Endothelial dysfunction in patients with severe acute pancreatitis:improved by continuous blood puriflcation therapy1
The endothelium dysfunction is one of the critical pathophysiologic disorders in patients with severe acute pancreatitis(SAP). To investigate the effect of continuous blood purification (CBP) on endtothelial function，we made a prospective study of 20 patients with SAP，9 of whom had evidence of sepsis，All patients underwent CWH for 72 h. Soluble E-selectin (sE-selectin)，soluble thrombomodulin,permeability of the endothelial monolayer，and endothelial intracellular calcium (”Ca2+ ”;)levels were used as the markers for the assessment of endothelial function and the effect of CBP therapy in patients with SAP. Blood samples were taken from the patients at 0，2，12，24，48，and 72 h during CVVH therapy. sE-selectin and Thrombomoduiln were measured by ELISA. The endothelial permeability and activation were evaluatedusing cultured endothelial monolayer and intracellular Ca2+ concentration. The results showed that during CVVH treatment，the hemodynamics and mean arterial pressure (MAP) were stable. APACHII score was improved significantly after CVVH. Endothelial dysfunction was evident in patients with SAP as compared to normal controls. Patients with SAP had increased levels of sE-selectin，endothelial permeability and intracellular ”Ca2+”I，which is more higher in patients with sepsis than those without sepsis. The level of thrombomodulin showed a tendency to increase，however，these changes were not significant between SAP patients and controls. After CBP treatment，sE-selectin levels substantially decreased in all patients. CBPtreatment also significantly diminished the endothelial permeability and decreased the intracellular ”Ca2+ ” concentration. These data demonstrate that endothelial dysfunction is present in patients with SAP and the degree of endothelial damage may correlated with the disease severity. CBP therapy can not only improvethe general conditions，APACHII score，but also effectively improve endothelial dysfunction.
重症急性胰腺炎 血液透析 连续性血液净化疗法 选择蛋白 凝血调节蛋白 细胞内钙离子
Zhao-Hong CHEN Zhi-Hong LIU Chen YU Da-Xi JI M.D. Lei-Shi LI
Research Institute of Nephrology Jinling Hospital，Nanjing niversity School of Medicine，Nanjing 21000 Research Institute of Nephrology，Jinling Hospital，Nanjing University School of Medicine，Nanjing 2100 Research Institute of Nephrology，Jinling Hospital，Nanjing University School of Medicine，anjing 21000 Research Institute of Nephrology，Jinling Hospital，anjing University School of Medicine，Nanjing 21000
国内会议
济南
英文
3-15
2007-05-31（万方平台首次上网日期，不代表论文的发表时间）