乌司他丁联合奥曲肽治疗急性胰腺炎的疗效及作用机制分析

Efficacy of ulinastatin combined with octreotide in the treatment of acute pancreatitis and its actionmechanism analysis

目的观察急性胰腺炎以乌司他丁（Urinastatin,UTI）、奥曲肽联合治疗的疗效及机制.方法将96例急性胰腺炎患者按随机数表法分为A组和B组,A组UTI联合奥曲肽,B组奥曲肽,各48例.于治疗前（T1）及治疗2周后（T2）检测两组患者血清炎症因子[白介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）]水平和血液流变学指标（血浆比黏度、血小板粘附率、全血比黏度高切）状态,T2时评估疗效.结果A组总有效率（95.83%）高于B组（81.25%）（χ2=5.031,P=0.025）.T2时,两组血清IL-8、TNF-α、IL-6水平（26.63±5.49、34.53±6.51,24.63±8.2122.04±4.27、29.56±5.51）ng/L,均较T1时（48.21±7.19、49.19±7.85,61.2641.59±6.63、40.57±5.75）ng/L降低（t=16.527、9.959,18.106、14.201,17.175、9.578,均P〈0.05）,且A组低于B组（t=6.427,3.833,7.474,均P〈0.05）.T2时,两组血浆比黏度、血小板粘附率、全血比黏度高切[（1.76±0.13、1.94±0.22,36.54±6.51、49.78±8.47）%,（5.24±0.7均较T1时[（2.15±0.36、2.16±0.37,81.35±13.46、81.36±13.48）%,（6.28±1降低（t=7.059、3.541,20.764、13.743,5.144、2.256,均P〈0.05）,且A组低于B组（t=4.880,8.580,3.197,均P〈0.05）.结论UTI联合奥曲肽治疗急性胰腺炎可显著提高疗效,减轻炎症反应,改善血液微循环,于病情转归有利.

Objective To observe the efficacy and action mechanism of ulinastatin （UTI） combined with octreotide in the treatment of acute pancreatitis. Methods 96 cases of acute pancreatitis were divided into the group A （UTI and octreotide, n=48） and the group B （octreotide, n=48） according to the random number table method. The levels of serum infammatory factors [interleukin -8 （IL-8）, tumor necrosis factor α （TNF-α）, interleukin -6 （IL-6）] and the blood rheology indexes （plasma viscosity, platelet adhesion rate, high shearing of whole blood viscosity） were measured before treatment （T1） and after 2 weeks of treatment （T2）, and the effcacy was evaluated at T2. Results The total effective rate in the group A was higher than that in the group B （95.83% vs.81.25%; χ2 =5.031, P=0.025）. At T2, the levels of serum IL-8, TNF-α, IL-6 in the two groups[（26.63±5.49）, （34.53±6.51）, （24.63±8.21）, （31.48±9.27）, （22.04±4.27）, （29.56±5.51） ng/L] were lower than those at T1 [（48.21±7.19）, （49.19±7.85）, （61.26±11.36）, （60.84±10.92）, （41.59±6.63）, （40.57±5.75） ng/L] （t=16.527, 9.959, 18.106, 14.201, 17.175, 9.578; P〈0.05）, those in the group A were lower than those in the group B （t=6.427, 3.833, 7.474; P〈0.05）. At T2, plasma viscosity, platelet adhesion rate, high shearing of whole blood viscosity in the two groups [（1.76±0.13）%, （1.94±0.22）%, （36.54±6.51）%, （49.78±8.47）%, （5.24±0.77）, （5.79±0.91） map/s] were lower than those at T1 [（2.15±0.36）%, （2.16±0.37）%, （81.35±13.46）%, （81.36±13.48）%, （6.28±1.18）, （6.27±1.16） map/s] （t=7.059, 3.541, 20.764, 13.743, 5.144, 2.256; P〈0.05）, those in the group A were lower than those in the group B （t=4.880, 8.580, 3.197; P〈0.05）. Conclusion UTI combined with octreotide in the treatment of acute pancreatitis can signifcantly improve the effcacy, reduce infammatory reaction, and improve the blood microcirculation, and it is favorable for prognosis of the disease.