Involvement of intestinal in the pathogenesis of systemic inflammatory response syndrome in acute pancreatitis

Abstract

Background. Until now, acute pancreatitis remains in the focus of attention in modern abdominal surgery, which is due to the preservation of a high level of morbidity and mortality, as well as high treatment costs. The purpose of the study was to establish the role of the impaired functional state of the intestine in the pathogenesis of the systemic inflammatory response syndrome in acute pancreatitis. Materials and methods. 36 patients with acute pancreatitis were studied, divided into 2 groups: the first (n = 20) – moderate severity; the second (n=16) – severe. The patients underwent complex conservative therapy. Methods: assessment of the functional status of the intestine, determination of the level of toxins, the severity of oxidative processes and phospholipase activity. The observation period is up to 5 days. Results. In patients with acute pancreatitis, there were signs of the development of a systemic inflammatory reaction syndrome. Its most significant manifestations were expressed in the syndrome of endogenous intoxication. Thus, the toxicity index for albumin increased significantly. The syndrome of endogenous intoxication is especially pronounced in patients with severe pancreatitis. Thus, the value of the albumin toxicity index increased 6.94 times in comparison with the norm after a day, 7.68 times after three days, 6.0 times after five days (p < 0.05). The difference in the values in the groups, according to the terms of control, was expressed in 1.38, 1.78 and 1.90 times (p < 0.05). In acute pancreatitis, the level of toxins and hydrophilic nature increased significantly. The phenomena of endogenous intoxication in acute pancreatitis were associated with significant manifestations of oxidative stress and phospholipase activity. It turned out that in patients of the second group, these phenomena were expressed to a much greater extent. Thus, the level of diene conjugates in the blood plasma of patients increased more by 2.38, 2.50 and 2.39 times (p < 0.05), respectively. The difference in the values of this indicator in the groups was significant and was expressed in 32.7, 18.0 and 34.6%, respectively, at the stages of observation. Significantly higher (by 21.9, 27.3 and 34.8%) in this group was the activity of phospholipase A2. Violation of the intestinal barrier function – manifestations of enteral distress syndrome - in patients with acute pancreatitis was registered on the basis of data obtained by analyzing data from a number of tests. It was found that there is a correlation between the manifestations of the systemic inflammatory response syndrome and disorders of the functional status of the intestine (r = 0.757–0.948, p < 0.05). Conclusions. Enteral distress syndrome plays an important role in the pathogenesis of systemic inflammatory response syndrome in acute pancreatitis. Violation of the intestinal barrier function leads to flooding of the body with toxins. In the pathogenesis of intestinal lesions, membrane stabilization triggers play a significant role – excessive activity of membrane lipid peroxidationand excessive activity of phospholipase A2.

Keywords

• pancreatitis
• systemic inflammatory response syndrome
• intestines
• oxidative stress
• toxins