OXIDATIVE STRESS - AN IMPORTANT PHENOMENON WITH PATHOGENETIC SIGNIFICANCE IN THE PROGRESSION OF ACUTE-PANCREATITIS

Background-Reactive oxygen species and related oxidative damage have b een implicated in the initiation of acute pancreatitis. Changes in the se parameters during disease progression merit further investigation. Aims-To evaluate changes and the clinical relevance of superoxide radi cals, endogenous antioxidants, and Lipid peroxidation during the cours e of acute pancreatitis. Patients and Methods-Superoxide radicals (mea sured as lucigenin amplified chemiluminescence), ascorbic acid, dehydr oascorbic acid, a tocopherol, and lipid peroxidation (measured as thio barbiturate reactive substances) were analysed in blood samples from 5 6 healthy subjects, 30 patients with mild acute pancreatitis, and 23 p atients with severe acute pancreatitis. The association with grades of disease severity was analysed, Measurements were repeated one and two weeks after onset of pancreatitis. Results-In the blood from patients with acute pancreatitis, there were increased levels of the superoxid e radical as well as lipid peroxides, There was notable depletion of a scorbic acid and an increased fraction of dehydroascorbic acid. Change s in a tocopherol were not great except in one case with poor prognosi s. Differences between severe and mild acute pancreatitis were signifi cant (p<0.01). Variable but significant correlations with disease seve rity scores were found for most of these markers. The normalisation of these indexes postdated clinical recovery one or two weeks after onse t of disease. Conclusions-Heightened oxidative stress appears early in the course of acute pancreatitis and lasts longer than the clinical m anifestations, The dependence of disease severity on the imbalance bet ween 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.