Abstract: 【Abstract】 Objective Early gut mucosal dysfunction is one of the critical pathophysiological disorders in patients with severe acute pancreatitis (SAP). To investigate the effects of continuous blood purification on SAP induced gut mucosal dysfunction, we conducted a prospective study in 26 patients with SAP. Method All patients were treated with continuous veno-venous hemofiltration (CVVH) for 24 hours. Permeability of the epithelial monolayer, serum concentrations of diamine oxidase (DAO), D-lactate and endotoxin were used as the markers for the assessment of epithelial function. Blood samples were taken from the patients at 0, 6, 12 and 24h during CVVH. Serum DAO, D-lactate and endotoxin were determined by spectrophotometry. Monolayer Caco-2 cells incubated with patient’s serum were used as the model to assess SAP-induced epithelial permeability changes by measuring their trans-epithelial electric resistance (TEER). Expression and distribution of actin in the cells were observed by immunofluorescence. Result The Acute Physiology and Chronic Healthy Evaluation (APACHE) Ⅱ score was significantly improved after CVVH. Compared with the normal controls, SAP patients showed the increase of serum DAO, D-lactate, endotoxin and epithelial permeability. Peripheral filament bands in the cells became blurred, with loose cell-cell junctions. After CVVH, serum DAO, D-lactate and epithelial permeability decreased, and the organization of actin improved in all patients. Conclusion Early gut mucosal dysfunction is present in SAP patients. CVVH improves patients’ general conditions as well as their gut mucosal dysfunction, probably resulting from the clearance of over-expressed pro-inflammation cytokines and reorganization of actin in epithelial cells.

Key words: Continuous veno-venous hemofiltration, DAO, D-lactate, Trans-epithelial electrical resistance, F-actin