage of CD4+ T-lymphocytes (39.49±2.98) and CD8+ T-lymphocytes (20.49±2.68) were high. Whereas the activation of NF-kB was undetectable.All animals from SAP group were investigated 24 hours after SAP induction by duodenopancreaticobiliary injection of sodium deoxycholate, the results were as below:There were 4 deaths in SAP models group. Histologically, the boundary of pancreas was not clear, and neutrophil infiltrations in the alveoli were present. The percentage of CD4+ T-lymphocyte (27.79±2.80%) was lower than that of sham operated group (39.42±2.86%) statistically p0.01. The ratio of CD4+/CD8+ T-lymphocytes in SAP group (0.88±0.11%) was also significantly lower than that of the sham operated group (1.94±0.13%) with P value 0.05. It indicates cells mediated immunity defective in SAP.We assessed NF-kB activation in rat of SAP induced by injection of sodium deoxycholate into CBD, 3 hours after the episode of SAP, immunohistochemistry examination show: the percentage of NF-kB activated in SAP animals was high (42.25±5.07%) and accomondate with the pathological changes in the pancreatic tissue.We also evaluated the influence of some medicines [ulinastatin, dexamethasone, Chinese medicine (Laifuchengqi syrup)], on the Apoptosis of lymphocytes and on the NF-kB activation. We found that, Ulinastatin and Chinese medicine (Laifuchengqi syrup) can inhibit the apoptosis of CD4+ T-lymphocytes. Dexamethazone inhibited the activation of NF-kB. Conclusion: SAP is serious disease with high morbidity and mortality. Apoptosis of lymphocytes contribute to immunodysfunction; which increases the disease severity and MODS. The trans location and activation of NF-kB may be the key factor that increases SAP and involves acute necrotic pancreatitis (ANP) and death.The anti-inflammatory effect of Dexamethazone, ulinastatin and Chinese medicine (Laifiichengqi syrup) on SAP may be through decreasing the activation of NF-kB.


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