褪黑素联合前列地尔在急性胰腺炎中的作用研究

Clinical study on melatonin combined with alprostadil in the treatment of patients with acutepancreatitis

目的观察褪黑素联合前列地尔在急性胰腺炎患者中的治疗效果。方法急性胰腺炎患者70例，常规治疗后死亡14例设为I组，经常规治疗后治愈28例设为Ⅱ组，褪黑素联合前列地尔＋常规治疗治愈28例设为Ⅲ组。每组再按6h、48h,4d时间点采血，检测白细胞计数、血气分析、血淀粉酶、内毒素及丙二醛（MDA）的含量。结果I组6h、48h、4d白细胞计数、血淀粉酶、内毒素、MDA较Ⅱ、Ⅲ组明显升高（P〈0．05），内毒素于4d达最高值[（273．5±20．4）pg／L]，MDA于4d达最高值[（5．12±0．87）斗mol／L]。Ⅲ组48h、4d白细胞计数、动脉血二氧化碳分压（PaCO2）、血淀粉酶、内毒素及MDA较I、Ⅱ组均降低（P〈0．05）。结论褪黑素联合前列地尔既抗氧化、抗炎、抗凋亡，又改善了胰腺、肺、小肠的微循环，同时保护细胞膜及溶酶体膜，有效防止了胰腺各种消化酶的释放；有效抑制肠道内细菌易位，减少了肠源性内毒素的产生及促炎因子释放，有效减轻了急性胰腺炎患者的全身炎性反应。

Objective To observe the results of melatonin combined with alpmstadil in the treatment of patients with acute pancreatitis. Methods Seventy patients with acute pancreatitis were included in the study, 14 patients died after conventional treatment were set to group I , 28 patients cured after conventional treatment were set to group Ⅱ and 28 cases cured after melatonin combined with alprostadil and conventional treatment were set to group Ⅲ. White blood cell count, blood gas analysis, serum amylase, endotoxin and malondialdehyde （MDA） content was detected at 6 h, 48 h and 4 d. Results White blood cell count, serum amylase, endotoxin, MDA content at 6 h, 48 h and 4 d in group I were higher than those in group Ⅱ, Ⅲ （P 〈 0.05 ）. Endotoxin levels reached a maximum in the 4 d [ （273,5 ± 20.4） pg/L ], and MDA content reached a maximum in the 4 d [（5.12 ± 0.87）μmol/L]. White blood cell count, partial pressure of carbon dioxide in artery （PaC02）, serum amylase, endotoxin and MDA content at 48 h, 4 d in group Ⅱ were lower than those in group I , Ⅱ （P 〈 0.05）. Conclusions Melatonin combined with alprostadil not only shows antioxidant, anti-inflammatory, anti-apoptotic effect but also improves the pancreas, lung, small intestine microcirculation, protects the cell membrane and the lysosomal membrane, and prevents effectively the pancreatic digestive enzymes release; also it inhibits intestinal bacterialtranslocation, reduces the generation of gut-derived endotoxin and pro-inflammatory cytokine release. It can reduce effectively the systemic inflammatory response in acute pancreatitis.