Терапевтический архив (Feb 2004)
Participation of cytokines and role of biliary-pancreatic reflux in mechanisms of exacerbation and chronicity of recurrent pancreatitis
Abstract
Aim. To evaluate the role of some pro- and anti-inflammatory cytokines, acute phase proteins and biliary-pancreatic reflux in pathogenesis of development and recurrence of chronic recurrent pancreatitis (CRP) and alcohol chronic pancreatitis (ACP). Material and methods. IL-8, IL-4, IL-10, TNF-alpha, lactoferrin (LF) and cerruloplasmin were estimated by a standard enzyme immunoassay in 186 CRP and 32 ACP patients. Results. The levels of proinflammatory cytokines, TNF-alpha and IL-8 as well as anti-inflammatory cytokines IL-4 and IL-10 in CRP patients reached their maximum on exacerbation day 5-7 while in ACP - on day 1-2. High cytokines levels correlate with exacerbation severity. In transition to remission, the levels of cytokines and acute phase proteins (lactoferrin, ceruloplasmin) went down. In remission some patients showed episodes of rising IL-8 and TNF-alpha to the level typical for exacerbation but without clinical manifestations. This may point to latent recurrences. TNF-alpha rose in remission most frequently in patients with biliary-pancreatic reflux. Antiinflammatory treatment of duodenitis (papillitis) lowered basal pressure of Oddi's sphincter stopping biliary-pancreatic regurgitation and leading to breaking the pathogenetic chain of CRP exacerbations. Conclusion. Proinflammatory cytokines TNF-alpha and IL-8 promote development of CRP. This should be taken into consideration while planning combined therapy.
