Serum Lipase Amylase Ratio in Predicting Aetiology, Severity and Outcome of Acute Pancreatitis in a Tertiary Care Hospital

2017 ◽  
Vol 5 (2) ◽  
pp. 88-92
Author(s):  
Majharul Haque ◽  
Golam Azam ◽  
Debashis Kumar Sarkar ◽  
Anisur Rahman
Keyword(s):  
Acute Pancreatitis ◽  
Sensitivity And Specificity ◽  
Severe Acute Pancreatitis ◽  
Alcoholic Pancreatitis ◽  
Care Hospital ◽  
Biliary Pancreatitis ◽  
Serum Lipase ◽  
Arterial Blood ◽  
Function Test ◽  
Acute Alcoholic Pancreatitis

Background: Acute pancreatitis is a relatively common disease with variable prevalence in different countries. Different modalities are available for predicting aetiology, severity and outcome of acute pancreatitis with different sensitivity and specificity. Moreover, some are not widely available, some are very expensive. A single, cheap, widely available marker with high sensitivity and specificity is yet to be identified. The present study intends to find out the utility of serum lipase amylase ratio in predicting the aetiology, severity and outcome of acute pancreatitis.Methods: This prospective, observational study was done at the Department of Gastrointestinal Hepatobiliary & Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, during the period of July 2014 to March 2016. A total of 71 patients with acute pancreatitis were included. Complete blood count, serum amylase, serum lipase, serum calcium, liver function test, renal function test, fasting lipid profile, ultrasonography of whole abdomen, CT scan of upper abdomen and arterial blood gas (ABG) were done in all patients. Statistical analysis was done with SPSS version 16.Results: Among 71 patients, 23(32.4%) were due to biliary cause, 15(21.1%) were due to hypertriglyceridaemia, 4(5.6%) were due to alcohol and 22(31%) were due to unknown causes. 45 (63.4%) patients had mild attack, 10(14.1%) patients had moderate attack and 16(22.5%) patients had severe attack of acute pancreatitis. Out of 71 patients, 17(23.9%) developed complication whereas 54(76.1%) developed no complication. Serum lipase amylase ratio in patients with biliary pancreatitis was 1.40±0.39 and in patients with non-biliary pancreatitis was 2.39±0.84(p <0.001). Again, serum lipase amylase ratio in patients with acute alcoholic pancreatitis was 2.89±0.79 and in patients with non-alcoholic acute pancreatitis was 1.95±0.81 (p=0.002). Serum lipase amylase ratio in patients with acute pancreatitis due to hypertriglyceridaemia was 2.75±0.68 and in patients with acute pancreatitis due to other than hypertriglyceridaemia was 1.62±.65(p< 0.001). This study showed that serum lipase amylase ratio was <2.0 in acute biliary pancreatitis and this ratio was >2.5 in acute alcoholic pancreatitis and in acute pancreatitis due to hypertriglyceridaemia. Serum lipase amylase ratio in patients with mild acute pancreatitis was 1.95±0.89; in patients with moderately severe acute pancreatitis the ratio was 2.37±0.92 and in patients with severe acute pancreatitis, the ratio was 2.22±0.70. The difference of lipase amylase ratio among these groups of patients was not statistically significant (p=0.273). Mean lipase amylase ratio among the patients without complication of acute pancreatitis was 2.03±0.92 whereas this ratio among the patients with complication was 2.17±0.68. This difference of lipase amylase ratio was not statistically significant (p=0.557).Conclusion: Role of serum lipase amylase ratio in predicting the aetiology and severity of acute pancreatitis has been addressed in several recent studies. This study was another attempt to achieve this goal. Predicting the aetiology of acute pancreatitis by such a cheap tool will guide further diagnostic work up and management strategy will avoid unnecessary investigations.Bangladesh Crit Care J September 2017; 5(2): 88-92

scholarly journals The role and importance of biochemical markers in diagnosis of alcoholic acute pancreatitis

