Am. J. Respir. Crit. Care Med., Vol 152, No. 5, Nov 1995, 1527-1533.
Lymphatic release of cytokines during acute lung injury complicating severe pancreatitis
P Montravers, S Chollet-Martin, JP Marmuse, MA Gougerot-Pocidalo and JM Desmonts
Departement d'Anesthesie Reanimation Chirurgicale, Hopital Bichat, Paris, France.
In severe acute pancreatitis (SAP), the mechanisms leading to adult
respiratory distress syndrome (ARDS) are usually attributed to the release
of active enzymes and vasoactive substances from the pancreas. Thoracic
duct drainage has been proposed as a means of removing the portion of these
substances that drain through retroperitoneal lymphatics before they reach
the systemic circulation. This technique was used in six patients with ARDS
complicating SAP. The levels of proinflammatory cytokines (tumor necrosis
factor-alpha [TNF alpha], interleukin-1 [IL-1], and interleukin-6 [IL-6]),
neutrophil enzymes (myeloperoxidase and lactoferrin), and pancreatic
enzymes (amylase, lipase and trypsin) were measured in plasma and lymph in
the first 24 h of ARDS and then on Day 2, Day 4, and at the end of the
drainage (Day 8). High plasma concentrations of these products were
measured. A moderate lymph-to-plasma gradient was observed for IL-6,
lipase, and trypsin, while similar levels in plasma and lymph were recorded
for the other substances. Plasma levels of pancreatic enzymes were weakly
correlated with the lung injury score and lymph level of cytokines. These
results suggest that in patients with ARDS due to SAP, cytokines as well as
pancreatic enzymes could contribute to the development of the lung injury,
and that lymphatics are potential vectors of these mediators.
