乌司他丁联合奥曲肽对重症急性胰腺炎患者血清胰蛋白酶原激活肽、淀粉样蛋白A及血清炎性反应因子的影响
Effects of ulinastatin combined with octreotide on serum trypsinogen activating peptide and amyloid A in patients with severe acute pancreatitis and the influence of serum inflammatory reaction factors
目的 探讨乌司他丁联合奥曲肽对重症急性胰腺炎患者胰蛋白酶原激活肽( TAP )、血清中淀粉样蛋白A(SAA)及血清炎性反应因子的影响.方法 选择我院 2011 年2月至2016 年9月收治的重症急性胰腺炎患者178 例,采用随机数字表法将患者随机分为对照组81例和观察组97例.在常规治疗基础上,对照组采用0. 50 mg奥曲肽+0. 9%氯化钠注射液,以 20 mg/h 持续静脉泵入,1次/d,共 3 d.观察组在对照组治疗基础上,给予乌司他丁10万U+250 ml 0. 9% 氯化钠溶液静脉滴注,2 次/d,共 3 d.治疗前、后检测两组患者的TAP、SAA及血清炎性反应因子,并对其进行分析比较.结果 观察组患者治疗前TAP、SAA、脂肪酶及淀粉酶水平分别为(45. 21±9. 64) nmol/L、(458. 62±75. 41) mg/L、(14 731. 7±812. 5) U/L、(9 341. 3±831. 3) U/L,治疗后分别为(26. 38±7. 13) nmol/L、(201. 23±64. 31 ) mg/L、(10 321. 4±762. 8) U/L、(5 416. 7±306. 8) U/L;对照组治疗前分别为(43. 14±8. 53) nmol/L、(463. 71 ±62. 83) mg/L、(13 826. 2±731. 3) U/L、(9 126. 4±835. 1) U/L,治疗后分别为(37. 41±8. 32) nmol/L、(316. 42±68. 71 ) mg/L、(12 318. 5±797. 3) U/L、(7 423. 1±752. 3) U/L;两组治疗后均较治疗前降低(P均<0. 05);观察组治疗后降低更为明显,与对照组比较差异有统计学意义( P均<0. 05).观察组患者治疗前降钙素原、C 反应蛋白及甘油三酯水平分别为(6. 04±1. 25) μg/L、(237. 3±13. 2) mg/L、(32. 18 ±1. 32) mmol/L,治疗后分别为(2. 37±0. 96) μg/L、(48. 9±11. 2) mg/L、(12. 73±3. 61) mmol/L;对照组治疗前分别为(5. 72±1. 43) μg/L、(213. 1±16. 2) mg/L、(30. 76±1. 94) mmol/L,治疗后分别为(4. 21 ±1. 32) μg/L、(156. 2±14. 7) mg/L、(24. 69±1. 26) mmol/L;两组患者治疗后各指标均较治疗前降低(P均<0. 05);观察组治疗后降低更为明显,与对照组比较差异均有统计学意义( P均<0. 05).观察组患者治疗前白细胞介素 6、白细胞介素 8、肿瘤坏死因子 α、血栓素及前列环素水平分别为( 292. 48 ±19. 57)、(105. 52±11. 41)、(4. 31±0. 58)、(442. 16±40. 23)、(167. 42±12. 29)ng/L,治疗后分别为(67. 43 ±9. 21)、(23. 19±3. 26)(1. 27±0. 32)、(192. 20± 16. 89)、(364. 57±27. 02) ng/L;对照组治疗前分别为(278. 31 ±22. 49)、(113. 21±11. 45)、(4. 32±0. 48)、(428. 32±36. 54)、(159. 31±13. 42)ng/L,治疗后分别为(125. 74±16. 52)、(67. 21±7. 65)、(3. 16±0. 29)、(321. 46±25. 51)、(246. 73±20. 52)ng/L;两组患者治疗后白细胞介素6、白细胞介素8、肿瘤坏死因子α及血栓素水平均较治疗前降低( P均<0. 05);前列环素水平较治疗前增高,差异有统计学意义(P<0. 05).结论 乌司他丁联合奥曲肽治疗重症急性胰腺炎可降低血脂水平,减少炎症因子,减轻全身炎症反应,显著改善患者的抑制炎性反应及促进炎性反应平衡,检测患者TAP、SAA及血清炎性反应因子对重症急性胰腺炎的诊断及病情判断,有一定临床指导价值.
