The diffuse reduction in spleen density: an indicator of severe acute pancreatitis?

Guangdong Shao,Xuewei Bai,Bei Sun,Yanmei Zhou,Maitao Jiang,Zengfu Song,Xiaoqian Wang,Xiangren Jin

doi:10.1042/bsr20160418

Abstract

We observed that acute pancreatitis (AP) was associated with diffuse reduction in spleen density (DROSD) in some patients. Furthermore, the condition of these patients was more serious, and the potential relationship between DROSD and structural and functional injury of the spleen remained unclear. Therefore, we performed a preliminary exploration of these factors. We analysed pertinent clinical data for AP patients with normal spleen density (control group) and for those with DROSD (reduction group) at the First Affiliated Hospital of Harbin Medical University (June 2013–June 2015). We measured the immunoglobulin M (IgM) B-cells of the AP patients and examined pancreatic and splenic tissues from AP rats with optical microscopy and TEM. The reduction group had a higher acute physiology and chronic health evaluation II (APACHE II) score, a longer length of stay (LOS) and lower serum calcium than the control group. The levels of triglycerides (TG) and total cholesterol (TC) did not differ significantly between the two groups. The percentage of IgM memory B-cells was significantly lower in the DROSD group than in the control group. TEM revealed that the spleen T-lymphocytes were normal in AP rats, but pyroptotic and necrotic spleen B-cells were observed in the severe AP rats. In AP, DROSD was an independent indicator of more severe conditions. Furthermore, spleen B-lymphocytes showed obvious damage at the cellular level, and the immunological function of the spleen was down-regulated when AP was associated with DROSD.

Highlights

Acute pancreatitis (AP) is a complex abdominal disease that involves an intense local and systemic inflammatory response syndrome (SIRS)
We found that in AP the spleen could be changed, which was characterized by diffuse reduction in density morphologically, and this phenomenon was related to the condition of AP
We found that the average spleen computed tomography (CT) value of the patients in the severe acute pancreatitis (SAP) group was significantly less than that in the mild acute pancreatitis (MAP) and moderately severe acute pancreatitis (MSAP) groups (Figure 2d), suggesting that the decrease in spleen density was related to the severity of AP

Summary

Introduction

Acute pancreatitis (AP) is a complex abdominal disease that involves an intense local and systemic inflammatory response syndrome (SIRS). Severe acute pancreatitis (SAP) is more serious because it is prone to cause complicated multiple organ dysfunction syndrome (MODS), which is one of the main causes of death in patients with SAP [1,2,3]. We consulted much of the relevant literature, but only related case reports c 2017 The Author(s).

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