2012 ◽  
Vol 65 (3-4) ◽  
pp. 152-157
Author(s):  
Snezana Tesic-Rajkovic ◽  
Biljana Radovanovic-Dinic ◽  
Tatjana Jevtovic-Stoimenov
Keyword(s):  
Acute Pancreatitis ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
Biochemical Markers ◽  
Biochemical Parameters ◽  
Serum Amylase ◽  
Alcoholic Pancreatitis ◽  
Serum Lipase ◽  
Acute Alcoholic Pancreatitis ◽  
Biochemical Analyses

Introduction. Alcoholic acute pancreatitis occurs in 10% of alcoholics, who take more than 80g alcohol daily. Different biochemical markers are used to diagnose acute pancreatitis, and some of them may help in establishing etiology of acute pancreatitis. Material and Methods. This study is a prospective review of 21 patients. All patients were hospitalized at the Department for Gastroenterology and Hepatology or at the Department for Surgery of the Clinical Centre of Nis in the period from August 1st 2009 to March 1st 2010 with diagnosis of acute alcoholic pancreatitis. Detailed anamnesis, clinical examination, biochemical analyses and ultrasonography of the upper abdomen were done in all patients. All patients provided data on alcohol abuse. Results. The analysis of the corresponding biochemical parameters revealed a statistically significant correlation between the following values: serum amylase and serum lipase (R=0.964674; p<0.001), cholesterol and triglycerides (R=0.93789; p<0.001), total and direct bilirubin (R=0.857899; p<0.001) and between aspartate aminotransferase and alanine aminotransferase (R=0.824461, p<0.001) in patients with alcoholic acute pancreatitis. In addition, there was a statistically significant correlation between the values of serum amylase and urinary amylase (R=0.582742, p<0.001). Discussion. The analysis of biochemical markers showed that some of them were significant for beforehand diagnosis of alcoholic acute pancreatitis, which is in accordance with other studies. Conclusion Some biochemical parameters can be potential predictors of alcoholic acute pancreatitis (lipase/amylase ratio >2, greater ratio of aspartate aminotransferase/ alanine aminotransferase, enhanced triglycerides and values of mean corpuscular volume.

scholarly journals Specificity of Lipase & Amylase Separately, in Alcoholic & Non-Alcoholic Pancreatitis

2020 ◽  
Vol 7 (47) ◽  
pp. 2799-2805
Author(s):  
Mohammed Nihad ◽  
Jinu Ibrahim Jamaludeen
Keyword(s):  
Acute Pancreatitis ◽  
Sensitivity And Specificity ◽  
Alcoholic Pancreatitis ◽  
Age Group ◽  
Medical College ◽  
Specificity And Sensitivity ◽  
Diagnostic Test Evaluation ◽  
Acute Alcoholic Pancreatitis ◽  
Sensitivity Specificity ◽  
Spread Sheet