更多Objective To investigate the effects of ulinastatin combined with octreotide in patients with severe acute pancreatitis TAP, SAA and serum inflammatory factors. Methods From February 2011 to September 2016,one hundred and seventy-eight patients with severe acute pancreatitis treated in the Second Affiliated Hospital of Hainan Medical University were enrolled in the study and were divided into the control group(81 cases) and observation group (97 cases). On the basis of routine treatment,the control group was treated with 0. 50 mg octreotide +0. 9% sodium chloride injection,continuous intravenous infusion at 20 mg/h, and 1 time /d,with a total of 3 d. On the basis of the control group,the observation group was given ulinastatin 100 thousand U+250 ml 0. 9% sodium chloride solution intravenous drip,2 times /d,with a total of 3 d. Before and after treatment,TAP,SAA and serum inflammatory factors in two groups were detected and analyzed. Results The levels of TAP,SAA,lipase and amylase in the observation group were (45. 21±9. 64) nmol/L,(458. 62 ±75. 41) mg/L, ( 14731. 7 ± 812. 5) U/L and ( 9341. 3 ± 831. 3) U/L respectively, compared with ( 26. 38 ±7. 13) nmol/L, ( 201. 23 ± 64. 31 ) mg/L, ( 10 321. 4 ± 762. 8) U/L and ( 5 416. 7 ± 306. 8) U/L after treatment. Before treatment,the control group were (43. 14±8. 53) nmol/L,(463. 71±62. 83) mg/L,(13826. 2 ±731.3) U/L and (9126.4±835.1) U/L,and the control group were (37.41±8.32) nmol/L,(316.42 ±68. 71) mg/L,(12 318. 5±797. 3) U/L and (7 423. 1±752. 3) U/L. After treatment,the two groups were lower than those before treatment (P<0. 05),and the decrease was more obvious in the observation group after treatment. Compared with the control group,the difference was statistically significant ( P<0. 05) . The level of calcitonin,C reactive protein and triglyceride in the observation group were ( 6. 04 ± 1. 25) ng/mL, ( 237. 3 ±13. 2) mg/L and ( 32. 18 ± 1. 32) mmol/L respectively before treatment. After treatment, they were ( 2. 37 ±0. 96) ng/mL,(48. 9±11. 2) mg/L and (12. 73±3. 61) mmol/L. Before treatment,the control group was (5. 72 ± 1. 43 ) ng/mL, ( 213. 1 ± 16. 2 ) mg/L, ( 30. 76 ± 1. 94 ) mmol/L and ( 5. 32 ± 1. 21 ) mmol/L, respectively. After treatment,they were (4. 21±1. 32) ng/mL,(156. 2±14. 7) mg/L and (24. 69±1. 26) mmol/L respectively. The levels of calcitonin,C reactive protein and triglyceride in the two groups were lower than those before treatment (P<0. 05),and the decrease was more obvious in the observation group after treatment,and the difference was statistically significant compared with the control group. (P<0. 05); tn the observation group,the levels of interleukin 6,interleukin 8,TNF - alpha,thromboxane and prostacyclin were (292. 48±19. 57) ng/L, (105. 52 ± 11. 41 ) ng/L, ( 4. 31 ± 0. 58 ) ng/L, ( 442. 16 ± 40. 23 ) ng/L and ( 167. 42 ± 12. 29 ) ng/L respectively.After treatment,they were (67.43±9.21) ng/L,(23.19±3.26) ng/L,(1.27±0.32) ng/L, (192. 20± 16. 89) ng/L and ( 364. 57 ± 27. 02) ng/L respectively. Before treatment, the control group was (278. 31±22. 49) ng/L,(113. 21±11. 45) ng/L,(4. 32±0. 48) ng/L,(428. 32±36. 54) ng/L and (159. 31 ±13. 42) ng/L,compared with (125. 74±16. 52) ng/L,(67. 21±7. 65) ng/L,(3. 16±0. 29) ng/L,(321. 46 ±25. 51) ng/L,(246. 73±20. 52) ng/L after treatment. After treatment,the levels of IL-6,IL-8,TNF-alpha and thromboxane in the two groups were all lower than those before the treatment ( P<0. 05 ) . The levels of prostacyclin in the two groups were all higher than those before treatment ( P<0. 05) . Conclusion Ulinastatin combined with octreotide in the treatment of severe acute pancreatitis can reduce the level of blood lipid,reduce inflammatory factors,reduce systemic inflammatory response, improve the patient's inhibition of inflammatory response and promote the balance of inflammatory reaction, and test the patient's TAP, SAA and serum inflammatory response factors to the diagnosis of SAP and the judgment of the disease,and have certain clinical guidance.
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