| 1 | Pathogenic aspects of pulmonary complications in acute pancreatitis patients显示文摘BACKGROUND:Experimental and clinical observations show that proinflammatory cytokines and oxidative stress are involved in the development of local and particularly systemic complications in acute pancreatitis (AP) patients. There are often pulmonary complications in such patients. The mechanisms through which lung injury is induced in AP are not fully clear. METHODS:In order to assess the role of activated neutrophils, pro- and anti-inflammatory cytokines and adhesion molecules at the onset and development of respiratory complications and respiratory failure, we measured the serum levels of pro-inflammatory (IL-1β, IL-6, IL-8, IL-18, TNF-α) and anti-inflammatory (IL-1ra, IL-10) cytokines in 51 AP patients who had been diagnosed with pancreatitis-associated lung injury with and without the development of organ dysfunction. RESULTS:When admitted to the hospital, severe AP patients had increased concentrations of IL-1β, IL-6, IL-8, IL-18, and TNF-α. The concentration of IL-18 alone was considerably increased in the patients who later developed respiratory failure. The onset of acute respiratory distress syndrome in the AP patients was accompanied by an increase in the level of anti-inflammatory cytokines, especially IL-10. It was noted that in severe lung injury, myeloperoxidase activity in the blood increased significantly, but still reflected the processes taking place in the lung parenchyma. Increase in the concentrations of adhesion molecules preceded the development of pulmonary infiltration with respiratory failure symptoms, which provoked endothelial dysfunction and determined the capillary surface permeability for neutrophils and monocytes.CONCLUSIONS:In the pathogenesis of respiratory complications in AP cytokines, chemokines and adhesion molecules, in particular IL-1β, IL-6, IL-8, IL-18, TNF-α, ICAM-1, and E-selectin play major roles. At IL-18 concentrations >650 pg/ml, AP patients are likely to develop pulmonary dysfunction (sensitivity 58%, specificity 100%, LR-positive >58) which allows us to use it as a screening test. | Serge Chooklin | 2009 | Hepatobiliary & Pancreatic Diseases International2009，8，2： | 47 |
| 2 | Pathogenic role of myeloperoxidase in acute pancreatitis显示文摘BACKGROUND:Myeloperoxidase(MPO)has been implicated in promoting tissue damage in various inflammatory diseases.However,MPO blood levels in relation to the severity of acute pancreatitis(AP)and its time-course have not been studied.The present study aimed to determine the role of MPO in AP.METHODS:We studied 86 patients with AP(48 patients with mild and 38 with severe pancreatitis)and 18 controls(volunteers).The relations of serum MPO levels to cytokine level,severity,and time-course of pancreatitis were studied.The serum level of MPO and cytokines were measured by MPO-EIA and cytokines ELISA,respectively.RESULTS:The highest level of MPO was noted at the first day in patients with severe AP.A decrease of MPO blood level occurred during the first three days in all patients with necrotizing pancreatitis.The development of pancreatitis-associated lung injury and purulent complications was accompanied by increased MPO levels.Administration of pentoxifylline significantly reduced the MPO blood level,which was clearly correlated with the levels of proinflammatory cytokines in the two groups of patients.CONCLUSIONS:The results of the present study showed the MPO blood level is dependent on the severity of AP and on cytokine blood levels.Pentoxifylline in the complex management of severe AP may improve the results of treatment. | Serge Chooklin Andriy Pereyaslov Ihor Bihalskyy | 2009 | Hepatobiliary & Pancreatic Diseases International2009，8，6： | 8 |
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