The Pathogenesis Of Acute Lung Injury In Severe Acute Pancreatitis And The Prevention Effect Of Dexamethasone

Objective: To investigate the serum level of MCP-1, sTREM-1 andTNF-αin severe acute pancreatitis(SAP) patients and to determine the role ofthese molecules in the pathologic progress of acute lung injury accompanysevere acute pancreatitis and to explore the preventive effect and mechanismof dexaethasone.Methods: A total of 48 severe acute pancreatitis(SAP) patients wereincluded, according to whether complicated with ALI/ARDS were dividedinto ALI/ARDS group and non ALI/ARDS group on admission. The SAPpatients who were not complicated with ALI/ARDS were randomly dividedinto two groups (conventional treatment group and dexamethasone group).Then randomly find twenty mild acute pancreatitis patients (MAP) andeighteen healthy volunteers as control groups. MAP group were only treatwith fasting, fluid replacement, keeping balance of water, electrolytes andacid-base. Conventional treatment group were treat with fasting, fluidreplacement, keeping balance of water, electrolytes and acid-baseantibiotics, somatostatin, lansoprazole, Chaishaochengqi Decoction（chinesemedicine）. The dexamethasone group plus dexamethasone 20mg/d afteradmission for three days, the other treatments were same as conventionaltreatment group. The ALI/ARDS group and MAP group were collectedvenous blood on admission, The dexamethasone treatment group andconventional treatment group were collected venous blood on admission, thethird and fifth day after admission. Use enzyme-linked immunosorbent assay to detect serum levels of MCP-1, sTREM-1, TNF-αin all groups. All APpatients did Acute Phtsiology and Chronic Health Evaluation II score at thetime of collect venous blood.Results:1 There are 8 patients complicated with ALI/ARDS on admission in allSAP patients.2 Serum level of MCP-1, sTREM-1 and TNF-αconcentration in all APpatients were higher than control group on admission, the difference betweenthem have statistically significan（tP﹤0.05）. In all AP patients, serum level ofMCP-1, sTREM-1 and TNF-αconcentration and APACHE II score inALI/ARDS group and non ALI/ARDS group were higher than MAP group,the difference between them have statistically significant（P﹤0.05）.3 Serum level of MCP-1, sTREM-1, TNF-αconcentration and APACHEII score in ALI/ARDS group were higher than non ALI/ARDS group, Theserum level of sTREM-1, TNF-αand APACHE II score between two groupshave statistically significant（P﹤0.05）. But serum level of MCP-1 betweentwo groups have no statistically significant（P﹥0.05）.4 Serum level of MCP-1, sTREM-1 and TNF-αconcentration andAPACHE II score between dexamethasone treatment group and conventionaltreatment group have no statistically significan（tP﹥0.05）on admission. Aftertreatment, serum level of MCP-1, sTREM-1, TNF-αand APACHE II score oftwo groups were decreased, but the dexamethasone treatment group decreasedmore significantly than conventional treatment group. Serum level ofsTREM-1, TNF-αbetween two groups have statistically significan（tP﹤0.05）at the third and fifth day. Serum level of MCP-1 have statistically significant（P﹤0.05）at the fifth day. the APACHE II score have no statistically significant（P﹥0.05）at each time point.5 The incidence of ALI/ARDS , mechanical ventilation and mortalityin the conventional treatment group was 40%, 20% and 15%. But theincidence of ALI/ARDS , mechanical ventilation and mortality in thedexamethasone treatment group was 20%, 10% and 5%, lower than theconventional treatment group , but the difference between the two groupshave no statistically significant（P﹥0.05）.Conclusions:1 The serum level of MCP-1, sTREM-1and TNF-αon admission werehigh expression, may have closely relationship with the occurrence anddevelopment of the acute pancreatitis associated lung injure (APALI).2 The dexamethasone have a preventive effect on SAP complicated withALI/ARDS, the mechanism may be related to the inhibit expression ofMCP-1, sTREM-1and TNF-αin serum.