| Objective：Gastrointestinal motility disorder is a common complicationof AP. The clinical manifestations of gastrointestinal motility disorders areabdominal distension, enteroparalysis and reduction of exhaust and defecation.A delay in intestinal transit time appears as an early event in acute pancreatitis,preceding intestinal bacterial overgrowth and translocation, resulting inintestinal infections. Gastrointestinal motility disorder may develop intogastrointestinal failure, more seriously, may occur multiple organ failure andabdominal compartment syndrome. Serious acute patients with ACS have amortality of50%–70%. The purpose of this study was to detect MTL, VIP,5-HT, the change of Abdomen diametrical ratio and oro-cecal transit time, toinvestigate the gastrointestinal dynamic in acute pancreatitis patients. In orderto provide potential treatments strategy for gastrointestinal motility disorder inacute pancreatitis.Methods：The subjects were hospitalized acute pancreatitic patients inDepartment of Gastroenterology, the Second Hospital of Hebei MedicalUniversity from March2012to December2012.26of40cases were male and14were female. Age ranged from18to80years old. The mean age was(45.10±15.70) years. Gallstone pancreatitis patients were16cases, acutepancreatitis of hyperlipidemia were10cases, acute pancreatitis caused byheavy drinking were6cases, acute pancreatitis caused by overeating were4cases, cryptogenic pancreatitis were4cases. According to Ranson score andCT classification, SAP included15cases, MAP included25cases. Fifteenhealthy volunteers with a mean age of37(range20~55) were taken as controlgroup.The peripheral venous blood(3milliliter)of all patients at24h,3d and7d after their admission，serum was preserved in refrigerators(-80centigrade)tomeasure MTL、VIP、5-HT after being separated by centrifugal machine．At thesame time hydrogen breath test measure oro-cecal transit time and computertomography measure the abdomen diametrical ratio. MTL, VIP and5-HT weredetected by double antibody sandwich ABC-ELISA.Data were presented as means±standard deviation. Repeated measure wasapplied to examine the differences between the groups and time. A probabilityof less than0.05was considered significantly.Results:1The change of MTL in acute pancreatitis: The MTL levels of allpatients on the first day, the third day and the seventh day decreasedsignificantly compared with the control group(P<0.05)，respectively. The MTLlevels of SAP group on first day, third day and the seventh day decreasedsignificantly compared with MAP group(P<0.05), respectively. In SAP group,compared with the MTL levels on the third day, the MTL levels on the firstday decreased significantly, the MTL levels on the seventh day increasedsignificantly(P<0.05). In MAP group, compared with the MTL levels on thethird day,the MTL levels on the first day decreased significantly, the MTLlevels on the seventh day increased significantly(P<0.05).2The change of VIP in acute pancreatitis: The VIP levels of SAP groupand MAP group at first day increased significantly compared with the controlgroup(P<0.05), respectively. The VIP levels of SAP group on first dayincreased significantly compared with MAP group(P<0.05). Compared withMAP group, there were no statistical differences in the VIP levels at third dayin SAP and the control group(P=0.418, P=0.062). The VIP levels of SAPgroup on third day increased significantly compared with the control group(P<0.05). The VIP levels of SAP and MAP group at seventh day increasedsignificantly compared with the control group(P<0.05), respectively. Therewas no significant difference in the VIP level at seventh day between the SAPgroup and MAP group (P=0.593). In SAP group, compared with the VIPlevels of the first day,the VIP levels at the third day decreased significantly, the VIP levels at the seventh day decreased significantly(P<0.05); The VIPlevels at the seventh day decreased significantly Compared with the VIP levelsat the first day. In MAP group, compared with the VIP levels of the thirdday,the VIP levels at the first day increased significantly, the VIP levels at theseventh day increased significantly(P<0.05); there was no significantdifference in the VIP levels at the first day and at seventh day (P=0.961).3The change of5-HT in acute pancreatitis: The5-HT levels of controlgroup and MAP group at first day increased significantly compared with SAPgroup(P<0.05), respectively; There was no significant difference in the5-HTlevels at the first day between SAP and MAP group (P=0.882). There was nosignificant difference in the5-HT levels at the third day among SAP group,MAP group and control group. There was no significant difference in the5-HT levels at the seventh day among SAP group, MAP group and controlgroup. In SAP group, compared with the5-HT levels of the first day,the5-HTlevels at the third day increased significantly, the5-HT levels at the seventhday increased significantly(P<0.05); there was no significant difference in the5-HT levels at the third day and at seventh day (P=0.747). In MAP group, onthe first day, the third day and the seventh day, there was no significantdifference in the5-HT levels among the three groups.4The change of OCTT in acute pancreatitis: The OCTT of SAP groupand MAP group on the first day, the third day and the seventh day wasprolonged significantly compared with the control group, respectively(P<0.05).The OCTT of SAP group on first day, third day and the seventh day wasprolonged Compared with MAP group，respectively(P<0.05). In SAP group,compared with the OCTT on the third day, the OCTT on the first day wasprolonged significantly, the OCTT on the seventh day was shortenedsignificantly(P<0.05). In MAP group, compared with the OCTT on the thirdday, the OCTT on the first day was prolonged significantly, the OCTT on theseventh day was shortened significantly(P<0.05).5The change of abdomen diametrical ratio in acute pancreatitis:During treatment, the change of Abdomen diametrical ratio of SAP group largen significantly compared with MAP group(F=0.239, P<0.05).6The correlation analysis of OCTT and gastrointestinal hormones:In MAP group, there was no correlation between the change of Abdomendiametrical ratio and the change of OCTT with during treatment (P=0.623).The change of Abdomen diametrical ratio during treatment was positivelycorrelated with the change of OCTT(r=0.595, P<0.05).The MTL level of APgroup at the first day, the third day and the seventh day were negativelycorrelated with OCTT, respectively(r=-0.898, r=-0.719, r=-0.574, P<0.05).The VIP level of AP group at the first day and the third day were positivelycorrelated with OCTT, respectively(r=0.808, r=0.421, P<0.05). There was nocorrelation between the VIP level and OCTT at the seventh day(P=0.126).The5-HT level of AP patients at the first day was negatively correlated with OCTT,while there was no correlation at the third day(P=0.148)or the seventh day(P=0.239).Conclusions：1The OCTT was prolonged and abdomen diametrical ratio increased inacute pancreatitic patients. Acute pancreatitic patients often accompanied withgastrointestinal motility disorder， the degree of gastrointestinal motilitydisorder increases with the severity of acute pancreatitis.2There is a disorder of gastrointestinal hormones in patients with acutepancreatitis. MTL, VIP and5-HT can reflect the severity of acute pancreatitis.3Gastrointestinal motility disorders in patients with acute pancreatitis maybe associated with disorders of the gastrointestinal hormones. |
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