The Study Of Effect Of Thoracic Duct Drainage And Salvianolate On Renal Injury In Rats With Severe Acute Pancreatitis

Objective: Severe acute pancreatitis (SAP) is characterized by its acuteonset, fast progress, and high mortality.Most of patients died from secondaryinfection and multiple organ failure. Its pathogenesis is complex and notknown entirely. The kidney is one of the organs which often be affected withsevere acute pancreatitis except pancreas.According to some literatures，SAPwith acute kidney injury (AKI)’s rate was up to53.9%, as the further developto acute renal failure, the mortality’s rate was up to50%.Acute kidney injuryhas become one of the important risk factors for the reason of death. Itspathogenesis may be related to renal ischemia and hypoxia、bacterial andendotoxin’s attack、 the renal parenchyma damaged by cytokines andinflammatory mediators, and also related to activation the renin-angiotensinsystem’s activation and the change of renal microcirculation.Therefore, furtherresearch about its pathogenesis and seek some effective control measures havea very important clinical value. Currently, the thoracic duct lymph drainagehas been widely studied in severe burns, septic shock and bacterial endotoxin’sdouble injury. The studies suggest that the thoracic duct lymph drainage canbe a transfer pathway of blood bacteria and endotoxin translocation.Salvianolate can against oxidative stress, improve microcirculation and themetabolism of cells.Salvianolate used to treat of strokes’s decubationcurrently.In this study, the SAP model in rats was made by retrograde inject intobiliopancreatic duct with5%sodium taurocholate. Then according to detectthe change of the level of amylase enzyme (AMY), creatinine (CR), bloodurea nitrogen (BUN) in blood and endotoxin in thoracic duct lymphdrainage,to find difference between SAP rats,neck duct lymph drainage andafter Salvianolate’s intravenous injection. The purpose of this study is toreveal the mechanism of kidney injury in SAP in rats, by the way, also to find effective treatment and provide an experiment’s support for clinical practice.Methods:144healthy male SD rats, weight of330±30g, were divided into18groups randomly, and8rats in each group.Including: cervical sham operationgroup+abdominal sham operation group (J group)2,6,12hours group;cervical thoracic duct drainage+abdominal sham operation group (Shamgroup)2,6,12hours group; cervical sham operation group+SAP group2,6,12hour group; cervical thoracic duct drainage+SAP group (L group)2,6,12hours group; SAP+salvianolate group (D group)2,6,12hours group;cervical thoracic duct drainage+SAP+salvianolate group (LD group)2,6,12hours group. In this experiment the SAP model in rats was made byretrograde inject into biliopancreatic duct with5%sodium taurocholate. Andthen set up channels via tail vein to infuse liquid, each group of rows asrequired cervical thoracic duct cannulation drainage and slowly injectedsalvianolate via the tail. At a predetermined time points after2,6,12h, we canobserve renal tissue, measure the amount of ascites,collect serumspecimens,plasma and tissue samples.Thoracic duct lymph drainage groupneed collect lymph per hour. Observing organize’s changes, determining thepathology score of pancreas and kidney under the lightmicroscopy,determining the content of the serum amylase (AMY), creatinine(CR), blood urea nitrogen (BUN), serum catalase (CAT) and glutathioneperoxidase (GSH-PX) and thoracic duct lymph drainage.Result:1. Compared with Sham group,the amount of ascites and ascites’color,pathological changes of the pancreas and kidney, the level of serum amylase(AMY), creatinine (CR), blood urea nitrogen (BUN), and thoracic duct lymphdrainage ‘s endotoxin,serum catalase (CAT) and glutathione(GSH-Px) of ratsin J group have no significant difference.2. Compared with J and Sham group, the color of ascites is getting dark,and the amount of ascites is increasing with time in rats of SAP group, A widerange of significant edema, piece bleeding and black necrosis in pancreas, can be generally seen in6h and12h group.Saponification spots were found on thesurface of pancreas. The kidney of SAP12h group become swelling and has adark red surface. The levels of serum AMY, creatinine (CR), blood ureanitrogen (BUN) were significantly