Intervention strategies for secondary infection following acute necrotizing pancreatitis in rats

Objective: To observe the effects of 6 intervention measures on gut barrier function and endotoxin bacterial translocation （BT） following acute necrotizing pancreatitis （ANP） in rats. Methods: A lethal model of ANP was reproduced by infusion of artificial bile into biliopancreatic duct and then divided randomly into: （1） ANP group （n=39, no treatment）,（2） Chinese medicine group （n=9）, （3） MgSO 4 group （n=6）, （4） SDD group （n=8）, （5） somatostatin group （n=19）, （6）TNFα McAb group （n=6） and （7） IL-1ra group （n=6）. Blood levels of amylase, D lactic acid, TNFα, IL-1β and endotoxin were measured, intestinal flora and incidence of BT to organs were examined, and morphology of pancreas and tight junction on ileum epithelia was assessed on cryofracture replicas at various time points. Results: In early stage of ANP, flora disturbance and tight junction damage occurred in the gut, plasma D lactate and endotoxin levels were increased, and BT rate was as high as 59.5% at 72 h. Serum TNFα and IL-1β were elevated significantly. Treatment with Chinese medicine markedly improved gut barrier function and reduced BT rate （37%）, blood levels of amylase, endotoxin and cytokines. Having similar purgative response as Chinese medicine, MgSO₄ did not show any beneficial effect on gut barrier protection, and the incidence of endotoxemia and BT was not reduced. In SDD group, flora balance was preserved well, and similar results as Chinese medicine were obtained. Somatostatin markedly blunted amylase and cytokine release and ameliorated gut barrier damage during early phase of ANP. TNFα McAb and IL-1ra also alleviated pathologic changes in pancreas and endotoxemia. Conclusion: Treatment with Chinese medicine, SDD and somatostatin attenuated gut barrier damage and BT after ANP, and could be advisable for reducing the chance of secondary infection after ANP, while purgation alone was not effective.