Research of Continuous Regional Arterial Infusion of Dexamethasone Treatment for Severe Acute Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TU Qiaoli ¹ , ZHANG Shilong ¹ ,  SHI Bin ² , LIU Hong ³ , CAO Wenying. ⁴

1.Surgical Intensive Care Unit of Lanzhou University Medical College Graduate School, Lanzhou 730000, Gansu Province, China;;
2.Emergency Medicine and ICU, Songjiang District Central Hospital, Shanghai 201600, China;;
3.Medical Imaging of Lanzhou University Medical College Graduate School, Lanzhou 730000, Gansu Province, China;;
4.Neurosurgery of The Second Affiliated Hospital of Guangzhou Medical College Graduate School, Guangzhou 510260, Guangdong Province, China;

Corresponding author：

SHI Bin, Email: joysb1969@sina.com

Keywords：

Severe acute pancreatitis; Rabbit; Dexamethasone; Continuous regional arterial infusion

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ObjectiveTo study the effects of continuous regional arterial infusion (CRAI) of dexamethasone on plasma inflammatory factors of severe acute pancreatitis (SAP) rabbits. MethodsTwentyfour rabbits were randomly divided into sham operation group, SAP group, intravenous infusion of dexamethasone group and CRAI of dexamethasone group (each group 6 rabbits) by random number table. The serum tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and amylase (AMY) levels in rabbits were tested at hour 0.5, 3, 6, 9, and 12 after modeling succeed. The pathological changes of pancreas and the survival were observed on day 3 after modeling succeed. ResultsCompared with the sham operation group, the serum levels of IL-6 significantly increased at 3 h and reached the peak at 6 h, decreased at 9 h (all P lt;0.05); levels of IL-10 significantly increased at 6 h, continuously elevated at 9 h and 12 h (all P lt;0.001); levels of TNF-α significantly increased at 0.5 h (P lt;0.001), reached the peak at 6 h (P lt;0.001) and decreased at 9 h (P lt;0.05); levels of AMY significantly increased at 9 h, continuously elevated at 12 h (all P lt;0.05) in the SAP group. Compared with the SAP group, the serum levels of IL-6 and IL-10 in the CRAI of dexamethasone group all significantly decreased at 6 h, 9 h, and 12 h (P lt;0.001); levels of IL6 significantly decreased only at 6 h in the intravenous infusion of dexamethasone group; levels of TNF-α in the CRAI of dexamethasone group significantly decreased at 3 h, 6 h, 9 h, and 12 h (all P lt;0.001), which in the intravenous infusion of dexamethasone group significantly decreased only at 6 h (P lt;0.05); levels of AMY in the CRAI of dexamethasone group and intravenous infusion of dexamethasone group all significantly decreased at 12 h (P lt;0.05). Compared with the intravenous infusion of dexamethasone group, the serum levels of IL-6 and IL-10 in the CRAI of dexamethasone group all significantly decreased at 6 h (P lt;0.05) and 12 h (P lt;0.001); levels of TNF-α all significantly decreased at 3 h, 6 h, 9 h, and 12 h (all P lt;0.001); levels of AMY were not significantly different (P gt;0.05). The pathological changes of pancreas in the CRAI of dexamethasone group were obvious, the death of rabbits reduced on day 3 after modeling succeed. ConclusionCRAI dexamethasone can effectively reduce the systemic inflammatory response and pancreatic inflammation, and reduce mortality.

Citation： TU Qiaoli,ZHANG Shilong,SHI Bin,LIU Hong,CAO Wenying.. Research of Continuous Regional Arterial Infusion of Dexamethasone Treatment for Severe Acute Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(12): 1278-1282. doi: Copy

