前列地尔联合生长抑素治疗重症急性胰腺炎临床疗效及其对患者炎症因子的影响

Alprostadil combined with somatostatin for treatment of severe acute pancreatitis: Clinical efficacy and impact on inflammatory factors

目的观察前列地尔联合生长抑素治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的临床疗效及对患者炎症因子的影响.方法选取浙江省金华文荣医院消化内科在2013-04/2017-05收治的82例SAP患者,按照随机数字表法平均分为观察组和对照组,对照组在常规治疗基础上加用生长抑素治疗,观察组在常规治疗基础上加用生长抑素联合前列地尔治疗,2 wk一疗程;观察两组患者临床疗效、症状缓解时间、血清炎症因子水平、不良反应及死亡率.结果观察组临床总有效率为92.68%(38/41),对照组临床总有效率为75.61%(31/41),比较差异具有统计学意义(χ~2=4.479,P<0.05).观察组腹痛缓解时间、肠功能恢复时间、血淀粉酶恢复时间、消化内科住院时间均低于对照组,差异具有统计学意义(P<0.05).治疗后两组患者白细胞计数(white blood count,WBC)、C反应蛋白(C-reactive protein,CRP)、淀粉酶(amylase,AMY)、谷丙转氨酶(alanine transaminase,ALT)、谷草转氨酶(aspartate transaminase,AST)、肌酐(creatinine,Cr)水平明显下降,治疗后7、14 d观察组WBC、CRP、AMY、ALT、AST、Cr水平明显低于对照组,差异具有统计学意义(P<0.05).治疗后两组患者内毒素、肿瘤坏死因子-α(tumor necrosis factor alpha,TNF-α)、白介素(interleukin,IL)-6、IL-1β水平明显下降,观察组内毒素、TNF-α、IL-6、IL-1β水平明显低于对照组,差异具有统计学意义(P<0.05).观察组患者治疗期间出现4例头晕头痛、嗜睡,均经对症治疗后好转;观察组死亡率为2.44%(1/41),对照组死亡率为17.07%(7/41),比较差异具有统计学意义(χ~2=4.986,P<0.05).结论前列地尔联合生长抑素治疗SAP疗效确切,患者症状恢复快,能够显著降低患者炎症因子水平,值得临床借鉴.

AIM To observe the clinical efficacy of alprostadil combined with somatostatin in the treatment of severe pancreatitis（SAP） and the influence on inflammatory factors. METHODS Eighty two patients with SAP treated from April 2013 to May 2017 were enrolled in this study. They were randomly divided into either an observation group or a control group. Both groups were given routine treatments and alprostadil, and the observation group was additionally given somatostatin. After 2 wk of therapy, clinical efficacy, symptom remission time, serum inflammatory factor levels, adverse reaction rate, and mortality rate of the two groups were compared. RESULTS The total effective rate was 92.68%（38/41） in the observation group and 75.61%（31/41） in the control group, and there was a significant difference between them（χ~2 = 4.479, P 〈 0.05）. Times to recovery of bowel pain, intestinal function, and blood amylase as well as hospital stay were significantly shorter in the observation group than in the control group（P 〈 0.05）. The levels of white blood count（WBC）, C-reactive protein（CRP）, amylase（AMY）, alanine transaminase（ALT）, alanine transaminase（AST）, and creatinine（Cr） in the observation group were significantly lower than those in the control group at 7 d and 14 d after treatment（P 〈 0.05）. The levels of endotoxin, TNF-α, IL-6, and IL-1β in the observation group were significantly lower than those in the control group（P 〈 0.05）. The mortality rate in the observation group（2.44%, 1/41） was significantly lower than that in the control group（17.07%, 7/41）（χ~2 = 4.986, P 〈 0.05）. CONCLUSION Alprostadil combined with somatostatin in the treatment of severe pancreatitis has obvious efficacy and can reduce symptoms and the inflammatory response quickly.