| Background/Aims:Severe acute pancreatitis(SAP) is a acute abdomen with rather vexing therapeutic effect.Besides pancreatic ischemia,hypoxia and other local pathophysiological changes, SAP accompanies with systemic inflammatory response syndrome(SIRS), is easy to result in adult respiratory distress syndrome(ARDS), multiple organ dysfunction syndrome(MODS) and other severe complications ,even leads to death. Intra oxygen injection and N-acetylo-L-cysteine (NAC) were respectively or combinatively used to early SAP of rats. The concentrations of blood cytokines;the changes of pancreatic histopathology,pancreatic tissue cytokine receptors and pancreatic microcirculation were investigated in this study,to explore the effects and mechanisms of the therapeutic measures for SAP's clinical therapy.Materials and Methods: 75 Sprague-Dawley rats were randomly devided into five groups:sham-operated group(A);SAP-untreated group(B);SAP treated with intra oxygen injection group(C); SAP treated with NAC group(D); SAP treated with intra oxygen injection in combination with NAC group(E).SAP was induced by retrograde injection of 3.5% sodium taurocholate(lml,0.2ml/min)via main pancreatic duct except for A group.the rats were offered by intra oxygen injection(0.1ml/100g)or NAC(0.1ml/100g) and / or saline via external jugular vein,their supplied liquid volume were equal.Blood samples and pancreatic specimens of each group rats were taken at the 1,3,5th hr after operation, for the measurement of interleukin-2 (IL-2) and tumor necrosis factor(TNF-α), for histopathologic score and for IL-2Ra(interleukin-2 receptor-a) as well as TNFR1 (tumor necrosis factor receptor-1) by hybridization in situ . On the other hand ,group A,B,C were used for pancreatic micro vessel corrosion casts at the 4th hr after operation,the pancreatic microvessel changes were observed by scanning electron microscope.Results:(1)The plasma levels of IL-2 and TNF- α , pancreatic histopathological scores in the rats of group B were significantlydifferent from those of group A,C,D,E respectively(P<0.05), the levels of plasma IL-2 were elevated, TNF-α inhibited, the pancreatic lesions were relative gentler in SAP-treated groups.(2)In aspects of plasma IL-2 levels ,pancreatic histopathological scores and pancreatic tissue IL-2Ra positive scores,group C, D were statistically different to group E respectively(P<0.05);Group C had obvious differences with group D and E (P<0.05) in plasma TNF- α ,there was no difference between group D and E(P>0.05).(3)At the first hr ,the pancreatic tissue positive scores of IL-2Ra in group B were obvious higher than those of A,C,D group ,while the scores of TNFR1 in group B were higher than those of A,C,D,Egroup (P<0.05);The scores of IL-2Ra at group B,C,D,E were significantly increased than that of A group except group C,D at the first hr(P<0.05),the scores of TNFR1 in group B,C,D,E were higher than those of A group except D group at the first ,third hr and E group at the first hr;Group C was not different from group D in these two marker(P>0.05);As to pancreatic tissue IL-2Ra positive scores,group E were demonstrated statistical higher than C group at the first and 3rd hr or D group at the 3rd hr (P<0.05),group E were distinctly lower than group C,D in pancreatic tissue TNFRl positive scores respectively at the 5th hr.(4)Pancreatic microvessel injuries were partially improved in contrast to group C at the 4th hr after operation.ConcIusion:(1)Treatment of early SAP of rats with intra oxygen injection or NAC strikingly improve the pathophysiological changes,help to reconstruct the dynamic equilibrium of anti-inflammatory and proinflammatory cytokine. Intra oxygen injection therapy may improve cell immunity and pancreatic microcirculation.(2)Combining intra oxygen injection with NAC are more effective than either of them in the treatment of early SAP rats.
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