Pathophysiological aspects of severe acute pancreatitis-associated lung injury

Predictors and outcomes of acute respiratory failure in hospitalised patients with acute pancreatitis

BACKGROUND AND AIM

Acute pancreatitis (AP) is associated with organ failures and systemic complications, most commonly acute respiratory failure (ARF) and acute kidney injury. So far, no studies have analysed the predictors and hospitalisation outcomes, of patients with AP who developed ARF. The aim of this study was to measure the prevalence of ARF in AP and to determine the clinical predictors for ARF and mortality in AP.

METHODS

This is a retrospective cohort study using the Nationwide Inpatient Sample database from the year 2005-2014. The study population consisted of all hospitalisations with a primary or secondary discharge diagnosis of AP, which is further stratified based on the presence of ARF. The outcome measures include in-hospital mortality, hospital length of stay and hospitalisation cost.

RESULTS

In our study, about 5.4% of patients with AP had a codiagnosis of ARF, with a mortality rate of 26.5%. The significant predictors for ARF include sepsis, pleural effusion, pneumonia and cardiogenic shock. Key variables that were associated with a higher risk of mortality include mechanical ventilation, age more than 65 years, sepsis and cancer (excluding pancreatic cancer). The presence of ARF increased hospital stay by 8.3 days and hospitalisation charges by US$103 460.

CONCLUSION

In this study, we demonstrate that ARF is a significant risk factor for increased hospital mortality, greater length of stay and higher hospitalisation charges in patients with AP. This underlines significantly higher resource utilisation in patients with a dual diagnosis of AP-ARF.

Involvement of the PI3K/Akt/NF-κB Signaling Pathway in the Attenuation of Severe Acute Pancreatitis-Associated Acute Lung Injury by Sedum sarmentosum Bunge Extract

Sedum sarmentosum Bunge possesses excellent anti-inflammatory properties and was used in the treatment of inflammatory diseases. The aim of the present study was to investigate the efficiency of Sedum sarmentosum Bunge extract (SSBE) on severe acute pancreatitis-associated (SAP-associated) acute lung injury (ALI) in rats and to explore the underlying mechanisms. Here, we used a sodium taurocholate-induced SAP rat model to determine the role of SSBE in ALI. During the course of pancreatitis, the expressions of phosphorylated phosphoinositide 3-kinases (PI3K)/protein kinase B (Akt) and nuclear factor-kappa B (NF-κB) p65 in the lungs were upregulated. Meanwhile, a parallel increase in the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in the lungs was observed after the induction of SAP. Treatment with SSBE significantly reduced the expression of p-Akt and p-p65 in the lungs and attenuated the severity of SAP-associated ALI compared to the SAP group at 12 h and 24 h. In summary, this study showed that SSBE has beneficial effects on SAP-associated ALI, probably through the PI3-K/Akt signaling pathways by suppressing the NF-κB activities.

CaM and TNF-α mediate myocardial damage in acute necrotizing pancreatitis in rats

AIM: To investigate the role of calmodulin (CaM) and tumor necrosis factor (TNF)-α in myocardial injury associated with acute necrotizing pancreatitis (ANP) in rats.

METHODS: Thirty-six male Sprague-Dawley (SD) rats were randomly divided into a sham-operation (SO) group and an ANP group. ANP was induced by retrograde injection of sodium taurocholate into the biliopancreatic duct. Rats were sacrificed at 1, 4 and 8 h after operation. HE staining was used to observe the pathological changes of pancreatic and myocardial tissues. Fluorescence monitoring method was used to determine the free Ca²⁺ concentration in rat myocardial cells. The expression of CaM and TNF-α in myocardial cells was analyzed by real-time PCR.

