乌司他丁联合大剂量氨溴索对急性呼吸窘迫综合征患者细胞因子的影响

Influence of ulinastatin combined with large-dose ambroxol on the cytokines in patients with acute respiratory distress syndrome

目的观察乌司他丁联合大剂量氨溴索对急性呼吸窘迫综合征(ARDS)患者细胞因子的影响。方法将173例入住重症监护室(ICU)的ARDS患者随机分成4组:A组43例,采用常规综合治疗和机械通气治疗;B组43例,在A组基础上加用大剂量氨溴索治疗;C组42例,在A组基础上加用乌司他丁治疗;D组45例,在A组基础上加用乌司他丁和大剂量氨溴索治疗,共7 d。观察4组患者治疗前后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)水平的变化,记录28 d病死率。结果 C、D 2组治疗后48 h以及治疗后7 d的TNF-α、IL-6、IL-8水平显著低于A组(P<0.01),而IL-10水平只在治疗后48 h显著低于A组(P<0.01);B、C、D组28 d病死率低于A组,但差异无统计学意义(P>0.05)。结论乌司他丁联合大剂量氨溴索治疗能降低ARDS患者的TNF-α、IL-6、IL-8水平,对ARDS患者有较好的治疗作用。

Objective To observe the influence of ulinastatin combined with large-dose ambroxol on the cytokines in patients with acute respiratory distress syndrome（ ARDS）. Methods A total of 173 patients with ARDS admitted into Intensive Care Unit（ ICU） were randomly divided into 4groups. Group A（ n = 43） was treated with comprehensive therapy and mechanical ventilation. On this basis,group B（ n = 43）,group C（ n = 42） and group D（ n = 45） were added large-dose ambroxol,ulinastatin as well as ulinastatin combined with large-dose ambroxol respectively. The changes of tumor necrosis factor-α（ TNF-α）,interleukin-6（ IL-6）,IL-8 and IL-10 levels were observed among 4groups before and after treatment,and 28-days mortality was also recorded. Results The levels of TNF-α,IL-6 and IL-8 in the groups C and the group D were significantly lower than those in 48 hours and 7 days after treatment in the group A（ P 0. 01）,while IL-10 was markedly lower than the group A in 48 hours after treatment（ P 0. 01）. The 28-days mortality of group B,group C and group D were all lower than that of group A（ P 0. 05）. Conclusion Ulinastatin combined with large-dose ambroxol can decrease the levels of TNF-α,IL-6 and IL-8 in the patients with ARDS,so it has a better therapeutic effect in the treatment of ARDS.