higher (P <0.01), and increased with time;the activity of plasma catalase (CAT) and glutathione peroxidase (GSH-PX)were significantly lower (P <0.01).3. Compared with J and Sham group, the amount of ascites of rats in Dgroup, L group, LD group is larger, the color of ascites is very dark, pancreaticpathology score was significantly higher (P <0.01),the content of serum AMY,creatinine (CR), blood urea nitrogen (BUN) and thoracic duct lymph drainageof toxins was significantly higher (P <0.05, or P <0.01), and become higherwith time; the activity of plasma catalase (CAT) and glutathione peroxidase(GSH-PX) were significantly lower (P <0.01).4. Compared with SAP group, the amount of ascites in L group is lower(P<0.01), pancreatic pathology score was significantly lower(P <0.01), Thecontent of serum AMY, creatinine (CR), blood urea nitrogen (BUN) weresignificantly lower (P <0.05, or P <0.01), and obvious decreased with time (P<0.05, or P <0.01); The activity of plasma catalase (CAT) and glutathioneperoxidase (GSH-PX) were significantly lower (P<0.01).5. Compared with SAP group, the amount of ascites in D group islower(P <0.01), pancreatic pathology score was significantly lower(P <0.01),The content of serum AMY, creatinine (CR), blood urea nitrogen (BUN) weresignificantly lower (P <0.05, or P <0.01), and obvious decreased with time (P<0.05, or P <0.01);The activity of plasma catalase (CAT) and glutathioneperoxidase (GSH-PX) were significantly lower (P<0.01).6. Compared with SAP group, the amount of ascites in LD group islower(P <0.01), pancreatic pathology score was significantly lower(P <0.01),The content of serum AMY, creatinine (CR), blood urea nitrogen (BUN) weresignificantly lower (P <0.05, or P <0.01), and obvious decreased with time (P<0.05, or P <0.01); The activity of plasma catalase (CAT) and glutathioneperoxidase (GSH-PX) were significantly lower (P<0.01). 7.Compared with L、D group, the amount of ascites of rats in LD groupis lower(P <0.01), pancreas’s edema, piece bleeding and black necrosis werealleviated,pancreatic pathology score was significantly lower(P <0.01), renalpathology was significantly better, the content of serum AMY, creatinine (CR),blood urea nitrogen (BUN) were significantly lower (P <0.05, or P <0.01), andobvious decreased with time (P <0.05, or P <0.01); The activity of plasmacatalase (CAT) and glutathione peroxidase (GSH-PX) were significantly lower(P<0.01).Conclusion:1. Renal parenchymal of SAP model rats shows extensive bleeding, renaltubular epithelial cell necrosis, renal interstitial congestion, inflammatory cellinfiltration, tubular stenosis, blockage and other pathological changes,Thecontents of AMY, CR, BUN significantly increased in serum.The activity ofCAT and GSH-PX in renal tissue were significantly reduced.Indicating thatkidney injury occurred in SAP and renal function is impaired.2. SAP with renal injury, the content of the endotoxin toxin in thethoracic duct lymph were significantly higher than that in control groups, thecontents of endotoxin in serum were also significantly elevated.It suggestedthat SAP was closely related with renal damage.3. In SAP with AKI, the activity of CAT, GSH-PX in serum, lymph,pancreas and kidney tissue homogenates decreased.It indicated that thebody’santioxidant capacity declined.4. After the drainage thoracic duct lymph, compared with SAP group, therenal pathological damage significantly reduced, the content of AMY, CR,BUN in serum were significantly lower, the activity of CAT and GSH-PXsignificantly increased, and the content of endotox in blood also decreasedsignificantly.It indicated that thoracic duct drainage played a protective roleon the kidneys in SAP.5. The intraveuous injection salvianolate improved systemicmicrocirculation, scavenged oxygen free radicals, and reduced the degree ofrenal damage in SAP. 6.When thoracic duct drainage and salvianolate were combined used totreat SAP rats, pancreatic pathology scores of rats was significantly lower; thecontent of serum AMY, creatinine (CR), blood urea nitrogen (BUN) weresignificantly lower, the activity of andplasma catalase (CAT) and glutathioneperoxidase (GSH-PX) were significantly lower. Endotoxin in Lymph, bloodalso reduced. Combination of two interveges showed better therapitic effect tothe SAP than single one.