奥曲肽与生长抑素辅助治疗非胆源性急性中重症胰腺炎的效果及对炎性介质的影响

The effect of Octreotide and somatostatin in adjuvant therapy of non biliary acute moderate and severe pancreatitis and its influence on inflammatory mediators

目的比较奥曲肽与生长抑素辅助治疗非胆源性急性中重症胰腺炎的效果及对炎性介质的影响。方法入选2015年10月~2017年3月解放军第一〇五医院收治的118例非胆源性急性中重症胰腺炎患者为研究对象,根据随机数字表法将其分为A组(61例)、B组(57例)。在常规治疗的基础上,A组给予奥曲肽方案,B组给予生长抑素方案,疗程7 d。比较两组临床指标恢复时间、疗效及并发症发生率。结果两组患者腹痛、体温、白细胞计数、血清淀粉酶恢复正常时间及平均住院时间比较差异均无统计学意义(P>0.05)。治疗7 d,两组急性生理和慢性健康评分(APACHEⅡ)下降数值比较差异无统计学意义(P>0.05);两组治疗后总有效率比较差异无统计学意义(P>0.05);两组外周血肿瘤坏死因子α(TNF-α)、白介素(IL)-6、IL-8、超敏C反应蛋白(hs-CRP)下降数值比较,差异均无统计学意义(P>0.05)。两组治疗期间假性胰腺囊肿、肺部感染、消化道出血、呼吸衰竭、胃肠胀气发生率比较,差异均无统计学意义(P>0.05),A组治疗中低血糖发生率显著低于B组(P<0.05)。结论奥曲肽、生长抑素辅助治疗非胆源性急性中重症胰腺炎效果相近,均能显著降低炎性介质表达,使用生长抑素低血糖发生率高于奥曲肽。

Objective To compare the efficacy of Octreotide and somatostatin in adjuvant therapy of non biliary acute moderate and severe pancreatitis and its influence on inflammatory mediators. Methods One hundred and eighteen cases of non biliary acute moderate and severe pancreatitis treated in PLA 105 Hospital from October 2015 to March 2017 were selected as research objects and divided into group A（61 cases） and group B（57 cases） according to random number table method. On the basis of routine treatment, group A and B were treated with Octreotide and somatostatin respectively for 7 days, and the recovery time of clinical indices, efficacy and complications of the two groups were compared. Results The recovery time on abdominal pain, fever, white blood cell count, serum amylase and the mean hospitalization time between the two groups had no significant differences（P〉0.05）. After treatment for 7 days, the differences on decreased acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） scores of the two groups were not statistically significant（P〉0.05）. The overall efficacy of the two groups had no significant difference（P〉0.05）; the decreased values of the two groups on tumor necrosis factor-α（TNF-α）, interleukin（IL）-6, IL-8, high-sensitivity C-reactive protein（hs-CRP） showed no statistically significant difference（P〈0.05）. The incidence of pancreatic pseudocyst, pulmonary infection, gastrointestinal bleeding, respiratory failure, flatulence in the two groups had no significant differences（P〉0.05）. Group A had a lower hypoglycemia rate than that of group B（P〈0.05）. Conclusion Octreotide and somatostatin in adjuvant therapy of non biliary acute moderate and severe pancreatitis has similar efficacy, both can significantly reduce inflammatory mediators, but hypoglycemia incidence is higher than that of somatostatin treatment.