大黄对重症急性胰腺炎患者血清高迁移率族蛋白B1影响的临床研究

Clinical study on influence of Rheum officinale on serum high mobility group protein B1 in patients with severe acute pancreatitis

目的观察大黄灌肠对重症急性胰腺炎(SAP)患者血清高迁移率族蛋白B1(HMGB1)的影响。方法选取2014年10月至2016年10月该院收集SAP患者60例,分为观察组和对照组,各30例,对照组给予常规治疗,观察组加用大黄治疗,分别在入院后第1、3、5天动态监测患者血清HMGB1水平,对患者进行急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,观察患者胃肠功能恢复时间、连续性肾脏替代疗法(CRRT)治疗时间。结果入院第1天,两组患者血清HMGB1水平比较,差异无统计学意义(P>0.05);第5天观察组患者血清HMGB1水平较第1天明显降低,且低于对照组,差异均有统计学意义(P<0.05)。观察组第3天与第1天血清HMGB1水平的差值与第3天APACHEⅡ评分呈明显负相关(r=-0.604,P<0.05)。观察组腹痛、腹胀缓解时间,排气、排便时间及CRRT治疗时间均较对照组短,差异均有统计学意义(P<0.05)。结论大黄可能通过有效抑制晚期炎性因子HMGB1的表达,改善SAP患者的症状和转归。

Objective To observe the effect of rhubarb enema on serum level of high mobility group protein 131 （HMG131） in patients with severe acute pancreatitis （SAP）. Methods A total of 60 cases of patients with SAP in our hospital were collected from October 2014 to October 2016, and were randomly divided into the observation group and control group （30 cases in each group）. Serum levels of HMG131 were dynamically detected on the 1st, 3rd and 5th day after admission. The acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） was conducted. The recovery time of gastrointestinal function and time for continuous renal replacement therapy （CRRT） were observed. Results On the 1st day after admission, no statistically significant difference was found in serum level of HMG131 between the two groups （P〉0.05）. The serum level of HMGB1 in the observation group was obviously decreased on the 5th day after admission,which was lower than that in the control group, there was statistically signifi- cant difference（P〈0.05）. In the observation group,the value of difference between serum level of HMGB1 on the 1st day after ad- mission and that on the 3rd day after admission was significantly negatively related with the APACHE Ⅱ score on the 3rd day after admission（r=- 0. 604, P〈0.05）. In the observation group, the remission time of abdominal pain and abdominal distension, first time of exhaust and defecation and time for CRRT were significantly shorter than those in the control group, there were statistically significant differences （P〈0.05）. Conclusion Rhubarb could improve symptoms and prognosis of patients with SAP through ef- fectively inhibit the expression of HMGB1.