清胰汤联合丙氨酰谷氨酰胺对重症急性胰腺炎伴肠功能衰竭患者血清内毒素、胃动素和肠黏膜功能的影响

Effects of Qingyi Decoction Combined with Alanine Glutamine on Serum Endotoxin,Motilin and Intestinal Mucosal Function in Patients with Severe Acute Pancreatitis and Intestinal Failure

目的观察清胰汤联合丙氨酰谷氨酰胺对重症急性胰腺炎(SAP)伴肠功能衰竭患者血清内毒素、胃动素和肠黏膜功能的影响。方法患者88例按随机数字表法分为两组,均给予对症治疗,在此基础上对照组采用丙氨酰谷氨酰胺治疗,研究组在对照组基础上联合清胰汤治疗。观察两组临床症状缓解时间、中医证候积分、临床疗效,检测患者血清内毒素、胃动素、肠黏膜通透性、二胺氧化酶、D-乳酸水平,同时检测肿瘤坏死因子-α(TNF-α)、白介素-18(IL-18)水平。结果研究组首次排便时间、体温恢复正常时间、肠道功能恢复时间、腹痛缓解时间显著短于对照组(P <0.05);研究组总有效率为88.64%,显著高于对照组的70.45%(P <0.05);与治疗前比较,两组治疗后中医证候积分明显降低(P <0.05),且研究组较对照组低(P <0.05);两组治疗后内毒素明显降低(P <0.05),且研究组低于对照组(P <0.05),两组胃动素明显升高(P <0.05),且研究组较对照组高(P <0.05);两组治疗后肠黏膜通透性、二胺氧化酶、D-乳酸水平明显降低(P <0.05),且研究组低于对照组(P <0.05);两组治疗后TNF-α、IL-18水平明显降低(P <0.05),且研究组低于对照组(P <0.05)。结论清胰汤联合丙氨酰谷氨酰胺可有效改善SAP伴肠功能衰竭患者血清内毒素、胃动素和肠黏膜功能,提高治疗效果。

Objective： To observe the effects of Qingyi Decoction combined with Alanine Glutamine on serum endotoxin,motilin and intestinal mucosal function in patients with severe acute pancreatitis（SAP） and intestinal failure. Methods： 88 cases were divided into the study group and the control group with 44 cases in each group,according to the random digital table method. The two groups were treated with symptomatic treatment. On this basis,the control group was treated with Alamyl Glutamine,and the study group was treated with Qingyi Decoction on the basis of the control group. The remission time of clinical symptoms,TCM symptom scores and clinical efficacy of the two groups were observed,and the serum endotoxin,motilin,intestinal permeability,diamine oxidase,D-lactic acid levels and the levels of TNF-α and IL-18 were detected. Results： The time of first defecation,the time of body temperature restored to normal,the recovery time of intestinal function and the time of relieving abdominal pain in the study group were significantly lower than those in the control group（P〈0.05）;the total effective rate of the study group was 88.64%,which was significantly higher than that of the control group 70.45%（P〈0.05）;compared with before treatment,the TCM syndrome scores of both groups were significantly lower（P〈0.05）,and the study group was lower than the control group（P〈0.05）;the endotoxin in both groups decreased significantly after treatment（P〈0.05）,and the study group was lower than the control group（P〈0.05）;the motilin level in the two groups increased significantly（P〈0.05）,and the study group was higher than the control group（P〈0.05）;after treatment,the permeability of intestinal mucosa,the levels of diamine oxidase and D-lactic acid in both groups were significantly lower（P〈0.05）,and the study group was lower than the control group（P〈0.05）;the levels of TNF-α and IL-18 in both groups were significantly lower（P〈0.05）,and the study group was lower than the control group（P〈0.05）. Conclusion： The combination of Qingyi Decoction and Alamyl Glutamine can effectively improve the serum endotoxin,motilin and intestinal mucosal function in patients with SAP and intestinal failure,and improve the therapeutic effect.