Effects of chronic pancreatic impairment on development of acute pancreatitis

对于慢性胰腺炎急性加重患者的胰腺外分泌功能知之甚少。我们研究了自发性慢性胰腺炎动物模型诱导急性胰腺炎后胰腺外分泌功能的变化。慢性胰腺炎的WBN/Kob大鼠在胰外瘘手术准备后1 ~ 6天依次进行胰腺外分泌功能测试。我们在手术准备后4天，以10 μg/kg/hr的速率静脉给药4小时，诱导另一只WBN/Kob大鼠急性胰腺炎。给药前后1天在清醒状态下进行胰腺外分泌功能检查。在未给予小蛋白的WBN/Kob大鼠中，胰腺外分泌功能在手术后3-6天几乎保持不变。给药后立即出现明显的高淀粉酶血症。在给药后，胰腺镜下显示明显的间质水肿和细胞内腺泡细胞空泡化，并发现先前存在的慢性胰腺炎。基础和胆囊收缩素刺激的血流速率、碳酸氢盐输出量和蛋白质输出量在给药前一天明显受损，在给药后一天进一步降低。慢性胰腺炎大鼠模型急性加重期间胰腺外分泌功能减退明显恶化。

Little is known about pancreatic exocrine function during acute exacerbation in patients with chronic pancreatitis. We investigated changes in pancreatic exocrine function after inducing acute pancreatitis in an animal model of spontaneous chronic pancreatitis. WBN/Kob rats with chronic pancreatitis sequentially underwent pancreatic exocrine function test one to six days after surgical preparation with external pancreatic fistula. We induced acute pancreatitis in another WBN/Kob rats by intravenous administration of caerulein at a rate of 10 μg/kg/hr for 4 hours four days after surgical preparation. Pancreatic exocrine function test was undertaken in a conscious state one day before and after caerulein administration. In WBN/Kob rats not given caerulein, pancreatic exocrine function remained almost constant at 3-6 days after surgery. Marked hyperamylasemia developed immediately after caerulein administration. After its administration, the pancreas microscopically showed prominent interstitial edema and intracellular vacuolization of acinar cells in addition to the finding of preexisting chronic pancreatitis. Basal and cholecystokinin-stimulated flow rate, bicarbonate output, and protein output, which were substantially impaired one day before caerulein administration, were further reduced one day after its administration. Pancreatic exocrine hypofunction is markedly deteriorated during acute exacerbation in a rat model with chronic pancreatitis.