BACKGROUND Clinically, the course of all causes of acute pancreatitis is similar; however, inpatients with severe biliary pancreatitis, we can prevent complications with the help of ERCP. Serum L / A ratio of > 2 could help diagnose alcohol as the causative agent1 . Hence, our study aims at assessing the validity in Government Medical College, Thiruvananthapuram, after assessing the specificity and sensitivity of amylase and lipase in alcoholic and non-alcoholic patients separately and lipase amylase ratio as an indicator to distinguish acute alcoholic from non-alcoholic pancreatitis. We also wanted to study the prevalence of pancreatitis in age group of 20 - 40. METHODS This is a diagnostic test evaluation conducted among 92 inpatients of Department of General Surgery selected through consecutive sampling. After randomly selecting patients admitted with a provisional diagnosis of acute pancreatitis, the first investigator administered the consent form, if accepted, examined the patient, evaluated the laboratory parameters. Then these patients were prospectively followed and evaluated. Data are then analysed using Excel spread sheet version 2019 and SPSS software and sensitivity, specificity, prevalence and diagnostic accuracy were determined. RESULTS Among 92 patients, 80 (87 %), 55 (58.8%) and 25 (27.2%) were found to have pancreatitis, alcoholic and non-alcoholic causes respectively. 35 (38 %) patients were in the age group of 31 – 35 years. It was found that lipase has 94.55 % & 91.6 % sensitivity and specificity in alcoholic and 84 % & 91.6 % sensitivity and specificity in non-alcoholic pancreatitis patients, respectively, and amylase has 69 % & 91.67 % sensitivity and specificity in alcoholic and 72 % & 91.67 % sensitivity and specificity in non-alcoholic pancreatitis respectively. CONCLUSIONS Serum amylase and lipase are inevitable investigations with good sensitivity and specificity in the diagnosis of acute pancreatitis. Lipase amylase ratio >2 is diagnostic of alcoholic pancreatitis. KEYWORDS Acute Pancreatitis, Acute Alcoholic Pancreatitis, Acute Non-Alcoholic Pancreatitis, Specificity of Lipase and Amylase, Lipase Amylase Ratio

scholarly journals Systematic Review of Most Common Causes of Acute Pancreatitis

2019 ◽  
Author(s):  
Roberto Carlos ◽  
Mariana Zilio ◽  
Almeida Lucas ◽  
Albert Fernando ◽  
Arianna Costas
Keyword(s):  
Systematic Review ◽  
Acute Pancreatitis ◽  
Meta Analysis ◽  
Alcoholic Pancreatitis ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Idiopathic Pancreatitis ◽  
Common Causes ◽  
Acute Alcoholic Pancreatitis ◽  
Etiologic Diagnosis

Introduction: Cholelithiasis and consumption of alcohol are the most frequent causes of acute pancreatitis (AP), accounting for about 30 to 40% of the cases, respectively. The frequency of acute biliary pancreatitis is high in a certain population in Brazil. Objective: To estimate the global frequencies of acute biliary pancreatitis (ABP), acute alcoholic pancreatitis (AAP) and the cases considered as acute idiopathic pancreatitis (AIP) in studies published from October 2006 to December 31, 2018. Methods: A systematic review of observational studies was performed from October 2006 to December 31, 2018. A meta-analysis by the random effects model was used to calculate the frequencies of global ABP, AIP and AAP and subgroups. Results: Forty-six studies representing 2,341,007 AP cases were included in 36 countries. The overall estimate for acute biliary pancreatitis (ABP) was 41.6% (95% CI 39.2-44.1), followed by acute alcoholic pancreatitis (AAP) with 20.5% (95% CI) 16.6- 24.6) and acute idiopathic pancreatitis (AIP) in 18.3% (95% CI 15.1-27.7). Conclusion: ABP is the most prevalent etiology of AP, being two times more frequent than second-placed pancreatitis. Latin America has a frequency for ABP much higher than the rest of the world. The importance of the etiologic diagnosis is the treatment of the cause for prevention of recurrence.

scholarly journals A study of Acute Liver Failure in adults in a tertiary care hospital

2019 ◽  
Vol 5 (6) ◽  
pp. 204-207
Author(s):  
Dr. Mohini Singh ◽  
◽  
Dr. Srilakshmi Sathiyaseelan ◽  
Devarasetty Shashank ◽  
Dr. S.R. Ramakrishnan ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Viral Hepatitis ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
Care Hospital ◽  
Arterial Blood ◽  
Function Test

Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. The prognosis is poor for untreated cases of Acute liver failure, so early recognition and management of patients with acute liver failure is crucial. A cause for acute liver failure can be identified in 60 to 80 percent of patients. Identifying the underlying cause of the liver failure is important because it influences the approach to management and provides prognostic information. Aims and Objectives: The aim of our study is to identify the clinical features, etiology and outcome of acute liver failure in a tertiary care hospital. Materials and Methods: This study is an observational study where patients with Acute Liver Failure admitted in ICU in our institution after meeting the diagnostic criteria for Acute liver failure were included in the study. Details of history, relevant symptoms and baseline investigations included, complete blood count, blood glucose, renal function test, serum electrolytes, liver function test (LFT), prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), creatine kinase (CK)], arterial blood gas analysis, arterial lactate, arterial ammonia, amylase and lipase level and pregnancy test (if female) and ultrasonography (USG) abdomen were recorded, MRI brain and other investigations relevant to the admission diagnosis, co morbidities and aetiology if needed were recorded. All the patients received standard supportive treatment for ALF. Results: In this study of 57 patients, majority of the patients were from the age group 41 to 50 years (17 patients) and 31 to 40 years (13 patients). 36 patients were male and 21 patients were females. Jaundice and encephalopathy was observed in all 57 (100%) patients, 24 (42%) patients had INR >2.5, 27 (47%) patients had serum creatinine >1.2 mg/dl and 18 (31.5%) patients had serum ammonia levels >100 micromol/L. The lowest value for serum aminotranferase was observed in infections (other than viral hepatitis) and maximum value was observed in drugs leading to ALF.In 20 (35%) patients viral hepatitis was the cause for ALD, followed by drugs and toxins which was the cause of ALD in 18 (31.5%) patients. Infections other viral hepatitis as the aetiology for ALF was observed in 16 (28%) of patients. Ischemic hepatitis was observed in 1 and Wilson’s disease was noted in 2 patients. Total 6 (10.5%) patients out of 57 patients had died, 4 patients with hepatitis B infection, 1 patient with paracetamol over dosage and 1 patient with dengue fever had died. Conclusion: Viral hepatitis and drugs are the commonest cause for acute liver failure. The aetiology of ALF varies significantly worldwide. Determining the etiology of acute liver failure requires a combination of detailed history taking and investigations. A broad evaluation is required to identify a cause of the acute liver failure, as the prognosis is poor in untreated cases of acute liver failure, so early recognition and management of patients with acute liver failure is crucial.

scholarly journals Comparison of BISAP and Ranson’s score for predicting severe acute pancreatitis and establish the validity of BISAP score

2020 ◽  
Vol 7 (5) ◽  
pp. 1473
Author(s):  
Amulya Aggarwal ◽  
Alok V. Mathur ◽  
Ram K. Verma ◽  
Megha Gupta ◽  
Dheeraj Raj
Keyword(s):  
Acute Pancreatitis ◽  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Severe Acute Pancreatitis ◽  
Predictive Value ◽  
Scoring System ◽  
Treatment Protocol ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Clinical Scoring

Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.

Role of Alanine Aminotransferase in Determining the Biliary Etiology in Acute Pancreatitis

2021 ◽  
Vol 18 (2) ◽  
pp. 44-47
Author(s):  
Shiv Vansh Bharti ◽  
Anup Sharma
Keyword(s):  
Acute Pancreatitis ◽  
Alanine Aminotransferase ◽  
Reference Value ◽  
Alcoholic Pancreatitis ◽  
Biliary Pancreatitis ◽  
Drug Induced ◽  
Abdominal Ultrasonography ◽  
Excessive Alcohol Consumption ◽  
Idiopathic Pancreatitis ◽  
Definitive Therapy

