前列腺素E1治疗重症急性胰腺炎的临床研究

The clinical study of prostaglandin E1 in treatment of patients with severe acute pancreatitis

目的探讨前列腺素E1(PGE1)在治疗重症急性胰腺炎(SAP)中的作用。方法将42例SAP患者随机分为治疗组和对照组各21例,于入院后第1、5、10d检测外周血内毒素、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及超敏C反应蛋白(HsCRP);监测血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-二聚体(D-dimer);检测血清淀粉酶和乳酸脱氢酶(LDH)和清蛋白(ALB);比较两组治疗10d后APACHEⅡ评分、CT评分、住ICU时间、病死率及中转手术率。结果治疗5d和10d后,治疗组内毒素、TNF-α、IL-6和HsCRP均低于对照组(P<0.05);治疗组血清淀粉酶和LDH均低于对照组(P<0.05);治疗组PLT高于对照组;D-dimer、FIB、APTT和PT低于对照组(P<0.05);治疗10d后治疗组APACHEⅡ评分低于对照组(P<0.05);治疗组住ICU时间短于对照组(P<0.05);两组28d病死率差异无统计学意义(P>0.05);治疗组中转手术率低于对照组(P<0.05)。结论 PGE1可减轻SAP患者炎症介质和细胞因子的过度释放,改善胰腺的微循环,纠正高凝状态,改善预后,有较好的临床疗效。

Objective To explore significance of the prostaglandin E1（PGE1）in severe acute pancreatitis.Methods42 patients with severe acute pancreatitis were randomly divide into the treatment group and the control group.Each group had 21 patients.The peripheral blood endotoxin,tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）and high sensitive C reactive protein（Hs-CRP）,PLT and the blood coagulation indexes of patients（D-dimer,FIB,APTT and PT）,serum amylase and lactatedehy drogenase（LDH）and serum albumin（ALB）were detected on the first,4th,7th day after admission.After 10 dtreatment,acute physiology and chronic health evaluation（APACHE Ⅱ score）and CT score,time in ICU,the mortality of 28 dand transit operation rate were compared in the two groups.Result After the treatment for 5d,10 d,the endotoxin,TNF-α,IL-6and Hs-CRP of treatment group were lower than that of control group（P0.05=.The serum amylase and LDH of treatment group were lower than that of control group（P0.05）.The PLT of treatment group were higher than that of control group.D-dimer,FIB,APTT and PT of treatment group were lower than that of control group（P0.05）.After the treatment for 10 d,APACHE Ⅱ score of treatment group were lower than that of control group（P0.05）.The time in ICU of treatment group were shorter than that of control group（P0.05）.There was no statistical significance in the mortality of 28 din the two groups（P0.05）.The transit operation rate of treatment group were lower than that of control group（P0.05）.Conclusion PGE1 can reduce acute phase inflammatory mediators and the release of cytokines,improve the pancreatic microcirculation,correct the hypercoagulable state,and improve the prognosis of patients with SAP.