Study On The Effect Of The Pancreatic Juice Regurgitation On Acute Hepatic Injury

Objective: Some diseases about the pancreas and gallbladder often occur at the same person, The phenomenon of"the pancreas and gallbladder disease come on at the same time"has been taken more and more attention. Many experiments and clinical datum have approved that the pancreas and gallbladder diseases have some internal relationship. All of this attributed to pancreatcobiliary, when it was obstructed with small stone,foreign matter and the dysfunction of Oddi spincter that the pancreatic juice and bile could mutual reflux ,and the abnormal flux of pancreatic juice and bile could cause the injury of gallbladder and pancreas. Recently, many animal experiments and clinical researches have detailedly discussed the injury of hepatic when the bile duct obstructed, and it approved that the obstruction of bile duct causes the changes of hepatic function index and the changes of the liver tissue. However ,it is rarely reported on the hepatic injury caused by the pancreatic juice reflux to the bile duct after pancreatcobiliary duct has been obstructed .In our experiment, we methoded of injecting pancreatic juice to rabbit bile duct as model to simulate the pancreatic juice regurgitation , and studyed the changed of ALT,AST,ALP,GGT,TBIL in the serum ,and the NO,NOS in serum and the liver tissue , observed the change of the liver tissue pathologic structure , further to study the effect of pancreatic juice regurgitation on acute liver injury ,and the effect of NO in the process of hepatic injury. And provide the theoretical base for the liver injury when bile duct has been obstructed.Methods: 45 healthy rabbits weighing 2.0-2.5Kg were randomly divided into 3 groups:the sham operation group(SO group),the simple bile duct ligated group(BDL group),and the group which the bile duct injected with pancreatic enzyme before it ligated (M group),in which male and female were equally and each group including 15 rabbits . All the rabbits were prohibited to eat but not drink before operation. After animal model successfully settled, all the animals were killed after three days, and determined the serum ALT,AST,ALP,GGT,TBIL , the bile AMY,NO,NOS of serum and the liver tissue ,got the liver tissue ,and observed the pathologic changes with light microscope after HE staining. The experimental data expressed as mean standard deviation. The statistic significance is analyzed by SPSS 13.0, a statistic software.Result:1 The change of the liver appearance: The liver of BDL group and the M group become swelling; The change of the liver of part of animals in M group are serious, and sparse pus on the surface could be seen. In the light microscope ,the liver tissue both of the BDL group and M group have the changes as dropsy,vacuole denaturalization and putrescence in small section, the white blood cell invaded. And a few animals in M group are severer than BDL group.2 The serum hepatic function index: the ALT,AST become higher in the M group and BDL group ,when compared with the SO group, have significant difference (p<0.05); Compared the M group with BDL group, have difference (p<0.05); While TBIL,GGT,ALP became higher in the M group and BDL group, when compared with the SO group, have difference (p<0.05) , compared the M group with BDL group, it have no obvious difference(p<0.05).3 The bile amylase: In the M group are obviously higher than the SO group and BDL group , have significant difference(p<0.05).Compared BDL group with SO group, have no difference (p>0.05).4 Compare the NO,NOS of the liver and the serum between the SO group and M group or the BDL group , have difference ( p<0.05); But compare the M group with BDL group, it have no obvious difference (p>0.05).Conclusions:1 After pancreaticobiliary duct has been obstructed, the pancreatic juice and bile could mutual reflux, the levels of ALT and AST in M group increased obviously ,Compared with BDL group have difference. Which approved that when pancreaticobiliary duct has been obstructed, pancreatic juice reflux to bile duct attribute a certain effect on the process of the liver injury.2 After pancreaticobiliary duct has been obstructed and pancreatic juice injected to bile duct caused acute or chronic cholecystitis, and lead to the liver injury. While compared with BDL group, the levels of ALP,GGT and TBIL in M group have no obvious difference . Approved the bile duct obstructed and cholestasis are the important reason of the hepatic injury. It's the effectively method to resume the function of liver that releasing the obstructing of bile duct as early as possible.3 Compared with the sham operation group the level of NO and NOS in serum and liver tissue increased obviously both in M and BDL group . Which approve NO and NOS play an important role in the course of the liver injury.