Introduction: Acute pancreatitis a disorder that has numerous causes and an obscure pathogenesis. It can be a serious abdominal emergency associated with significant morbidity and mortality. Cholelithiasis is most common cause of acute pancreatitis and excessive alcohol consumption is second most frequent cause which together account for approximately 80% of underlying etiology. The detection of biliary etiology is crucial to delivery of definitive therapy to prevent repeated attacks of acute pancreatitis. During an attack of acute pancreatitis, elevation of alanine aminotransferase to >150 IU/L is a predictive factor for biliary cause of acute pancreatitis. Aims: To investigate the predictive value of raised alanine aminotransferase in determining biliary etiology in patients presenting with acute pancreatitis. Methods: A prospective study was done among 70 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. Peak alanine aminotransferase within 48 hours of presentation was recorded. The diagnosis was based on typical clinical presentation of acute pancreatitis combined with an increase in serum amylase levels ≥ 3 times the upper limit of the laboratory reference value. All biliary cases were confirmed by abdominal ultrasonography. Results: The mean age of the patients was 47.9 ±15.7 years (19-88 years). Acute pancreatitis was common in 31-40 years of age group. Among them, 40(57.1%) were male and 30(42.9%) were female. Forty two (60%) patients had biliary pancreatitis, 20(28.5%) had alcoholic pancreatitis, 2(2.8%) patients had drug induced pancreatitis and 6(8.5%) patients had idiopathic pancreatitis. Mean alanine aminotransferase for biliary pancreatitis was 205.9U/L, while cases with other etiologies (alcoholic 58.4U/L; drug induced 62.6 U/L; and idiopathic 48.3 U/L) showed significantly lower values (p=0.001). Conclusion: An elevated alanine aminotransferase strongly supports a diagnosis of gallstones in acute pancreatitis.

scholarly journals Saikosaponin A-Induced Gut Microbiota Changes Attenuate Severe Acute Pancreatitis through the Activation of Keap1/Nrf2-ARE Antioxidant Signaling

2020 ◽  
Vol 2020 ◽  
pp. 1-19
Author(s):  
Jing Li ◽  
Jinfeng Han ◽  
Juan Lv ◽  
Shiji Wang ◽  
Lai Qu ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Acute Pancreatitis ◽  
Gut Microbiota ◽  
Severe Acute Pancreatitis ◽  
Rat Model ◽  
Inflammatory Responses ◽  
Standard Diet ◽  
Microbiota Composition ◽  
Serum Lipase ◽  
Saikosaponin A

Objective. Severe acute pancreatitis (SAP) is a serious and life-threatening disease associated with multiple organ failure and a high mortality rate and is accompanied by distinct oxidative stress and inflammatory responses. Saikosaponin A has strong antioxidant properties and can affect the composition of gut microbiota. We sought to determine the effects of Saikosaponin A interventions on SAP by investigating the changes of gut microbiota and related antioxidant signaling. Methods. A SAP model was established in Sprague-Dawley (SD) rats through the injection of sodium taurocholate into the biliopancreatic duct and confirmed by elevated levels of serum lipase and amylase. The model was fed a standard diet either with saline solution or with Saikosaponin A. Fecal microbiota transplantation (FMT) from Saikosaponin A-induced rats into the rat model was performed to test the effects of gut microbiota. The composition of gut microbiota was analyzed by using 16S rRNA gene sequencing. We measured apoptotic status, inflammatory biomarkers, and Keap1-Nrf2-ARE ((Kelch-like ECH-associated protein 1) nuclear factor erythroid 2-related factor 2-antioxidant response element) antioxidant signaling. Results. Saikosaponin A intervention attenuated SAP lesions and reduced the levels of serum amylase and lipase, oxidative stress, and inflammatory responses by reducing pathological scores and affecting the serum level of oxidative and inflammatory factors. Meanwhile, the expression of Keap1-Nrf2-ARE was increased. Saikosaponin A intervention improved microbiota composition by increasing the relative abundance of Lactobacillus and Prevotella species. FMT resulted in similar results as those caused by the Saikosaponin A intervention, suggesting Saikosaponin A may exert its function via the improvement of gut microbiota composition. Conclusions. Saikosaponin A-induced gut microbiota changes attenuate SAP progression in the rat model and may be a potential natural drug for adjuvant treatment of SAP. Further work is needed to clear up the points.