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2.	Office of Laboratory Animal Welfare. Public health service policy on humane care and use of laboratory animals [Z]. http://grants.nih.gov/grants/olaw/olaw.htm.
3.	Jacobs ML, Daggett WM, Civette JM, et al. Acute pancreatitis: analysis of factors influencing survival [J]. Ann Surg, 1977, 185(1): 4351.
4.	Waage A, Bakke O. Glucocorticoids suppress the production of tumour necrosis factor by lipopolysaccharidestimulated human monocytes [J]. Immunology, 1988, 63(2): 299302.
5.	Nakagawa M, Bondy GP, Waisman D, et al. The effect of glucocorticoids on the expression of Lselectin on polymorphonuclear leukocyte [J]. Blood, 1999, 93(8): 27302737.
6.	Galon J, Franchimont D, Hiroi N, et al. Gene profiling reveals unknown enhancing and suppressive actions of glucocorticoids on immune cells [J]. FASEB J, 2002, 16(1): 6171.
7.	Ramírez F, Fowell DJ, Puklavec M, et al. Glucocorticoids promote a TH2 cytokine response by CD4+ T cells in vitro [J]. J Immunol, 1996, 156(7): 24062412.
8.	Yubero S, Ramudo L, Manso MA, et al. Mechanisms of dexamethasonemediated chemokine downregulation in mild and severe acute pancreatitis [J]. Biochim Biophys Acta, 2009, 1792(12): 12051211.
9.	Wan MH, Li J, Gong HL, et al. Clinical observation on the effect of dexamethasone and Chinese herbal decoction for purgation in severe acute pancreatitis patients [J]. Chin J Integr Med, 2011, 17(2): 141145.
10.	Ramudo L, Yubero S, Manso MA, et al. Effects of dexamethasone on intercellular adhesion molecule 1 expression and inflammatory response in necrotizing acute pancreatitis in rats [J]. Pancreas, 2010, 39(7): 10571063.
11.	Ramudo L, Yubero S, Manso MA, et al. Effect of dexamethasone on peripheral blood leukocyte immune response in bilepancreatic duct obstructioninduced acute pancreatitis [J]. Steroids, 2010, 75(45): 362367.
12.	Zhang XP, Pan Y, Huang XM, et al. Effects of dexamethasone and Salvia miltiorrhizae on the small intestine and immune organs of rats with severe acute pancreatitis [J]. Inflammation, 2010, 33(4): 259266.
13.	Rook GA. Glucocorticoids and immune function [J]. Baillieres Best Pract Res Clin Endocrinol Metab, 1999, 13(4): 567581.
14.	Sherman S, Blaut U, Watkins JL, et al. Does prophylactic administration of corticosteroid reduce the risk and severity of postERCP pancreatitis: a randomized, prospective, multicenter study [J]. Gastrointest Endosc, 2003, 58(1): 2329.
15.	成兰．应用地塞米松的不良反应与注意事项 [J]. 中原医刊， 2002， 29(11): 4849．.
16.	Weiner GR, Geenen JE, Hogan WJ, et al. Use of corticosteroids in the prevention of postERCP pancreatitis [J]. Gastrointest Endosc, 1995, 42(6): 579583.
17.	Osman MO, Jensen SL. Acute pancreatitis: the pathophysiological role of cytokines and integrins. New trends for treatment? [J]. Dig Surg, 1999, 16(5): 347362.
18.	Satoh A, Gukovskaya AS, Edderkaoui M, et al. Tumor necrosis factoralpha mediates pancreatitis responses in acinar cells via protein kinase C and prolinerich tyrosine kinase 2 [J]. Gastroenterology, 2005, 129(2): 639651.
19.	Xue DB, Zhang WH, Yun XG, et al. Regulating effects of Arsenic trioxide on cell death pathways and inflammatory reactions of pancreatic acinar cells in rats [J]. Chin Med J, 2007, 120(8): 690695.
20.	白斗，王东．急性胰腺炎发病机制中炎性因子的作用研究进展 [J]. 吉林医学， 2011， 32(3): 572573．.
21.	徐延均，吴新民，郭亚民．肿瘤坏死因子α及白介素在急性胰腺炎中的作用 [J]. 中国普外基础与临床杂志， 2010， 17(9): 993996．.
22.	Stellato C, Beck LA, Gorgone GA, et al. Expression of the chemokine RANTES by a human bronchial epithelial cell line. Modulation by cytokines and glucocorticoids [J]. J Immunol, 1995, 155(1): 410418.
23.	Kyriakides C, Jasleen J, Wang Y, et al. Neutrophils, not complement, mediate the mortality of experimental hemorrhagic pancreatitis [J]. Pancreas, 2001, 22(1): 4046.
24.	Pastor CM, Vonlaufen A, Georgi F, et al. Neutrophil depletion-but not prevention of Kupffer cell activation－decreases the severity of ceruleininduced acute pancreatitis [J]. World J Gastroenterol, 2006, 12(8): 12191224.

