生长抑素、生长激素联合治疗重症急性胰腺炎的治疗效果

Therapeutic effect of combined therapy with somatostatin and growth hormone for severe acute pancreatitis

目的探讨生长抑素、生长激素联合治疗重症急性胰腺炎(SAP)的治疗效果。方法56例SAP患者随机分为生长抑素治疗组(予生长抑素十四肽治疗)和联合治疗组(予生长抑素十四肽、生长激素联合治疗),比较两组治疗前、后血浆蛋白、细菌培养、二重感染及CD4^+/CD8^+比值的变化。结果生长抑素治疗组治疗7 d后的血浆白蛋白水平为(26.0±1.5)g/L,与治疗前(24.0±1.3)g/L的差异无统计学意义(P>0.05)。而联合治疗组治疗后血浆白蛋白水平为(31.0±2.1)g/L,显著高于治疗前的(26.0±1.1)g/L(P<0.05)。生长抑素治疗组细菌培养阳性率为100.0%,显著高于联合治疗组的60.7%(P<0.05),以腹水或引流液较易有阳性结果;两组菌种鉴定主要以大肠杆菌和变形杆菌为主。生长抑素治疗组二重感染发生率为57.1%(16/28),与联合治疗组50.0%(14/28)的差异无统计学意义(P>0.05);但联合治疗组中真菌涂片为阳性的14例患者中,有真菌感染临床症状或体征者仅9例,而生长抑素治疗组中真菌涂片为阳性的16例患者均有轻重不一的临床表现。联合治疗组的CD4^+/CD8^+比值呈上升趋势,但与生长抑素治疗组的差异无统计学意义(P>0.05)。结论生长抑素、生长激素联合治疗SAP能降低细菌感染的发生率,减少肠道菌群移位,同时促进机体合成功能,保护肠黏膜屏障。

Objective To evaluate the therapeutic effect of combined therapy with somatostatin and growth hormone in the treatment of severe acute panereatitis （SAP）. Methods Fihy six SAP patients were randomized into two equal groups to receive somatostatin therapy or combined therapy with somatostatin and growth hormone. The changes in the plasma proteins, bacterial culture results, dual infection and CD4^＋/CD8^＋ cell ratio were evaluated in the two groups after the treatments. Results Exclusive somatostatin treatment for 7 days did not result in significant changes in the plasm proteins（[24.0±1.3] g/L before vs [26. ± 1.5] g/L after therapy, P 〉 0.05）, whereas combined therapy with somatostatin and growth hormone significantly increased the plasm proteins （[26. 0±1.1] g/L vs [31.0±2. 1] g/L, P 〈 0. 05）. Patients reeeiving exelusive somatostatin treatment had a bacterial culture positivity rate of 100%, which was significantly higher than that of the combined therapy group （60.7%, P 〈0.05）, and examination of the abdominal drains was more likely to produce positive results, with coliform bacillus and Bacillus proteus as the most common cause of infections. Dual infection occurred in 57. 1 %（14/28） of the patients with somatostatin treatment, similar to the incidence in the patients with combined therapy （50.0%[14/28], P 〉 0.05） ; but in the latter group, only 9 of the 14 patients were positive for fungal infection presented with clinical manifestations or signs, as compared with the former group in which all the 16 fungal infectiow positive patients had clinical manifestations of varying severities. The CD4^＋/CD8^＋ cell ratio tended to increase after the treatment in combined therapy group, but within the range comparable to that in somatostatin group（P 〉0.05）. Conclusion Somatostatin treatment combined with growth hormone may lower the risk of bacterial infections,reduce intestinal bacterial translocation, promote protein synthesis capacity, and protect the integrity of the intestinal mucosal barrier in patients with SAP.