Serum lipase: A better test to diagnose acute alcoholic pancreatitis

1992 ◽  
Vol 92 (3) ◽  
pp. 239-242 ◽  
Author(s):  
Vivek Gumaste ◽  
Pradyuman Dave ◽  
George Sereny
Keyword(s):  
Alcoholic Pancreatitis ◽  
Serum Lipase ◽  
Lipase A ◽  
Acute Alcoholic Pancreatitis

scholarly journals Protective Effect of Dachengqi Decoction on Pancreatic Microcirculatory in Severe Acute Pancreatitis via Down-regulating HMGB-TLR-4-IL-23-IL-17A Mediated Neutrophil Activation Though Targeting SIRT1

2021 ◽  
Author(s):  
Jia Wang ◽  
Lei Peng ◽  
Dan Chang ◽  
Da-qing Hong ◽  
Jiong Zhang
Keyword(s):  
Acute Pancreatitis ◽  
Cell Viability ◽  
Severe Acute Pancreatitis ◽  
Weight Ratio ◽  
Related Factors ◽  
Serum Lipase ◽  
Tnf Α ◽  
Wet Weight ◽  
Microcirculatory Function

Abstract BackgroundDachengqi decoction (DCQD), one of classic prescription of Chinese herbal medicine has been widely used in clinic to treat severe acute pancreatitis (SAP). The damage of pancreatic microcirculation plays key pathogenesis of SAP. However, little is known about the molecular pharmacological activity of DCQD on pancreatic microcirculation in SAP. Therefore, the purpose of the study attempted to confirm the improvement of DCQD on pancreatic microcirculation is associated with suppressing neutrophil mediated immune-inflammatory response through promoting the inactivation of HMGB1-TLR-4-IL-23-IL-17A axis via targeting the SIRT1 signal pathway in SAP.Material and MethodsSodium taurodeoxycholate and cerulein were used to establish model of SAP in vitro and vivo, respectively. The pancreatic pathological morphology, wet weight ratio, myeloperoxidase (MPO) activity, cell viability and microcirculatory function of the pancreas, as well as serum lipase and amylase expressions were evaluated. The expression levels of SIRT1, acety-HMGB1, TLR-4, HMGB1, IL-23, IL-17A, neutrophil chemokines (KC, LIX, and MIP-2), and inflammation-related factors (IL-6, IL-1β, and TNF-α), the translocation of HMGB1 and the interaction of SIRT-HMGB1 in the pancreas and serum were determined by ELISA real-time PCR, western blotting and immunoprecipitation.ResultsIn-vivo studies showed DCQD or neutralizing antibody (anti-23p19 or anti-IL-17A) could significantly decrease the activity of lipase, amylase, down-regulate the expression of CD68, MPO, wet/weight, IL-1β, IL-6, TNF-α,neutrophil chemokines (KC, LIX, MIP-2 ), alleviate pathological injury, and improve the microcirculatory function of the pancreas in rats with SAP. Moreover, DCQD remarkably augmented SIRT1 expression, promoted SIRT1 and HMGB1 combination, reduced HMGB1 translocation from nuclear to cytoplasm, and alleviated the expression of acetyl-HMGB1, HMGB1, IL-17A, TLR-4 and IL-23 in vitro and vivo with SAP. However, the intervention with EX527 (SIRT1 inhibitor) or r-HMGB1 (recombinant HMGB1) could obliviously reverse the above-mentioned influence of DCQD in SAP. In vitro, we confirmed that DCQD could decrease the acetylation, migration and release of HMGB1, and improve the decline of cell viability, SIRT1, SIRI-HMGB1 combination induced by cerulein with promoting macrophage to release IL-23 through HMGB1/TLR-4. ConclusionDCQD treatment improves SAP-induced pancreatic microcirculatory dysfunction by inhibiting neutrophil-mediated inflammation through the inactivation of HMGB1-TLR-4-IL-23-IL-17A signaling via Targeting SIRT1.Trial registration: No. 365, 2020.

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