摘要
目的 本研究通过观察急性胰腺炎 (AP)患者结肠转运时间 (CTT) ,同时测定血清胃动素(MTL)、胆囊收缩素 (CCK)和血管活性肠肽 (VIP)的变化 ,旨探讨急性胰腺炎患者胃肠动力紊乱以及胃肠激素的作用。方法 研究对象包括 2 4例AP和 2 5例正常对照者。AP的诊断依据临床特征、生化指标和影像学。采用APACHEⅡ评分系统及BalthazarCT分级评分系统对AP患者入院时的病情严重程度进行回顾性评分。根据Metcalf改良简化技术应用不透X线的标志物 (SITZMARKS )测定AP患者和正常人全结肠及各节段结肠CTT。放射免疫法测定血清MTL和CCK浓度 ,ELISA法测定血清VIP浓度。结果 14例轻型急性胰腺炎 (MAP)和 10例重症急性胰腺炎 (SAP)患者全结肠及各节段CTT (主要是右、左半结肠 )均较正常对照者显著延长 (P <0 0 5 )。而且 ,SAP患者的全结肠和各节段结肠CTT均较MAP患者显著延长 (P <0 0 5 )。MAP、SAP患者血清MTL、CCK浓度均较正常对照值显著下降 (P <0 0 1) ,但MAP患者与SAP患者的血清MTL、CCK浓度无差异。另外 ,MAP、SAP患者血清VIP浓度与正常值相比呈增高趋势 ,SAP患者血清VIP浓度较MAP患者显著升高 (P <0 0 5 )。结论 AP患者尤其是SAP患者常存在胃肠动力障碍 ,其可能的机制是血清中胃肠激素 (MTL、CCK、VIP)
Objective To investigate the alteration of colonic transit time(CTT)and its possible mechanisms with reference to the changes of serum motilin(MTL),cholecystokinin(CCK)and vasoactive intestinal peptide(VIP)in patients with acute pancreatitis(AP).Methods Twenty four non consecutive patients with AP and 25 heathy controls were included in this study.The diagnosis of AP was based on clinical features,biochemical indices and radiological investigation.The severity of AP patients at admission was evaluated retrospectively according to APACHE Ⅱ and Balthazar CT scoring system.Total and segmental CTT in patients of AP and heathy controls were determined by using ingestion of radiopaque markers(SITZMARKS )according to the modified Metcalfs method.Meanwhile,serum MTL and CCK were assessed using RIA,and serum VIP was measured using ELISA in this study.Results Compared to the heathy controls,the total CTT and segmental CTT(mainly right and left semi colon)were prolonged significantly in 14 patients with mild acute pancreatitis(MAP)and 10 patients with severe acute pancreatitis(SAP)( P <0 05).Moreover,the total CTT and segmental CTT were markedly delayed in patients with SAP compared patients with MAP( P <0 05).The levels of serum MTL and CCK were significantly decreased in MAP and SAP patients compared with those in controls( P <0 01).There was no significant difference on serum MTL and CCK levels between MAP and SAP patients.In addition,the concentration of serum VIP was increased in AP patients,and reached statistical significance in patients with SAP( P <0 05).Conclusion Gastrointestinal dysmotility often occured in AP patients,especially in SAP patients.The mechanisms might be due to synergistic actions of gut hormones including MTL,CCK and VIP.All these hormones could down regulate the colonic transit course,thus result in gastrointestinal dysmotility in patients with AP. [
出处
《中华急诊医学杂志》
CAS
CSCD
2002年第5期327-330,共4页
Chinese Journal of Emergency Medicine
基金
上海市科技启明星培养计划资助项目 (99QB14 0 0 9)
关键词
急性胰腺炎
胃肠动力
变化
机制
Pancreatitis
Gastrointestinal motility
Motilin
Cholecystokinin
Vasoactive intestinal peptide
