Oxidative stress: an important phenomenon with pathogenetic significance in the progression of acute pancreatitis

K Tsai,^a S-S Wang,^a T-S Chen,^a C-W Kong,^a F-Y Chang,^a S-D Lee,^a F-J Lu^b

^a Division of Gastroenterology and Intensive Care Unit, Department of Medicine, Veterans General Hospital, Taipei, and School of Medicine, National Yang-Ming University, Taiwan, ^b Department of Biochemistry, College of Medicine, National Taiwan University, Taiwan

Correspondence to: Prof. F-J Lu, Department of Biochemistry, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Taipei, Taiwan, Republic of China.

Accepted for publication 19 January 1998

BackgroundReactive oxygen species and related oxidative damage have been implicated in the initiation of acute pancreatitis. Changes in these parameters during disease progression merit further investigation.
AimsTo evaluate changes and the clinical relevance of superoxide radicals, endogenous antioxidants, and lipid peroxidation during the course of acute pancreatitis.
Patients and methodsSuperoxide radicals (measured as lucigenin amplified chemiluminescence), ascorbic acid, dehydroascorbic acid,  tocopherol, and lipid peroxidation (measured as thiobarbiturate reactive substances) were analysed in blood samples from 56 healthy subjects, 30 patients with mild acute pancreatitis, and 23 patients with severe acute pancreatitis. The association with grades of disease severity was analysed. Measurements were repeated one and two weeks after onset of pancreatitis.
ResultsIn the blood from patients with acute pancreatitis, there were increased levels of the superoxide radical as well as lipid peroxides. There was notable depletion of ascorbic acid and an increased fraction of dehydroascorbic acid. Changes in  tocopherol were not great except in one case with poor prognosis. Differences between severe and mild acute pancreatitis were significant (p<0.01). Variable but significant correlations with disease severity scores were found for most of these markers. The normalisation of these indexes postdated clinical recovery one or two weeks after onset of disease.
ConclusionsHeightened oxidative stress appears early in the course of acute pancreatitis and lasts longer than the clinical manifestations. The dependence of disease severity on the imbalance between oxidants and natural defences suggests that oxidative stress may have a pivotal role in the progression of pancreatitis and may provide a target for treatment.
(GUT 1998;42:850-855)

Keywords: acute pancreatitis;  free radicals;  superoxides;  antioxidants;  lipid peroxidation