RESULTS: Rats in the ANP all had pathological damage in pancreatic and myocardial tissues, which was progressively exacerbated. Compared with the SO group, the free Ca²⁺ concentration in rat myocardial cells was significantly reduced in the ANP group, and the free Ca²⁺ concentration decreased as the severity of the disease increased (P < 0.05). Compared with the SO group, the expression of CaM and TNF-α in myocardial cells was markedly up-regulated in the ANP group. The expression of CaM and TNF-α was negatively correlated with the calcium ion concentration in myocardial cells.

CONCLUSION: CaM and TNF-α mediate myocardial damage in ANP through inhibiting calcium channels.

Effects of rhubarb on intestinal flora and toll-like receptors of intestinal mucosa in rats with severe acute pancreatitis

OBJECTIVE

The aim of this study was to examine the effects of rhubarb on intestinal flora and toll-like receptors (TLRs) of intestinal mucosa in rats with severe acute pancreatitis (SAP).

METHODS

Healthy male Sprague-Dawley rats were randomly allocated into sham-operated surgical model of SAP without or with postoperative rhubarb treatment groups (7 in each group). Rats in with rhubarb group received 10% rhubarb decoction (1 mL/200 g) through tube feeding at every 8 hours during postoperative 24 hours. Serum amylase, amount of intestinal flora, and TLR2/TLR4 messenger RNA expression in intestinal mucosa were tested among 3 groups at postoperative 24 hours.

RESULTS

TLR2 and TLR4 messenger RNA expression levels in intestinal mucosa in SAP without rhubarb group were significantly higher than those in sham-operated or SAP with rhubarb groups (P < 0.05). The amount of intestinal lactobacilli and bifidobacteria in SAP without rhubarb group were significantly fewer than in those sham-operated group (P < 0.05) but not significantly different from those in SAP with rhubarb group (P > 0.05). The amount of intestinal Escherichia coli was relatively higher in SAP group than in sham-operated group (P > 0.05) but lesser in rhubarb treatment group (P > 0.05).

CONCLUSIONS

Rhubarb might maintain the intestinal mucosal barrier through regulating intestinal flora and inhibiting intestinal inflammatory response in rats with SAP.

Traditional Chinese medicine, Qing Ying Tang, ameliorates the severity of acute lung injury induced by severe acute pancreatitis in rats via the upregulation of aquaporin-1

Aquaporin-1 (AQP-1) is expressed in lung endothelial cells and regulates water transport; thus, AQP-1 plays an important role in a number of edema-associated lung diseases. Qing Yin Tang (QYT), a traditional Chinese medicine, has been shown to effectively reduce the mortality rate of acute lung injury (ALI) induced by severe acute pancreatitis (SAP). The current study aimed to investigate the detailed mechanisms underlying the effects of QYT on ALI induced by SAP, particularly the effects on the expression levels of AQP-1 in the lung tissue. ALI was established in Wister rats who were subsequently divided into four groups: SHAM, ALI, dexamethasone (DEX) and QYT groups (n=8 per group). In the QYT group, 20 ml/kg QYT was administered by gavage immediately following the induction of SAP. Blood and lung tissues were collected 8 h following the induction of pancreatitis. The lung wet/dry ratio, as well as the levels of blood gases, serum amylase and tumor necrosis factor-α (TNF-α), were measured at 4, 8 and 12 h following SAP-associated ALI induction surgery. The expression levels of AQP-1 in the lung tissue were detected by quantitative polymerase chain reaction, immunohistochemistry and western blot analysis. No statistically significant differences were observed with regard to the levels of serum amylase, wet/dry ratio, partial pressure of oxygen, serum TNF-α and pathological changes in the pulmonary tissue between the QYT and DEX groups; however, a statistically significant difference was observed when compared with the ALI group. The expression levels of AQP-1 significantly increased (P<0.05) and lung edema was alleviated in the QYT and DEX groups, when compared with ALI group. Therefore, the expression level of AQP-1 is associated with pulmonary edema. QYT protects the lungs from injury induced by SAP via the upregulation of AQP-1, which suppresses TNF-α expression.

