乌司他丁联合连续性肾脏替代疗法对急性重症胰腺炎患者炎症因子及免疫球蛋白的影响

Effects of Ulinastatin Combine with Continuous Renal Replacement Therapy on Inflammatory Factors and Immunoglobulins in Patients with Severe Acute Pancreatitis

目的:探讨乌司他丁联合连续性肾脏替代疗法(CRRT)对急性重症胰腺炎(SAP)患者炎症因子及免疫球蛋白的影响。方法:选取2013年2月至2017年8月期间我院收治的SAP患者148例为研究对象,根据随机数字表法分为对照组(n=74)与观察组(n=74),两组均给予常规治疗以及乌司他丁药物治疗,观察组则在此基础上联合CRRT治疗,两组均治疗28d后,观察并比较两组患者的临床疗效,治疗前后白细胞介素-6(IL-6)、C-反应蛋白(CRP)、降钙素原(PCT)及IgA、IgG、IgM水平的变化。结果:观察组的总有效率为90.54%(67/74),显著高于对照组的67.57%(50/74)(P<0.05)。两组患者治疗28d后血清IL-6、CRP、PCT水平较治疗前均显著降低,且观察组低于对照组(P<0.05)。两组患者治疗28d后IgA、IgG、IgM较治疗前均显著升高,且观察组IgG、IgM显著高于对照组(P<0.05)。治疗后观察组ICU住院时间短于对照组(P<0.05),两组患者病死率比较差异无统计学意义(P>0.05)。结论:乌司他丁联合CRRT治疗SAP效果显著,可有效降低患者炎症因子水平,调节免疫系统,改善患者预后,值得临床推广应用。

Objective： To investigate the effect of ulinastatin combine with continuous renal replacement therapy（CRRT） on inflammatory factors and immunoglobulin in patients with severe acute pancreatitis（SAP）. Methods： 148 SAP patients who were treated in our hospital from February 2013 to August 2017 were selected as the research object. They were divided into control group（n=74） and observation group（n=74） according to randomly number table, the two groups were given routine treatment and ulinastatin treatment, the observation group based on the combination of CRRT treatment, after treatment of 28 d, the clinical efficacy of two groups, the levels of interleukin-6（IL-6）, C-reactive protein（CRP）, procalcitonin（PCT） and IgA, IgG, IgM levels before and after treatment were compared.Results： The total effective rate of the observation group was 90.54%（67/74）, which was significantly higher than 67.57%（50/74） of the control group（P0.05）. The levels of serum IL-6, CRP and PCT in the two groups after treatment were significantly lower than those before treatment, and the observation group was lower than that of the control group（P0.05）. The IgA, IgG and IgM of the two groups after treatment of 28 d were significantly higher than those before treatment, the IgG and IgM in the observation group were significantly higher than those in the control group（P0.05）. The hospitalization time of ICU in observation group after treatment was shorter than that in control group（P0.05）, there was no significant difference in fatality rate between the two groups（P0.05）. Conclusion： Ulinastatin combine with CRRT is effective in the treatment of SAP, which can effectively reduce the level of inflammatory factors,regulate the immune system and improve the prognosis of patients, which is worthy of clinical application.