胰岛素强化治疗对急性胰腺炎患者肠黏膜功能及预后的影响

Effect of intensified insulin therapy on intestinal mucosal function and prognosis of patients with acute pancreatitis

目的探讨胰岛素强化治疗对急性胰腺炎患者肠黏膜功能及预后的影响。方法选取2013年1月至2017年1月青海仁济医院的急性胰腺炎患者50例,采用随机数字表法分为观察组与对照组,各25例。对照组采用常规药物治疗;观察组在对照组基础上采用胰岛素强化治疗。比较2组炎性因子、D-乳酸水平及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的差异。结果治疗后2组C反应蛋白、白细胞介素8、肿瘤坏死因子α均明显低于治疗前[观察组:(50±15)mg/L比(170±33)mg/L、(33.2±2.7)ng/L比(100.3±16.0)ng/L、(17±5)ng/L比(61±17)ng/L,对照组:(80±18)mg/L比(170±31)mg/L、(51.6±8.6)ng/L比(100.3±15.9)ng/L、(29±6)ng/L比(61±18)ng/L],观察组D-乳酸明显低于治疗前[(1.02±0.16)kU/L比(1.62±0.43)kU/L],且观察组上述指标均明显低于对照组(均P<0.05)。治疗后2组APACHEⅡ评分均明显低于治疗前[观察组:(9.6±2.4)分比(26.2±3.1)分,对照组:(14.6±3.1)分比(26.2±3.1)分],且观察组明显低于对照组(均P<0.05)。2组病死率差异无统计学意义(P>0.05)。结论胰岛素强化治疗可通过明显改善急性胰腺炎患者炎性反应程度,保护肠黏膜功能,最终改善预后状况。

Objective To explore the effect of intensified insulin therapy on intestinal mucosal function and prognosis of patients with acute pancreatitis. Methods Fifty patients with acute pancreatitis in Qinghai Renji Hospital from January 2013 to January 2017 were randomly divided into observation group and control group, with 25 cases in each group. The control group had conventional medical treatment; the observation group had intensified insulin therapy on the basis of control group. Levels of inflammatory factors, D-lactate and the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHEⅡ ） score were analyzed. Results Levels of C-reactive protein, intedeukin-8, tumor necrosis factor-or after treatment were significantly lower than those before treatment in both groups [ observation group ： （50 ± 15 ） mg/L vs （ 170 ± 33 ） mg/L, （ 33.2± 2. 7 ） ng/L vs （ 100. 3 ± 16. 0） ng/L, （17±5）ng/Lvs （61±17）ng/L; control group： （80±18）mg/Lvs （170±31）rag/L, （51.6±8.6）ng/Lvs （100. 3±15.9） ng/L, （29 ± 6） ng/L vs （61 ± 18 ） ng/L ] ; level of D-lactate after treatment was significantly lower than that before treatment in observation group [ （ 1.02 ± 0. 16 ） kU/L vs （ 1.62 ±0. 43 ） kU/L] ; levels of C-reactive protein, interleukin-8, tumor necrosis factor-α and D-lactate after treatment in observation were significantly lower than those in control group（P 〈0. 05）. The APACHE Ⅱ score after treatment was significantly lower than that before treatment in both groups [ observation group ： （9.6 ± 2. 4） points vs （ 26.2 ±3. 1 ） points ; control group ： （ 14. 6 ± 3.1 ） points vs （26. 2 ± 3. 1 ） points ] ; the APACHE score after treatment in observation was significantly lower than that in control group（P 〈 0. 05 ）. Fatality rate of patients had no significant difference between groups （P 〉0. 05）. Conclusion Intensified insulin therapy treating acute pancreatitis can significantly reduce inflammatory reaction, protect intestinal mucosal function and improve the prognosis.