1. Hirota M, Nozawa F, Okabe A, et al. Relationship between plasma cytokine concentration and multiple organ failure in patients with acute pancreatitis [J]. Pancreas, 2000, 21(2): 141146.
2. Office of Laboratory Animal Welfare. Public health service policy on humane care and use of laboratory animals [Z]. http://grants.nih.gov/grants/olaw/olaw.htm.
3. Jacobs ML, Daggett WM, Civette JM, et al. Acute pancreatitis: analysis of factors influencing survival [J]. Ann Surg, 1977, 185(1): 4351.
4. Waage A, Bakke O. Glucocorticoids suppress the production of tumour necrosis factor by lipopolysaccharidestimulated human monocytes [J]. Immunology, 1988, 63(2): 299302.
5. Nakagawa M, Bondy GP, Waisman D, et al. The effect of glucocorticoids on the expression of Lselectin on polymorphonuclear leukocyte [J]. Blood, 1999, 93(8): 27302737.
6. Galon J, Franchimont D, Hiroi N, et al. Gene profiling reveals unknown enhancing and suppressive actions of glucocorticoids on immune cells [J]. FASEB J, 2002, 16(1): 6171.
7. Ramírez F, Fowell DJ, Puklavec M, et al. Glucocorticoids promote a TH2 cytokine response by CD4+ T cells in vitro [J]. J Immunol, 1996, 156(7): 24062412.
8. Yubero S, Ramudo L, Manso MA, et al. Mechanisms of dexamethasonemediated chemokine downregulation in mild and severe acute pancreatitis [J]. Biochim Biophys Acta, 2009, 1792(12): 12051211.
9. Wan MH, Li J, Gong HL, et al. Clinical observation on the effect of dexamethasone and Chinese herbal decoction for purgation in severe acute pancreatitis patients [J]. Chin J Integr Med, 2011, 17(2): 141145.
10. Ramudo L, Yubero S, Manso MA, et al. Effects of dexamethasone on intercellular adhesion molecule 1 expression and inflammatory response in necrotizing acute pancreatitis in rats [J]. Pancreas, 2010, 39(7): 10571063.
11. Ramudo L, Yubero S, Manso MA, et al. Effect of dexamethasone on peripheral blood leukocyte immune response in bilepancreatic duct obstructioninduced acute pancreatitis [J]. Steroids, 2010, 75(45): 362367.
12. Zhang XP, Pan Y, Huang XM, et al. Effects of dexamethasone and Salvia miltiorrhizae on the small intestine and immune organs of rats with severe acute pancreatitis [J]. Inflammation, 2010, 33(4): 259266.
13. Rook GA. Glucocorticoids and immune function [J]. Baillieres Best Pract Res Clin Endocrinol Metab, 1999, 13(4): 567581.
14. Sherman S, Blaut U, Watkins JL, et al. Does prophylactic administration of corticosteroid reduce the risk and severity of postERCP pancreatitis: a randomized, prospective, multicenter study [J]. Gastrointest Endosc, 2003, 58(1): 2329.
15. 成兰．应用地塞米松的不良反应与注意事项 [J]. 中原医刊， 2002， 29(11): 4849．.
16. Weiner GR, Geenen JE, Hogan WJ, et al. Use of corticosteroids in the prevention of postERCP pancreatitis [J]. Gastrointest Endosc, 1995, 42(6): 579583.
17. Osman MO, Jensen SL. Acute pancreatitis: the pathophysiological role of cytokines and integrins. New trends for treatment? [J]. Dig Surg, 1999, 16(5): 347362.
18. Satoh A, Gukovskaya AS, Edderkaoui M, et al. Tumor necrosis factoralpha mediates pancreatitis responses in acinar cells via protein kinase C and prolinerich tyrosine kinase 2 [J]. Gastroenterology, 2005, 129(2): 639651.
19. Xue DB, Zhang WH, Yun XG, et al. Regulating effects of Arsenic trioxide on cell death pathways and inflammatory reactions of pancreatic acinar cells in rats [J]. Chin Med J, 2007, 120(8): 690695.
20. 白斗，王东．急性胰腺炎发病机制中炎性因子的作用研究进展 [J]. 吉林医学， 2011， 32(3): 572573．.
21. 徐延均，吴新民，郭亚民．肿瘤坏死因子α及白介素在急性胰腺炎中的作用 [J]. 中国普外基础与临床杂志， 2010， 17(9): 993996．.
22. Stellato C, Beck LA, Gorgone GA, et al. Expression of the chemokine RANTES by a human bronchial epithelial cell line. Modulation by cytokines and glucocorticoids [J]. J Immunol, 1995, 155(1): 410418.
23. Kyriakides C, Jasleen J, Wang Y, et al. Neutrophils, not complement, mediate the mortality of experimental hemorrhagic pancreatitis [J]. Pancreas, 2001, 22(1): 4046.
24. Pastor CM, Vonlaufen A, Georgi F, et al. Neutrophil depletion-but not prevention of Kupffer cell activation－decreases the severity of ceruleininduced acute pancreatitis [J]. World J Gastroenterol, 2006, 12(8): 12191224.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research of Continuous Regional Arterial Infusion of Dexamethasone Treatment for Severe Acute Pancreatitis

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