生长抑素联合中药对急性胰腺炎患者免疫功能的影响及临床疗效

Immuno-modulatory effect of somatostatin combined with traditional Chinese medicine on severe acute pancreatitis at early stage: A randomized control trial

目的:观察早期短程连续使用生长抑素思他宁对重症急性胰腺炎(severeacutepancreatitis,SAP) 患者免疫功能的影响及其临床疗效。方法:2003年1月～2004年6月共纳入的39例SAP患者按随机数字 表分组,其中对照组20例,接受中西医结合非手术治疗;治疗组19例加用思他宁,以250μg/h的剂量连续 给药72h。于治疗前后采血进行实验室检查及流式细胞仪检测,同时记录临床疗效指标。另对30例健康自 愿献血者作CD3、CD4、CD8的正常值检测。结果:(1)对照组与治疗组治疗前的外周淋巴细胞CD3、CD4、 CD4/CD8明显低于健康人组(P<0.05),但两组间无显著差异;第4天时治疗组CD3、CD4、CD4/CD8水平明 显升高,其中CD4、CD4/CD8高于对照组(P<0.05)。(2)急性期C反应蛋白在治疗前和第4天无显著差异, 第7天时治疗组明显低于对照组(P<0.05);治疗组白细胞计数、血清淀粉酶、脂肪酶、乳酸脱氢酶、天冬氨 酸氨基转移酶、急性生理和慢性健康评价指标Ⅱ(AcutePhysiologyandChronicHealthEvaluationⅡ,A PACHEⅡ)积分均比对照组恢复要快(P<0.05)。(3)两组间器官功能不全发生率和局部并发症发生率、 病死率无显著差异(P<0.05)。结论:早期短程使用生长抑素能改善SAP患者受损的细胞免疫功能,改善 病情;但对病死率和并发症发生率的影响还有待进一?

Objective： To evaluate the immuno-modulatory effect of short course administration of somatostatin （stilamin） continuously at early stage in patients with severe acute pancreatitis （SAP）.Methods： Thirty-nine patients with SAP （22 men, 17 women; the middle age was 49 years）were randomly allocated into control group （20 patients treated with non-surgical integrated traditional Chinese and Western medicine） and treatment group （ 19 patients treated with somatostatin administered intravenously at a dosage of 250 μg/h for consecutive 72 hours as well as the treatment for the control group）. Laboratory parameters,including the expressions of CD3, CD4 and CD8 in lymphocytes （tested by flow cytometry） and C reactive protein （CRP）, and indexes of therapeutic effect, including the occurrence of organic dysfunction, local complication and mortality between the two groups were compared. Another group of 30 healthy volunteers（19 men, 11 women; the middle age Was 47 years） were recruited for testing the normal levels of CD3, CD4 and CD8. Results： （1） The levels of CD3, CD4 and CD4/CD8 in lymphocytes before treatment in both groups were significantly lower than those in the healthy subjects （ P〈0. 05）, but there were no statistical differences between the two groups. At the 4t＂ day, CD3, CD4 and CD4/CD8 increased significantly in the treatment group （P〈 0.05） while no changes in the control group; the levels of CD4 and CD4/CD8 in the treatment group were also higher than those in the control group （P〈 0.05）. （2） The CRP levels of the 2 groups showed no statistical difference before and 4 days after the treatment, but the CRP level in the treatment group was significantly lower than that in the control group at the 7^th day （ P〈 0.05）. WBC count, serum levels of amylase, lipase, lactate dehydrogenase, aspartate aminotransferase, as well as the score of APACHE It in the treatment group recovered more quickly than those in the control group （P〈0.05）. （3） The occurrences of organic dysfunctions, local complications and mortality in both groups were not statistically different. Conclusion. The short course administration of somatostatin continuously at early stage can reduce the inflammatory response, up-regulate the cell immune function and improve the conditions of the patients with SAP, but its effect on mortality and morbidity needs further study.