Reposição volêmica com soluções salinas em pancreatite e perfil hepático de proteínas apoptóticas e de choque térmico

Abstract

ObjectiveLiver failure can occur as a consequence of the systemic inflammation after acute pancreatitis. We assessed the effect of volume repositioning with hypertonic saline solution or normal saline on hepatic cytokine production and the expression of heat-shock proteins and apoptotic proteins after acute pancreatitis. MethodsWistar rats were divided in four groups: C - control animals that were not subjected to insult or treatment; NT - animals that were subjected to acute pancreatitis and received no treatment; normal saline - animals that were subjected to acute pancreatitis and received normal saline (NaCl 0.9%); and HS - animals that were subjected to acute pancreatitis and received hypertonic saline solution (NaCl 7.5%). Acute pancreatitis was induced by retrograde transduodenal infusion of 2.5% sodium taurocholate into the pancreatic duct. At 4, 12 and 24 h following acute pancreatitis induction, TNF-alpha, IL-1-beta, IL-6 and IL-10, caspase-2 and -7, Apaf-1, AIF and HSP60 and 90 were analyzed in the liver. ResultsCasp2 decreased in the normal saline and hypertonic saline groups (p<0.05 versus. C) at 12 h. Apaf-1, AIF and HSP90 remained unchanged. At 4 h, Casp7 increased in the NT group (p<0.01 versus C), although it remained at the baseline levels in the reperfused groups. HSP60 increased in all of the groups at 4 h (p<0.0.001 vs. C). However, the hypertonic saline group showed lower expression of HSP60 than the normal saline group (p<0.05). Hypertonic saline solution maintained the production of cytokines at normal levels. Volume reperfusion with normal or hypertonic saline significantly modulated the expression of Casp7. ConclusionVolume replacement with hypertonic or normal saline was effective in reducing caspase 7. However, only hypertonic solution was capable of regulating cytokine production and HSP60 expression at all time points.

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“…( 3 ) Thus, the original rationale based on its osmotic effect that enables small volume resuscitation in hypovolemic shock ( 2 ) and decreases brain edema after traumatic brain injury ( 4 ) may be too simplistic. The results presented by Rios et al ( 1 ) add to previous demonstrations of benefit from HSS on several different aspects of inflammation and organ function in pre-clinical models of systemic inflammatory response syndrome (SIRS) and sepsis. ( 3 ) However, human trials have failed to provide convincing evidence of efficacy.…”

“…In this issue of the Revista Brasileira de Terapia Intensiva, Rios et al ( 1 ) demonstrate the effects of volume replacement with hypertonic saline solution (HSS) on hepatic cytokine production and expression of heat-shock proteins and apoptotic proteins in an animal model of acute pancreatitis. HSS down-regulated liver cytokine production and HSP60 expression in a more robust manner when compared to normal saline solution.…”