Effects and mechanisms of alveolar type II epithelial cell apoptosis in severe pancreatitis-induced acute lung injury

This study aimed to examine the role of alveolar type II epithelial cell (AEC II) apoptosis in severe pancreatitis-induced acute lung injury (ALI) and the intervening role of Qingyi decoction (QYT). An SAP model was established in male Sprague-Dawley rats. Immunohistochemical analysis was conducted to observe the pathological changes in the pancreas and lung tissue. AEC II apoptosis was detected by flow cytometry and the free Ca²⁺ concentration in AECs II was determined by laser scanning confocal microscopy. A radioimmunoassay was performed to determine serum TNF-α content. Quantitative polymerase chain reaction (qPCR) and immunohistochemical analysis were performed to detect the mRNA and protein expression levels of Bax and caspase-8 in the lung tissue. Hematoxylin and eosin staining of lung tissue sections in the severe acute pancreatitis (SAP) group showed pathological changes from control tissue, consistent with acute lung injury (ALI). Flow cytometry showed that the level of AEC II apoptosis in the SAP group was significantly increased compared with that in the control group (P<0.01). Laser scanning confocal microscopy indicated that the free Ca²⁺ concentration in the AECs II of the SAP group was also significantly increased compared with that in the control (P<0.01). Radioimmunoassay demonstrated that the TNF-α levels were significantly increased in the SAP group compared with those in the control group (P<0.01), and qPCR results showed that the levels of Bax and caspase-8 apoptotic gene expression in the AECs II of the SAP group were significantly elevated (P<0.01). The aforementioned indicators were significantly lower following drug treatment compared with the levels observed in the SAP model group. These results suggest that AEC II apoptosis is involved in the ALI procedure associated with SAP. The mitochondrial pathway and death receptor pathway may have key regulatory roles in AEC II apoptosis. The use of QYT may significantly reduce the extent of lung injury.

Tumor necrosis factor-α levels early in severe acute pancreatitis: is there predictive value regarding severity and outcome?

GOAL AND BACKGROUND

One of the most important cytokines in pathogenesis of acute pancreatitis is tumor necrosis factor (TNF)-α. The aim of our study was to determine whether the plasma levels of TNF-α in patients with severe acute pancreatitis (SAP) on admission correlate with severity and outcome of SAP.

STUDY

Blood samples were obtained from 100 patients with SAP. Patients were divided into 2 groups according to severity: SAP group (n=69) and SAP-induced multiple organ dysfunction syndrome (MODS) group (n=31). Survivors were patients who were alive 90 days after taking the blood sample for cytokine measurement (53/100). Blood sample for cytokine measurement was drawn immediately after admission. TNF-α was measured by commercial ELISA test in plasma.

RESULTS

When comparing SAP group with SAP-induced MODS group, we found that mean values of TNF-α on admission were 191.5-fold lower in group with SAP-induced MODS (P<0.01). When comparing nonsurvivors with survivors, we found that mean values of TNF-α on admission were 63-fold higher in survivors (P<0.01). At cut-off level of 7.95 pg/mL sensitivity was 83.9% and specificity was 72.5%. Patients with TNF-α level lower than 7.95 pg/mL had 3.2-fold higher probability to develop SAP with MODS. At cut-off level of 10.5 pg/mL sensitivity was 83% and specificity was 77.4%. Patients with TNF-α level higher than 10.5 pg/mL had 4.8-fold higher probability to survive.

CONCLUSIONS

TNF-α is good predictor of severity and outcome. Low TNF-α concentration in patients with SAP predicts development of MODS and fatal outcome.

