清肝利胰汤治疗急性胰腺炎的临床疗效及对血清炎性因子的影响

Clinical Curative Study of Using Qinggan Liyi Decoction in the Treatment of Severe Acute Pancreatitis and Effect on Serum Inflammatory Factors

目的:观察清肝利胰汤治疗急性胰腺炎的临床疗效,以及相关炎性因子的水平变化,并对其治疗效果进行评价。方法:选取112例急性胰腺炎并且辨证为肝胆湿热型患者,随机分为对照组和观察组,对照组55例,观察组57例,对照组患给予口服西咪替丁,静脉滴注醋酸奥曲肽注射液治疗,观察组在对照组基础上给予清肝利胰汤治疗,10天为1疗程,根据病情治疗1~2个疗程。检测2组患者治疗前后血清中炎性因子:肿瘤坏死因子α(TNF-α)、白介素1β(IL-1β)及白介素6(IL-6),胃肠激素指标:胃动素(MTL)、胃泌素(GAS)及胆囊收缩素(CCK)的水平,并进行统计分析;观察腹痛腹胀、恶心呕吐、发热、肠鸣音、腹部压痛消失时间,同时监测血淀粉酶、尿淀粉酶恢复时间;观察并记录治疗前、治疗后5天、10天及15天APACHEⅡ评分;同时比较2组的疗效。结果:2组患者在治疗2个疗程后炎性因子的水平明显降低(P<0.05),MTL明显高于治疗前(P<0.05),GAS、CCK明显低于治疗前(P<0.05);治疗后观察组的TNF-α、IL-1β及IL-6的低于对照组(P<0.05),观察组的胃肠激素指标变化幅度显著高于对照组(P<0.05)。观察组患者的腹部压痛、发热、腹痛腹胀、肠鸣音的消失时间,血淀粉酶及尿淀粉酶恢复时间均显著较观察组患者短(P<0.05),而恶心呕吐的消失时间没有显著差异(P>0.05)。治疗5天、10天及15天后,2组的APACHEⅡ评分均显著低于治疗前(P<0.05),并且每个时间段观察组的APACHEⅡ评分均明显较对照组低(P<0.05)。对照组治疗总有效率为78.2%,而观察组治疗总有效率为91.2%,2组比较差异具有统计学意义(P<0.05)。结论:清肝利胰汤治疗急性胰腺炎疗效确切,其机制可能与下调机体炎性因子相关。

Objective：To observe the clinical efficacy of Qinggan Liyi Decoction in treating severe acute pancreatitis with liver depression and Qi stagnation,and the changes of related inflammatory factors,and to evaluate its therapeutic effect.Methods：112 cases of severe acute pancreatitis and syndrome of liver-Qi stagnation were randomly divided into controlled group and observation group,55 cases in the controlled group,57 cases in the observation group,the controlled group was given oral cimetidine intravenous drip treatment,Octreotide Acetate Injection,the observation group was given Qinggan Liyi Decoction on 10 d on the basis of the controlled group.For the 1 course of treatment,according to the disease treatment of 1~2 courses.Detection of2 groups before and after treatment in patients with inflammatory cytokines：tumor necrosis factor alpha（TNF-alpha）,interleukin1 beta（IL-1 beta） and interleukin 6（IL-6）,gastrointestinal hormone index（MTL） ：motilin and gastrin（GAS） and cholecystokinin（CCK） level,and statistical analysis observation;abdominal pain,nausea and vomiting,fever,abdominal tenderness,bowel sounds disappear time,and monitored the blood amylase and urine amylase recovery time;Observed and recorded before and after the treatment,5 d,10 d and 15 d APACHE score,and compare the curative effects of 2 groups.Results：The patients in the 2 groups after 2 courses of treatment,the level of inflammatory cytokines decreased significantly（P〈0.05）,MTL was significantly higher than before treatment（P〈0.05）,GAS and CCK were significantly lower than those before treatment（P〈0.05）;After treatment,TNF-alpha,IL-1 beta and IL-6 of the observation group were lower than the controlled group（P〈0.05）,gastrointestinal hormone index changes in the observation group was significantly higher than the controlled group（P〈0.05）.The observation group of patients with abdominal pain,fever,abdominal pain,bowel sounds disappear time,blood and urine amylase recovery time were significantly shorter than the observation group（P〈0.05）,while the disappearance time of nausea and vomiting had no significant difference（P〈0.05）.After treatment of 5 d,10 d and 15 d,the scores of APACHE II in the 2 groups were significantly lower than those before treatment（P〈0.05）,and the APACHE II scores in the observation group were significantly lower than those in the controlled group at each time period（P〈0.05）.The total effective rate in the controlled group was78.2%,while the total effective rate in the observation group was 91.2%,and the difference between the 2 groups was statistically significant（P〈0.05）.Conclusion：Qinggan Liyi Decoction is effective in the treatment of acute severe pancreatitis,and its mechanism may be related to the down-regulation of inflammatory factors.