乌司他丁联合生长抑素治疗重症急性胰腺炎对免疫及血管内皮功能的影响

Effects of Ulinastatin Combined With Somatostatin on Immune and Vascular Endothelial Function in Patients With Severe Acute Pancreatitis

目的探讨乌司他丁联合生长抑素治疗重症急性胰腺炎对免疫及血管内皮功能的影响。方法选取2015年5月—2017年5月在我院确诊治疗的SAP患者140例,随机分为对照组(n=70)和观察组(n=70),对照组患者给予基础对症治疗及乌司他丁治疗,观察组在对照组的基础上给予注射用生长抑素滴注给药,连续用药7 d。所有患者于治疗前后抽血检测肿癌坏死因子(TNF-a)、白细胞介素(IL-6)、C-反蛋白(CRP)、血管性血友病因子(v WF)、一氧化氮(NO),检测CD4细胞及CD8细胞的比例,测定血浆血栓素B2(TXB2)、内皮素(ET)、6-酮-前列环素(6-keto-PGF1α)浓度,记录所有患者腹胀、腹痛、恶心呕吐、腹膜刺激征等临床症状并进行统计分析。结果两组患者治疗后血清IL-6、TNF-a和CRP水平与治疗前相比均降低(P<0.05),治疗后观察组比对照组降低更加显著(P<0.05);两组患者CD4细胞比例及CD4/CD8均较治疗前升高,而且观察组升高更明显,差异有统计学意义(P<0.05),两组治疗后血浆TXB2、v WF、ET水平降低,NO及6-keto-PGF1α水平升高,与治疗前比较差异有统计学意义(P<0.05);观察组治疗后血浆TXB2、v WF、ET水平低于对照组,NO及6-keto-PGF1α水平高于对照组,两组间比较差异有统计学意义(P<0.05)。观察组腹胀、腹痛、恶心呕吐、腹膜刺激征缓解时间低于对照组,差异有统计学意义(P<0.05)。结论乌司他丁联合注射用生长抑素治疗可有效提高SAP患者治疗疗效,无明显副反应,临床治疗效果确切,效果优于单独应用乌司他丁。

Objective To investigate the effects of ulinastatin and somatostatin on immune and vascular endothelial function and the curative effect in severe acute pancreatitis（SAP）. Methods From May 2015 to May 2017, diagnosis and treatment of 140 cases of SAP in our hospital were randomly divided into control group（n =70） and observation group（n =70）, the control group was given basic treatment, and ulinastatin treatment. The observation group was given somatostatin for injection drip on the basis of the control group, continuous medication for 7 d. All the patients before and after treatment were detected tumor necrosis factor（TNF-a）, interleukin（IL-6）, C-protein（CRP）, von Willebrand factor（v WF） and nitric oxide（NO）, detection of CD4 cells and CD8 cell ratio, plasma thromboxane B2（TXB2） and endothelin（ET）, 6-keto prostacyclin（6-keto-PGF1α） concentration, all patients with abdominal distension, abdominal pain, nausea and vomiting, peritoneal irritation and other symptoms were statistically analyzed. Results The serum levels of IL-6, TNF-a and CRP in the two groups after treatment were lower than those before treatment（P 0.05）. After treatment, the observation group than the control group decreased more significantly（P 0.05）; The CD4 cell ratio and CD4/CD8 in the two groups were significantly higher than those before treatment, and the observation group increased more significantly there were significant differences（P 0.05）, TXB2, v WF, plasma ET levels decreased in two groups after treatment, NO increased and 6-keto-PGF1αlevels, there were significant differences compared with before treatment（P 0.05）; plasma TXB2, v WF, ET levels after treatment in the observation group than in the control group, NO and 6-keto-PGF1αlevels higher than that of control group, there were significant differences between the two groups（P 0.05）. The duration of abdominal distension, abdominal pain, nausea and vomiting, and peritoneal irritation in the observation group were significantly lower than those in the control group（P 0.05）. Conclusion Ulinastatin combined with somatostatin for Injection treatment can effectively improve the curative effect in the treatment of patients with SAP, there is no obvious adverse reaction, clinical treatment effect is better than the single application of ulinastatin.