低分子肝素联合乌司他丁对急性胰腺炎患者Th1/Th2平衡的影响

Effect of low molecular weight heparin combined with ulinastatin on acute pancreatitis in patients with type Th1/Th2 cytokine

目的观察低分子肝素联合乌司他丁对急性胰腺炎患者Th1/Th2型细胞因子的影响。方法选取2015年3月-2016年12月在内蒙古医科大学附属医院肝胆胰腺脾科接受治疗的急性胰腺炎患者90例,采用随机数字表法分为观察组和对照组,每组各45例,对照组患者给予乌司他丁治疗,观察组患者给予低分子肝素联合乌司他丁治疗,观察2组患者治疗后临床症状恢复情况,并分析2组患者治疗前后IFN-γ、TNF-α、IL-4与IL-10的改善情况。结果 (1)治疗后,观察组患者在腹痛消失时间、白细胞恢复时间、血清淀粉酶恢复正常时间、肠鸣音恢复、脂肪酶恢复正常及C-反应蛋白恢复时间上与对照组比较,差异有统计学意义(P<0.05);(2)2组患者在治疗第4天时,血清IFN-γ和TNF-α表达水平均较治疗前有明显改善(P<0.05),在治疗1周时,血清IFN-γ和TNF-α均较治疗4天时改善(P<0.05)。治疗1周时,观察组患者改善优于对照组(P<0.05),观察组患者在治疗4天和1周时,血清TNF-α较对照组明显下降(P<0.05);(3)2组患者治疗第4天时,血清IL-4与IL-10表达水平均较治疗前有明显改善(P<0.05),在治疗1周时,血清IL-4与IL-10均较治疗4天时改善(P<0.05)。治疗1周时,观察组患者血清IL-4与IL-10改善均优于对照组(P<0.05)。结论给予急性胰腺炎患者低分子肝素联合乌司他丁联合治疗,可有效调节患者炎性细胞因子释放,促进Th1/Th2类型细胞因子平衡,显著改善患者的临床症状。

Objective To investigate the effect of low molecular weight heparin machine combined with ulinastatin on acute pancreatitis in patients with type Th1/Th2 cytokine.Methods 90 patients with acute pancreatitis from March 2015-2016 year in Department of hepatobiliary and pancreatic medicine of affiliated hospital of inner mongolia medical university,the patients were randomly divided into 2 groups,45 cases in each group.The control group were treated with ulinastatin treatment,while observation group were treated with low molecular weight heparin combined with ulinastatin treatment.The recovery of clinical symptoms of the two groups of patients were observed after the treatment and the level of IFN-,TNF-α,IL-4 and alpha gamma IL-10 were analyzed before and after treatment in two groups.Results(1)After treatment,the time of disappearance of abdominal pain,recovery time of white blood cells,recovery of serum amylase from normal time,recovery of bowel sounds,recovery of lipase and recovery time of C-reactive protein were better than those of control group(P <0.05);(2)On the fourth day of the treatment,the levels of IFN-and TNF-αin serum were significantly higher than those before treatment(P<0.05).After treatment for 1 week,the levels of IFN-and TNF-αin serum were significantly higher compared with the levels on the 4 th day after the treatment.Serum TNF-α was significantly lower in the observation group at 4 and 1 week after treatment.After 1 weeks of treatment,the patients in the observation group were better than thoes in the control group(P<0.05).The serum TNF-αof patients treated for 4 days and 1 weeksin the observation group decreased significantly compared with the control group(P <0.05);(3)In both groups the expression of serum IL-4 and IL-10 levels were significantly improved at the fourth day of treatment compared with those before treatment(P <0.05).After 1 weeks of treatment,serum IL-4 and IL-10 were improved compared with those at the 4 th day after treatmentment(P <0.05).The serum IL-4 and IL-10 in the observation group was better than that in the control group at 1 weeks(P <0.05).Conclusion To give acute pancreatitis patients with low molecular weight heparin combined with ulinastatin combination therapy,can effective regulate the release of inflammatory cytokine and balance Th1/Th2 type of cytokine,which can significantly improve the clinical symptoms of patients.