乌司他丁与加倍酯治疗急性胰腺炎的疗效比较

Therapeutic effect of ulinastatin vs gabexate mesilate in management of acute pancreatitis

目的:回顾性比较及分析乌司他丁与加倍酯治疗急性胰腺炎(acute pancreatitis,AP)的疗效.方法:回顾我院2008-2012年收治的AP患者,筛选应用乌司他丁和/或加倍酯的患者共124例,比较其用药后症状(腹痛)、体征(腹部压痛)及实验室指标恢复正常所需的时间.结果:胆源性胰腺炎应用加倍酯较单用乌司他丁,其血淀粉酶、白细胞、中性粒细胞分数恢复正常所需时间(4.83d±1.13d vs7.52d±2.89d;6.23d±2.10d vs9.23d±3.56d;8.01d±1.58d vs12.12d±2.56d)及症状、体征缓解时间(3.72d±1.84d vs6.56d±3.25d;5.89d±2.51d vs9.58d±3.54d)明显缩短,差异显著,有统计学意义(P<0.05).非胆源性胰腺炎单用加倍酯或乌司他丁其临床症状、体征缓解时间及各实验室指标恢复正常所需时间均无明显差异.联合应用乌司他丁与加倍酯可明显缩短血淀粉酶、脂肪酶、白细胞、中性粒细胞分数、血糖恢复时间(4.22d±1.77d vs7.18d±2.25d;8.23d±1.36d vs14.56d±2.03d;4.23d±2.56d vs8.89d±2.35d;6.87d±0.79d vs11.23d±2.03d;7.89d±1.24d vs11.23d±2.75d)及腹痛、腹部压痛缓解时间(3.15d±1.23d vs5.78d±2.56d;4.12d±0.55d vs7.25d±2.12d),差异显著,有统计学意义(P<0.05).结论:加倍酯及乌司他丁均可有效的治疗急性胰腺炎,针对胰腺炎是否为胆源性,其作用疗效不同.因此,针对胰腺炎的诱发原因选用不同的抑酶制剂,可取得事半功倍的效果.

AIM： To compare the therapeutic effect of ulina- statin vs gabexate mesilate in the management of acute pancreatitis. METHODS： One hundred and twenty-four pa- tients with acute pancreatitis who were treated by gabexate mesilate and/or ulinastatin were enrolled. The time required for the relief of symptoms, signs and for the recovery of labora- tory parameters after medication were compared between the two groups. RESULTS： Compared to ulinastatin treatment, treatment with gabexate mesilate was associated with shorter time required for the relief of symp- tom, signs （3.72 d ± 1.84 d vs 6.56 d ± 3.25 d; 5.89 d ± 2.51 d vs 9.58 d ± 3.54 d, both P 〈 0.05） andfor the recovery of amylase, WBC, GR% （4.83 d ± 1.13 d vs 7.52 d ± 2.89 d; 6.23 d ± 2.10 d vs 9.23 d ± 3.56 d; 8.01 d ± 1.58 d vs 12.12 d vs 2.56 d; all P 〈 0.05） in patients with biliary pancreatitis; however, these parameters showed no signifi- cant difference in patients with non-biliary pan- creatitis. Combined use of gabexate mesilate and ulinastatin could significantly shorten the time required for the relief of symptoms, signs （3.15 d ± 1.23 d vs 5.78 d ± 2.56 d; 4.12 d vs 0.55 d vs 7.25 d ± 2.12 d, both P 〈 0.05） and for the recovery of amylase, lipase, WBC, GR% （4.22 d ± 1.77 d vs 7.18 d ± 2.25 d; 8.23 d ± 1.36 d vs 14.56 d ± 2.03 d; 4.23 d ± 2.56 d vs 8.89 d ± 2.35 d; 6.87 d ~ 0.79 d vs 11.23 d ± 2.03 d; 7.89 d ± 1.24d vs 11.23 d ± 2.75 d; all P 〈 0.05） and blood glucose. CONCLUSION： Both gabexate mesilate and ulinastatin are effective in the management of acute pancreatitis; however, their therapeutic effects differ significantly between patients with biliary pancreatitis and those with non-biliary pancreatitis.