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目的:观察重症急性胰腺炎(SAP)心肌功能损害时细胞凋亡调节基因在心肌组织中的表达及益活清胰汤的干预作用,进一步探讨SAP循坏功能障碍的发病机制。方法:63只SD大鼠随机分为假手术组(正常组n=9)、对照组(n=27)及治疗组(n=27益活清胰汤组)。SAP模型采用5%的牛磺胆酸钠胰胆管逆行注射方法建立。HE染色光镜下观察胰腺及心肌组织的病理变化,免疫组化法检测术后6 h、12 h、18 h各时点心肌Bcl-2、Bax及NF-κB的表达。结果:治疗组胰腺及心肌组织的病理变化减轻,SAP各时间点均可见NF-κB明显活化,治疗组各时间点NF-κB活化与对照组相比均明显减弱(P<0.05)。术后6h各组Bcl-2、Bax无显著性变化(P>0.05),12 h、18 h对照组Bcl-2的表达较正常组及治疗组显著减少(P<0.05),12 h、18 h对照组Bax的表达较假手术组及治疗组显著增加(P<0.05)。结论:SAP大鼠心肌NF-κB被激活,Bcl-2表达减少,Bax表达增加;应用益活清胰汤后NF-κB的活化及Bax的表达受到抑制,Bcl-2的表达上调,益活清胰汤对SAP大鼠心肌细胞调亡的具有抑制作用。
OBJECTIVE: To investigate the expression of apoptosis-regulatory genes in myocardial tissue of patients with severe acute pancreatitis (SAP) and the intervention of Yihuo Qingpan Decoction, and further explore the pathogenesis of SAP dysfunction. METHODS: Sixty-three SD rats were randomly divided into sham operation group (n=9 in normal group), control group (n=27) and treatment group (n=27 Yihuo Qingpan Decoction group). The SAP model was established using retrograde injection of 5% sodium taurocholate into the pancreatic duct. HE staining was used to observe the pathological changes of pancreas and myocardial tissue. The expression of Bcl-2, Bax and NF-kappaB in myocardium were detected at 6 hours, 12 hours, and 18 hours after operation by immunohistochemistry. Results: The pathological changes of the pancreas and myocardial tissues in the treatment group were relieved. NF-κB was significantly activated at all time points in SAP. Compared with the control group, the NF-κB activation in the treatment group was significantly decreased (P<0.05). There were no significant changes in Bcl-2 and Bax at 6 h postoperatively (P>0.05). The expression of Bcl-2 in the control group at 12 h and 18 h was significantly lower than that in the normal group and the treatment group (P<0.05). The expression of Bax in the control group was significantly higher than that in the sham group and the treatment group (P<0.05). CONCLUSION: NF-κB is activated in myocardium of SAP rats, Bcl-2 expression is decreased, and Bax expression is increased. Activation of NF-κB and the expression of Bax are inhibited after the application of Yihuo Qingyi Decoction, and the expression of Bcl-2 is up-regulated. Qingyi Decoction has an inhibitory effect on the apoptosis of rat cardiomyocytes in SAP.