维生素C联合奥曲肽治疗肝硬化消化道出血的预后及血清胆碱酯酶和氧化应激水平变化研究

Effects of Vitamin C Combined with Octreotide on the Prognosis of Patients with Cirrhosis and Gastrointestinal Bleeding and Changes in Serum Cholinesterase and Oxidative Stress

目的探讨维生素C联合奥曲肽治疗肝硬化消化道出血的预后、血清胆碱酯酶和氧化应激水平变化及其相互关系。方法选取2014年1月—2016年6月内江市第一人民医院收治的肝硬化消化道出血患者66例,采用抽签法将患者随机分为研究组和对照组,每组33例。对照组在常规治疗的基础上给予奥曲肽治疗,研究组在对照组的基础上每天给予维生素C 3 g静脉滴注,连续治疗至止血。比较两组疗效、住院期间死亡率,治疗前、治疗1 d、2 d和3 d时血清胆碱酯酶、超氧化物歧化酶(SOD)和丙二醛(MDA)水平。结果治疗后研究组显效25例(75.7%)、有效6例(18.2%)、无效2例(6.1%),对照组分别为16例(48.5%)、8例(24.2%)、9例(27.3%),研究组疗效优于对照组(u=-2.487,P=0.013);研究组住院期间死亡率低于对照组[6.1%(2/33)比27.3%(9/33),χ~2=5.345,P=0.021]。治疗方法与时间在血清胆碱酯酶、SOD和MDA水平上存在交互作用(P<0.05);治疗方法在血清胆碱酯酶、SOD和MDA水平上主效应显著(P<0.05);时间在血清胆碱酯酶、SOD和MDA水平上主效应显著(P<0.05)。治疗前、治疗1 d两组血清胆碱酯酶、SOD和MDA水平比较,差异均无统计学意义(P>0.05);治疗2、3 d研究组血清胆碱酯酶、SOD水平高于对照组,MDA水平低于对照组(P<0.05)。研究组治疗1、2、3 d血清胆碱酯酶、SOD水平高于治疗前,MDA水平低于治疗前(P<0.05);对照组治疗2、3 d血清胆碱酯酶、SOD水平高于治疗前,MDA水平低于治疗前(P<0.05)。Spearman相关分析结果显示,研究组患者治疗前、后血清胆碱酯酶、SOD和MDA水平与疗效/预后相关(P<0.05)。结论维生素C联合奥曲肽治疗肝硬化消化道出血可显著改善疗效及预后,升高血清胆碱酯酶、SOD水平,降低MDA水平,且与其疗效和预后相关,可能作为疗效和预后评估的参考指标,指导临床干预从而改善疗效和预后。

Objective To investigate the changes in prognosis,serum cholinesterase levels,and oxidative stress of liver cirrhosis patients with gastrointestinal bleeding treated with vitamin C combined with octreotide.Methods In total,66 patients with liver cirrhosis and gastrointestinal bleeding who were treated at First People's Hospital of Neijiang between January 2014 and June 2016 were selected and randomly divided into a study group and control group,with 33 cases in each group.The control group was treated with octreotide as a routine treatment,and the study group was given an intravenous drip of 3 g of vitamin C daily in addition to octreotide.All patients were treated until hemostasis.The efficacy and mortality during hospitalization,as well as the levels of serum cholinesterase,superoxide dismutase(SOD),and malondialdehyde(MDA)before hospitalization and on days 1-3 of treatment,were statistically compared between the two groups.Results Following treatment,there were 25 remarkable cases(75.7%),six effective cases(18.2%),and two ineffective cases(6.1%)in the study group,and 16 remarkable cases(48.5%),eight effective cases(24.2%),and nine ineffective cases(27.3%)in the control group,which reflects a more significantly curative effect in the study group compared with the control group(u=-2.487,P=0.013).The mortality rate of the study group was lower than that of the control group〔6.1%(2/33)vs.27.3%(9/33),χ2=5.345,P=0.021〕.There was intervention between the treatment method and time in the levels of serum cholinesterase,SOD,and MDA(P<0.05).The effect of treatment on the levels of serum cholinesterase,SOD,and MDA levels was significant(P<0.05).Time also exhibited significant effects on serum cholinesterase,SOD,and MDA levels(P<0.05).There were no significant differences in serum cholinesterase,SOD,and MDA levels between the two groups before treatment and on day 1 following treatment(P>0.05).The levels of serum cholinesterase and SOD in the study group on day 2 and 3 following treatment were higher than those in the control group,while the level of MDA was lower than that of the control group(P<0.05).The levels of serum cholinesterase and SOD in the study group on days 1-3 after treatment were higher than those before treatment,while the levels of MDA were lower than those before treatment(P<0.05).The levels of serum cholinesterase and SOD in the control group on days 2-3 after treatment were higher than those before treatment,while the level of MDA was lower than that before treatment(P<0.05).Spearman correlation analyses showed that the levels of serum cholinesterase,SOD,and MDA in the study group before and after treatment were correlated with efficacy and prognosis(P<0.05).Conclusion Vitamin C combined with octreotide in the treatment of cirrhosis and gastrointestinal bleeding can significantly improve efficacy and prognosis by increasing the levels of serum cholinesterase and SOD and reducing the level of MDA.The levels of serum cholinesterase,SOD,and MDA are related to the efficacy and prognosis,and may be used as reference indices for evaluation of the curative effect,which could guide clinical intervention and improve treatment as well as prognosis.