Abstract | OBJECTIVE: METHODS: 1. Clinical study: retrospective analysis of thirty-one patients about the effect of titrated fluid resuscitation protocol (TFR) on the occurrence of acute kidney injury (AKI) secondary to SAP. 2. Experimental study: rats (N = 30) were randomly divided into five groups: sham, model, low-volume FR (1.5 ml/kg/h), high-volume FR (10 ml/kg/h), and Poria cocos combined with high-volume FR (10 ml/kg/h + intraintestinal administration Poria cocos 5 g/kg); serum or plasma indicators and histopathologic scores were compared to explore the effect and mechanism of different fluid volumes and Poria cocos on organ function in SAP. RESULTS: The occurrence of AKI, fluid volume, and fluid velocity in TFR group was lower than that in the control group. Logistic regression analysis showed that increased Marshall scores and fluid velocity were risk factors for predicting occurrence of AKI in SAP. Low-volume FR decreased the levels of blood urea nitrogen (BUN), serum creatinine (Cr), matrix metalloproteinase ( MMP), and pathologic scores of the pancreas and kidney. High-volume FR increased ascites, MMPs, and kidney pathologic scores. Poria cocos decreased the levels of BUN, Cr, MMPs, and pathologic scores of the pancreas and kidney and increased the arterial oxygen saturation. CONCLUSION: TFR-associated lower fluid volume and velocity reduced the occurrence of AKI secondary to SAP. High volume might aggravate AKI via increased MMP release leading to endothelial glycocalyx damage and vascular endothelial dysfunction. Poria cocos reduced MMP release, relieved glycocalyx damage, and alleviated the pancreas and kidney injury aggravated by high fluid volume in SAP. Therefore, endothelial glycocalyx protection might be a new strategy in the treatment of SAP.
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Authors | Xiao-Lin Yi, Jing Hu, Qiu-Ting Wu, Yu-Mei Zhang, Qian Hu, Ling Yuan, Yi-Fan Miao, Huan Chen, Lv Zhu, Juan Li, Xian-Lin Zhao, Jia-Qi Yao, Xiao-Yu Dai, Mei-Hua Wan, Wen-Fu Tang |
Journal | Evidence-based complementary and alternative medicine : eCAM
(Evid Based Complement Alternat Med)
Vol. 2020
Pg. 6408202
( 2020)
ISSN: 1741-427X [Print] United States |
PMID | 33628293
(Publication Type: Journal Article)
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Copyright | Copyright © 2020 Xiao-Lin Yi et al. |