Experimental Observation Of Intermittently Short-term Peritoneal Lavage Treatment With Peritoneal Dialysis Solution For Early Severe Acute Pancreatitis

Objective:To observe the effect of intermittently short-term peritoneal lavage treatment with peritoneal dialysis solution on preliminary immune mechanisms for L-arginine induced Severe Acute Pancreatitis in rats. Determine the concentration of TIR4and sCD14in plasma by double antibody sandwich ELISA technique and analysis the expression of NF-kB by immunochemistry staining.Methods:The rat model of Severe Acute Pancreatitis was induced by intraperitoneal injection of L-arginine (3×1.2g/kg) at the concentration of70g/L.A total of48Male Sprague-Dawley rats(SD rats) were randomly divided into three groups, severe acute pancreatitis group; control group; lavage group. The rats of model group were killed at12th,24th and36th h after modeling(3×1.2g/kg, all hree times, each time/h).While the rats of control group were also killed at the above points of time after intraperitoneally injected equivalent0.9%saline (all three times, each time/h). The rats of lavage group cathetered for peritoneal dialysis solution peritoneal lavage with skin preparation and indwelling peritoneal lavage device in upper and lower abdomen (upper abdominal catheter in the pancreatic area, lower abdomen set pipe in the iliac fossa), tilted fixed on20～30°metal framework at lth h after modeling (each time/6h,100ml per time,lavage speed at60drops/min;12h group lavage2times,24h group lavage4times,36h group lavage6times).After lavements finished, the rats were killed. Determine the concentration of amylase and lipase in serum, TIR4and sCD14in plasma by double antibody sandwich ELISA technique, biopsy HE staining and pathological scores. The expression levels of NF-kB in pancreatic tissue from rats by immunohistochemistry were observed. Results:(1)Pathological observations:The rat model of Severe Acute Pancreatitis was successful by intraperitoneal injection of large doses of L-arginine.The pancreatic tissues of rats in control groups had no significant change, no seamless interstitial edema, and inflammatory cell infiltration under light microscope; Gastrointestinal flatulence, mesenteric and retroperitoneal adipose tissue necrosis, some bloody ascites can be seen in model groups. Inflammatory cell infiltration, lobular structure disorders, pancreatic tissue necrosis were visible in pancreatic tissue interstitial under microscopic, and the degrees of necrosis were increased with change of time point; The degrees of inflammatory cell infiltration, lobular structure and necrosis under microscopic in lavage groups were lesser than model groups.Pathological changes of pancreatic tissue in lavage group were significantly compared to severe acute pancreatitis group and control group (P<0.05);(2)The results of serum amylase and lipase:The contents of serum amylase and lipase of lavage group decreased compared to severe acute pancreatitis group (P<0.05),but not statistically significant to control group (P<0.05);(3)The results of TLR4and sCD14in blood:The concentration of TLR4and sCD14in blood of lavage group were significantly lower than severe acute pancreatitis group (P<0.05),but not statistically significant than control group (P>0.05) at each point of time;(4)The results of Expression levels of NF-kB of pancreatic tissue:Expression levels of NF-kB of pancreatic tissue were lower than severe acute pancreatitis group, but less or almost no expression in contro group.Conclusion:(1) The rat model of Severe Acute Pancreatitis was successful by intraperitoneal injection of large doses of L-arginine, There were a lot of inflammatory cell infiltration changes in pancreatic tissue stroma and increased levels of TLR4, sCD14and NF-kB, suggested that the above three factors are closely related to pancreatitis inflammation;(2) The treatment of intermittently short-term peritoneal lavage has a remarkable inhibitory effect on the immune function for early severe acute pancreatitis in rats.