Effects of Chai-Qin-Cheng-Qi decoction () on acute pancreatitis-associated lung injury in mice with acute necrotizing pancreatitis

OBJECTIVE: To investigate the effects of Chai-Qin-Cheng-Qi Decoction (, CQCQD) on acute pancreatitis-associated lung injury in mice with acute necrotizing pancreatitis (ANP). METHODS: Thirty healthy mice were randomly divided into three groups: an ANP group (ANP+placebo, n=10); a treatment group (ANP+CQCQD, n=10); and a control group (normal mice+placebo, n=10). ANP was induced by intraperitoneal injection with 8% L-arginine (4 μg/kg), and the control group was injected with normal saline. The treatment group received CQCQD (20 mL/kg), and the ANP and control groups received placebo (sucrose and starch) intragastrically at 2 h intervals. After the third intragastric administration, blood, pancreatic tissues and right lung tissues were collected for measurement of serum interleukin-6 (IL-6) and interleukin-10 (IL-10) by enzyme-linked immunosorbent assay, and the expression of heat shock protein 70 (HSP70) in lung tissue was determined by Western blot analysis. Pathological changes of pancreatic tissue and lung tissue were examined. RESULTS: Serum IL-6 was significantly higher in the ANP group compared with the control and the treatment groups (1589.63±377.28 vs. 927.46±210.42 pg/mL, P<0.05, and 1589.63±377.28 vs. 1107.73±351.62 pg/mL, P<0.05, respectively). The IL-10 concentration was significantly lower in the ANP group compared with the treatment group (920.64±101.68 vs. 1177.84±201.72 pg/mL, P<0.05), but no signififi cant difference was found between the ANP and control groups and between the treatment and control groups. The expression level of HSP70 in the ANP and control groups was signififi cantly lower than in the treatment group (0.93±0.03 vs. 1.42±0.21, P<0.01, and 0.81±0.09 vs. 1.42±0.21, P<0.01, respectively). There was no signififi cant difference in HSP70 levels between the ANP and control groups. Histological scores of pancreatic and lung tissue were significantly decreased in the treatment group compared with the ANP groups (4.50±0.54 vs. 6.20±1.65, P<0.05, and 3.00±0.63 vs. 3.87±0.83, P<0.05, respectively). CONCLUSIONS: The incidence of acute pancreatitisassociated lung injury in ANP mice correlates positively with serum IL-6 concentration. CQCQD may inhibit IL-6 induction and increase IL-10 concentration and HSP70 expression, effectively reducing lung injury.

Expression of CXCL11 and CXCR3 in acute lung injury associated with severe acute pancreatitis

AIM: To investigate the expression of chemokine CXCL11 and its receptor CXCR3 in acute lung injury associated with severe acute pancreatitis (SAP).

METHODS: Forty-eight SD rats were randomly and equally divided into two groups: control group and SAP group. SAP was induced in rats of the SAP group by retrograde injection of 4% sodium taurocholate into the bili-pancreatic duct. Each group was further randomly and equally divided into four subgroups for testing at different time points. The rats were randomly selected to be executed at 1, 3, 6, and 12 h after induction of SAP. Serum amylase, wet/dry weight ratio of the lung, and histological changes of the lung were measured. Expression of CXCL11 and CXCR3 proteins in the lung was detected by immunohistochemistry. Serum levels of CXCL11 were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS: Serum amylase was significantly higher in the SAP group than in the control group (P < 0.01). The lung wet/dry weight ratio was significantly higher at 3, 6, and 12 h in the SAP group than in the control group (all P < 0.05). The expression of CXCL11 and CXCR3 in the lung (all P < 0.05) and serum levels of CXCL11 at various time points (all P < 0.01) were significantly higher in the SAP group than in the control group (all P < 0.05).

CONCLUSION: CXCL11 and CXCR3 may play important roles in the pathogenesis of acute lung injury in SAP.

