低分子肝素和胰岛素降脂治疗对高脂血症急性重症胰腺炎患者预后的影响

Influence of low molecular weight heparin and insulin lipid-lowering therapy for prognosis of patients with hyperlipidemia and severe acute pancreatitis

目的:观察探讨低分子肝素和胰岛素降脂治疗对高脂血症急性重症胰腺炎患者预后的影响,总结临床应用价值。方法:选取高脂血症急性重症胰腺炎患者78例,按照随机数字表法分为胰岛素组及联合组,各39例,两组患者在常规内科治疗基础上,胰岛素组单纯给予胰岛素治疗,联合组给予胰岛素联合低分子肝素治疗,观察对比两组患者胃肠功能恢复时间、血、尿淀粉酶活性恢复正常时间、治疗前和治疗2周后TG、IL-6、TNF-α、PCT、IgG及IgM水平变化情况、并发症发生率及死亡率发生情况。结果:联合组胃肠功能恢复时间、血、尿淀粉酶活性恢复时间均较胰岛素组显著缩短,差异有统计学意义(P<0.05);治2周后,两组患者的TG、IL-6、TNF-α、PCT均较治疗前显著降低,差异有统计学意义(P<0.05),IgG、IgM较治疗前显著升高,差异有统计学意义(P<0.05);与胰岛素组相比,治疗2周后联合组的TG含量、IL-6、TNF-a、PCT、IgG及IgM水平改善情况更为理想,差异有统计学意义(P<0.05)。结论:胰岛素联合低分子肝素治疗高脂血症急性重症胰腺炎患者,可减少患者并发症和死亡率的发生,改善患者预后效果较好,值得合理推广。

Objective To observe and probe into the influence of low molecular weight heparin and insulin lipid-lowering therapy for prognosis of patients with hyperlipidemia and severe acute pancreatitis,to summarize the clinical application value. Method 78 cases of patients with hyperlipidemia were selected,and were divided into the insulin group and the combined group according to the random digit table extraction method,with 39 cases in each group.Two groups of patients were given basis of routine medical treatment.The insulin group were only given insulin treatment,while the combined group were treated with insulin combined with low molecular weight heparin.Then,the gastrointestinal function recovery time,blood and urine amylase activity returned to normal time,the changes of TG,IL-6,TNF-α,PCT,IgG and IgM levels before and after treatment for 2 weeks,and the incidence of complications and mortality of two groups of patients were observed and compared. Results The recovery time of gastrointestinal function,the recovery time of amylase activity in blood and urine in the combined group were significantly shorter than those in the insulin group ( P <0.05).The TG,IL-6,TNF-α and PCT of two groups after treatment for 2 weeks were significantly lower than those before treatment ( P <0.05),and the IgG and IgM were significantly higher than those before treatment ( P <0.05).After 2 weeks of treatment,the combined group was compared with the insulin group,the improvement of TG content,IL-6,TNF-α,PCT,IgG and IgM level was more ideal ( P <0.05). Conclusion The low molecular weight heparin and insulin lipid-lowering therapy in treatment of patients with hyperlipidemia and severe acute pancreatitis which can reduce the incidence of complications and mortality,and improve the prognosis of patients,thus it is worth promoting reasonably.