加贝酯对胆源性重症胰腺炎免疫功能的影响

Effects of Gabexate on Immunity in Patients with Biliary Sever Acute Pancreatitis

目的观察加贝酯对胆源性重症胰腺炎(SAP)患者免疫功能的影响.方法将30例胆源性SAP患者按随机原则分为加贝酯组(常规治疗+加贝酯15例)和对照组(15例).治疗7d后对患者临床效果、器官功能障碍(Marshal)l和急性病理生理和慢性健康评分系统(APACHE-Ⅱ)评分、ICU住院天数、第28天死亡率进行比较,同时在治疗前、治疗后3d、7d、28d采血,观察肿瘤坏死因子(TNF-α)及IL-10、T淋巴细胞亚群百分比及单核细胞HLA-DR表达和单核细胞数目的变化.结果(1)加贝酯组患者病情明显改善,血淀粉酶及ICU住院天数,APACHE-Ⅱ评分及Marshall评分与对照组差异有统计学意义(P<0.05).(2)加贝酯组患者第3、7、28天TNF-α及IL-10、T抑制细胞(Ts)百分比下降;总T淋巴细胞、T辅助细胞(Th)、单核细胞HLA-DR表达(百分比)和单核细胞数目均较对照组明显上升(P<0.05).结论加贝酯治疗能明显改善胆源性SAP患者病情及预后,提高机体免疫功能,改善患者单核细胞抗原呈递能力,减少ICU住院时间.

Objective To investigate of effects of gabexate on immunity in patients with biliary sever acute pancreatitis （SAP）. Methods 30 patients, diagnosed as biliary SAP, were divided into control group （15 patients ） and gabexate group （ therapy group, 15 patients） randomly. The eontrol group was given routine therapy while the therapy group was treated with gabexate for 7 days additionally, and two groups were observed for 28 flays. The clinical prognosis, the score of Marshall and APACHE- Ⅱ , the duration of ICU stay, the 28th mortality were compared, and the blood samples were taken from those patients before and after therapy on the 3rd, 7th, 28th day to measure the levels of plasma cytokines such as TNF- α, IL-10. Meanwhile, The effects of gahexate treatment on peripheral monocytes, monocytes HLA-DR expression and percent of T lymphocyte were also studied. Results （1） After gabexate treatment for 7 d, compared with the control group, the clinical prognosis was improved, the score of Marshall and APACHE- Ⅱ and the level of α-amlase decreased significantly （ P 〈 0.05） , the ICU length of stay decreased significantly also （ P 〈 0.05 ）. （2） After the treatment for 7 d, the levels of TNF- α and IL-10 and the percent of suppressor T lymphocyte （Ts） in therapy group decreased significantly, while levels of peripheral monocytes, HLA-DR expression and percent of helper T lymphocyte （Th） in gabexate group increased significantly （P 〈 0.05）. Conclusion Gabexate can not only effectively help to improve the prognosis of patients with biliary SAP, but also raise their immunity and HLA-DR expression, and decreased the length ICU of stay.