Role of intrapulmonary expression of inducible nitric oxide synthase gene and nuclear factor kappaB activation in severe pancreatitis-associated lung injury

The aim of this study is to explore the relationship of intrapulmonary activation of nuclear factor-kappaB (NF-kappaB) and the expression of inducible nitric oxide synthase (iNOS) mRNA with pulmonary injury in rats with severe acute pancreatitis (SAP). Fifty-four Sprague Dawley rats were randomly divided into three groups: sham operation (control) group (n = 18), SAP group (n = 18), and pyrrolindine dithiocarbamate (PDTC) pretreated group (n = 18). A SAP model was induced by retrograde injected 5% sodium taurocholate into the bile-pancreatic duct (1 ml/kg). PDTC-pretreated SAP rats were given 100 mg/kg body weight PDTC intraperitoneally before pancreatitis was induced. Six rats from each group were sacrificed at 3, 6, and 12 h after modeling. Activation of NF-kappaB in pulmonary tissues and pancreas tissues was detected by immunohistochemical methods. Intrapulmonary expression of iNOSmRNA was assayed by fluorogenic quantitative reverse transcription polymerize chain reaction. The expression of NF-kappaB in the SAP group in pulmonary tissues was enhanced significantly at any measure point compared with control group (58.4 +/- 10.8 vs. 3.8 +/- 1.8, 119.8 +/- 17.8 vs. 5.2 +/- 2.4, and 90.2 +/- 14.4 vs. 4.7 +/- 2.2, P < 0.01). But the expressions of NF-kappaB in the PDTC group were significantly lower than those in SAP group (54.3 +/- 9.6 vs. 58.4 +/- 10.8, 93.9 +/- 7.9 vs. 119.8 +/- 17.8, and 82.2 +/- 13.3 vs. 90.2 +/- 14.4, P < 0.05). The number of positive cells in SAP group and PDTC group reached its peak at 6 h and then declined. The expression of iNOSmRNA in PDTC groups was significantly weaker than that in SAP group (2.0 +/- 0.8 vs. 2.2 +/- 1.9, 2.4 +/- 1.2 vs. 4.6 +/- 1.8, and 1.5 +/- 0.8 vs. 3.2 +/- 1.5, P < 0.05). The activation of NF-kappaB may be involved in the SAP lung injury through regulating the expression of iNOSmRNA. PDTC might inhibit the activation of NF-kappaB and then reduce the expression of iNOSmRNA and effectively alleviate the severity of lung injury.

Effect of salvia miltiorrhizae on pulmonary apoptosis of rats with severe acute pancreatitis or obstructive jaundice

To investigate the effect of apoptosis about Salvia miltiorrhizae injection on the lungs of SAP and OJ rats. Total 288 rats were used for SAP-associated experiments and OJ-associated experiments, respectively. The rats were randomly divided into sham-operated, model control and treated group. According to the difference of time points after operation, the SAP rats in each group were subdivided into 3, 6 and 12 h groups while the OJ rats were divided into 7, 14, 21 and 28 days groups. The pathological changes, expression levels of Bax protein and apoptotic indexes in the lungs of SAP or OJ rats were observed, and the mortality rates of SAP or OJ rats were recorded, respectively. The numbers of dead SAP and OJ rats in treated groups declined. The pathological changes in the lungs of SAP or OJ rats in treated groups were relieved to varying degrees. There was no marked difference in pathological severity scores and the positive staining intensity of Bax protein between treated groups and model control groups (all P > 0.05). Salvia miltiorrhizae has some protective effect on the lungs of rats with SAP or OJ which may be related apoptosis although our results can not find significant difference between treated groups and model control groups.

