Acute pancreatitis and bacterial translocation
Acute pancreatitis and bacterial translocation
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DOI：
10.1023/a:1010786701289
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发表时间：
2001-05-01
影响因子：
3.1
通讯作者：
Lee, K
中科院分区：
文献类型：
--
作者：
Cicalese, L;Sahai, A;Lee, K
感染性并发症是急性麻醉性胰腺炎（AP）最常见和最严重的并发症，死亡率高达80%。尽管实验和临床研究表明胰腺感染的微生物来源可能是肠道，但这方面的信息很少。本研究使用轻度和重度AP模型评估细菌易位（BT）。轻度AP通过持续6小时静脉输注雨蛙肽诱导，而重度AP通过额外输注glycodeoxycholic acid至胆胰管诱导。在动物处死时（24小时），用器官培养物评价BT。为了确认移位微生物的胃肠道来源，在诱导AP之前24小时，还将荧光微球在饮用水中给予动物。在死亡时，在腹膜灌洗液中用荧光激活细胞分选仪（FACS）计数珠子，并在胰腺冷冻切片中用荧光显微镜计数珠子。与对照组相比，AP动物的远端小肠形态学显示出显著变化，如绒毛高度减少和微血管改变。与对照组的胰腺相比，轻度AP在100%的动物中诱导了胰腺BT。重度AP可导致胰腺BT增加。BT对肝脏和脾脏的作用也随着AP的增加而显著增加。荧光微球的存在证实了它们的肠衍生。这项研究提供了证据，肠道微生物的起源负责胰腺感染并发症在AP。剖腹手术后BT的证据表明，感染的风险增加与这些条件的关联。这可以为AP期间剖腹手术相关的高死亡率提供解释。
Infectious complications are the most frequent and severe complications of acute narcotizing pancreatitis (AP) with a mortality rate up to 80%. Although experimental and clinical studies suggest that the microbiologic source of pancreatic infection could be enteric, information in this regard is scant. This study evaluated bacterial translocation (BT) using mild and severe models of AP. Mild AP was induced by 6-hr continuous intravenous infusion of cerulein, while severe AP was induced by additional infusion of glycodeoxycholic acid into the biliopancreatic duct. BT was evaluated with organ cultures performed when animals were killed (24 hr). To confirm the gastrointestinal origin of the translocating microorganisms, fluorescent microspheres were also given to the animals in drinking water 24 hr before induction of AP. At the time of death beads were counted with a (fluorescence-activated cell sorter) (FACS) in peritoneal lavages and with fluorescent microscopy in frozen sections of the pancreata. Morphology of the distal small bowel showed significant changes in the animals with AP compared to controls, such as reduction of villus high and altered microvasculature. Mild AP induced BT to the pancreas in 100% of the animals, compared to pancreata from control groups. Severe AP induced increased BT to the pancreas. BT to liver and spleen was also significantly increased with AP. The presence of fluorescent microspheres confirmed their enteric derivation. This study provides evidence for the enteric origin of microorganisms responsible for pancreatic infectious complications during AP. The evidence of BT after laparotomy suggests an increased risk of infections with the association of these conditions. This could provide an explanation for the high mortality associated with laparotomy in course of AP.