Infectious complications in patients with severe acute pancreatitis

This study aims to investigate the clinical characteristics of infectious complications in severe acute pancreatitis (SAP). From September 2003 to March 2005, 140 patients with SAP were retrospectively identified. SAP was defined by the diagnostic criteria formulated for SAP at the 2002 Bangkok World Congress of Gastroenterology in Thailand. Clinical data of the infected and non-infected patients was compared and the characteristics of infection were also analyzed. There were 44 patients who developed infectious complications with a rate of 31.4% (44/140). The severity index, the incidence of complications and mortality, was significantly higher in the infected patients than in the non-infected patients (P<0.05). Of 65 episodes of infection, infected (peri) pancreatic necrosis accounted for 47.7% (31/65), pneumonia for 27.7% (18/65), bacteremia for 10.8% (7/65), urinary tract infection for 6.1% (4/65), and gastrointestinal tract infection for 7.7% (5/65). The earliest infection was observed in pneumonia (10.7±2.5 days), followed by bacteremia (13.7±1.5 days), gastrointestinal tract infection (16.8±3.9 days), infected (peri)pancreatic necrosis (17.6±2.9 days), and urinary tract infection (20.5±4.8 days). Gram-negative bacteria were preponderantly found, comprising 56.6% (64/113) of the isolated strains. Gram-positive bacteria and fungus accounted for 22.1% (25/113) and 21.2% (24/113) of the isolated strains, respectively. Infectious complications in patients with SAP occurred in those who had severe episodes, and consequently complicated the clinical courses. Infected (peri)pancreatic necrosis is the most susceptible and pneumonia is the earliest. Gram-negative bacteria were predominant in multi-microorganisms.

Effects of Salvia miltiorrhiza on intercellular adhesion molecule 1 protein expression in the lungs of rats with severe acute pancreatitis or obstructive jaundice

OBJECTIVE

The objective of the study was to observe the effects of Salvia miltiorrhiza on intercellular adhesion molecule 1 (ICAM-1) protein expression in the lungs of rats with severe acute pancreatitis (SAP) or obstructive jaundice (OJ).

METHODS

A total of 288 rats were used for SAP- and OJ-associated experiments. The rats were randomly divided into sham-operated, model control, and treated group. According to the difference of time points after operation, the SAP rats of each group were subdivided into 3-, 6-, and 12-hour groups, whereas the OJ rats were divided into 7-, 14-, 21-, and 28-day groups. The contents of interleukin (IL) 6, IL-18, nitric oxide, malondialdehyde, and superoxide dismutase in serum were determined, and pathological changes and ICAM-1 protein expression in the lungs were observed.

RESULTS

Compared with the respective model control groups, in treated groups of SAP and OJ rats, the numbers of dead rats declined; serum superoxide dismutase content significantly increased, and serum IL-18, IL-6, and malondialdehyde contents were significantly decreased; the positive staining intensity of ICAM-1 protein in the lungs decreased significantly (P < 0.05, P < 0.01, or P < 0.001); and pathological changes in the lungs were relieved.

CONCLUSIONS

Salvia miltiorrhiza plays a positive role in the protection of the lungs of SAP and OJ rats.

Advances in research of severe acute pancreatitis complicated by lung injury

Lung injury is one of the most common complications of severe acute pancreatitis (SAP). At present, the pathogenesis of SAP complicated by lung injury still remains unclear. However, great attention has been paid to it at home and abroad. Many factors such as pancreatic enzyme, polymorphonuclear neutrophil, oxygen free radical, cytokine, microcirculatory disturbance, complement, kinin, NO and ET play an important role in the pathogenesis of SAP by interacting with each other. This paper reviews the advances in the pathogenesis of SAP complicated by lung injury and related studies in order to provide the theoretical basis for its effective prevention and treatment.

Early growth response factor 1 expression in rat lungs and alveolar macrophages during acute pancreatitis

AIM: To investigate the possible role of early growth response factor 1 (EGR-1) in a rat model of lung injury complicated by taurocholate sodium-induced acute pancreatitis.

METHODS: Forty male Wistar rats were randomly divided into four groups. Normal saline was injected into the common bile duct (CBD) of rats in group A, and taurocholate sodium was injected into the CBD of rats in groups B, C and D. Three hours after injection, all animals were sacrificed, and blood, pancreas and lungs were harvested. Serum levels of tumor necrosis factor (TNF)-α and interleukin (IL)-1β were measured. Pathological scoring of the pancreas was analyzed, and the pulmonary wet to dry weight ratio was measured. Immunohistochemical staining of EGR-1 on lung paraffin sections was observed and assayed semi-quantitatively. Immunocytochemical staining of EGR-1 of AMs was observed and assayed semi-quantitatively, and the concentration of TNF-α and IL-1β in culture fluid was measured. AMs were divided into four groups and treated with elastase as above. EGR-1, TNF-α and IL-1β mRNA expressions were assessed using RT-PCR.

RESULTS: Pulmonary positive staining of EGR-1 was more intense in the model of severe acute pancreatitis. Furthermore, EGR-1 staining differed among acute pancreatitis models with different severities. EGR-1 expressed in lungs correlated with the parameters that demonstrated pancreatitis severity and pulmonary injury: pathological scoring of pancreatitis (r = 0.59), pulmonary wet to dry weight ratio (r = 0.61), and serum TNF-α (r = 0.63) and IL-1β (r = 0.58). EGR-1 protein and mRNA expressed in AMs were correlated with the TNF-α and IL-1β protein (r = 0.64, 0.51, P < 0.01) and mRNA levels (r = 0.62, 0.59, P < 0.01), and were partly dependent on the ERK 1/2 pathway.

CONCLUSION: EGR-1 may play an important role in lung injury during acute pancreatitis, and the possible mechanism relates to its mediation of production of inflammatory cytokines.

Influence of dexamethasone on inflammatory mediators and NF-kappaB expression in multiple organs of rats with severe acute pancreatitis

AIM

To observe the therapeutic effects of dexamethasone on rats with severe acute pancreatitis (SAP) and investigate the influences of dexamethasone on the inflammatory mediators and NF-kappaB expression in multiple organs of SAP rats as well as the mechanisms involved.

METHODS

Ninety Sprague-Dawley (SD) rats with SAP were randomly divided into the model group (n = 45) and dexamethasone treatment group (n = 45), and another 45 rats were selected for the sham operation group. All groups were randomly subdivided into the 3 h, 6 h and 12 h groups, each group containing 15 rats. The survival of all groups and pathological changes of multiple organs (liver, kidney and lung) were observed at different time points after the operation. The pathological score of multiple organs was carried out, followed by the determination of amylase, endotoxin and TNF-alpha contents in blood. The tissue microarray was used to detect the expression levels of NF-kappaB p65 protein in multiple organs.

RESULTS

There was no marked difference between the model group and treatment group in the survival rate. The amylase content of the treatment group was significantly lower compared to the model group at 12 h (P < 0.01, 7791.00 vs 9195.00). Moreover, the endotoxin and TNF-alpha levels of the treatment group were significantly lower than that of the model group at 6 h and 12 h (P < 0.01, 0.040 vs 0.055, 0.042 vs 0.059 and P < 0.05, 58.30 vs 77.54, 38.70 vs 67.30, respectively). Regarding the changes in liver NF-kappaB expression, the model group significantly exceeded the sham operation group at 3 h (P < 0.01, 1.00 vs 0.00), and the treatment group significantly exceeded the sham operation group at 12 h (P < 0.01, 1.00 vs 0.00), whereas no marked difference was observed between the model group and treatment group at all time points. The kidney NF-kappaB expression level in the treatment group significantly exceeded the model group (P < 0.05, 2.00 vs 0.00) and the sham operation group (P < 0.01, 2.00 vs 0.00) at 12 h. No NF-kappaB expression in the lung was found in any group.

CONCLUSION

Dexamethasone can lower the amylase, endotoxin and TNF-alpha levels as well as mortality of SAP rats. NF-kappaB plays an important role in multiple organ injury. Further studies should be conducted to determine whether dexamethasone can ameliorate the pathological changes of multiple organs by reducing the NF-kappaB expression in the liver and kidney. The advantages of tissue microarrays in pancreatitis pathological examination include time- and energy- saving, and are highly efficient and representative. The restriction of tissue microarrays on the representation of tissues to various extents due to small diameter may lead to the deviation of analysis.