柴芩承气汤联合埃索美拉唑对重症急性胰腺炎患者细胞炎性因子和肠道黏膜屏障功能的影响

Effect of Chaiqinchengqi decoction combined with esomeprazole on cytokines and intestinal mucosal barrier function in patients with severe acute pancreatitis

目的探讨柴芩承气汤联合埃索美拉唑对重症急性胰腺炎患者细胞炎性因子和肠道黏膜屏障功能的影响。方法选取诸暨市第三人民医院2018年1月至2019年9月诊治的重症急性胰腺炎患者62例,根据随机数字表法分为对照组和联合组,每组31例。对照组患者给予埃索美拉唑治疗,联合组在对照组基础上联合柴芩承气汤治疗。两组疗程均为14 d。比较两组治疗疗效和胃肠功能恢复情况,治疗前与治疗14 d细胞炎性因子和肠道黏膜屏障功能变化。结果联合组总有效率为93.55%(29/31),高于对照组的67.74%(21/31),差异有统计学意义(χ^2=6.613,P<0.05)。联合组腹胀缓解[(2.61±0.32)d]、腹痛缓解[(4.78±1.24)d]和肠鸣音恢复时间[(1.96±0.37)d]均快于对照组[(5.23±1.21)d、(8.63±1.49)d和(4.12±1.17)d],均差异有统计学意义(t=11.655、11.058、9.801,均P<0.05)。联合组治疗14 d血清肿瘤坏死因子α[(29.74±6.13)ng/L]、白细胞介素6[(35.46±8.71)ng/L]和C反应蛋白[(62.13±10.48)mg/L]均低于对照组[(49.65±8.76)ng/L、(59.73±6.63)ng/L和(98.74±15.36)mg/L],均差异有统计学意义(t=10.368、12.345、10.962,均P<0.05)。联合组治疗14 d血浆二胺氧化酶(DAO)[(1.72±0.62)ng/L]、D-乳酸[(7.85±1.43)mg/L]和内毒素[(2.13±0.46)Iu/L]均低于对照组[(3.20±0.56)ng/L、(11.27±3.10)mg/L和(4.25±0.51)Iu/L],均差异有统计学意义(t=9.863、5.578、17.186,均P<0.05)。结论柴芩承气汤联合埃索美拉唑对重症急性胰腺炎患者疗效明显,可减轻患者细胞炎性反应,改善患者肠道黏膜屏障功能。

Objective To investigate the effect of Chaiqinchengqi decoction combined with esomeprazole on cytokines and intestinal mucosal barrier function in patients with severe acute pancreatitis.Methods From January 2018 to September 2019,62 patients with severe acute pancreatitis who were treated in the Third People's Hospital of Zhuji were selected,and they were randomly divided into control group and combined group according to the random number table method,with 31 cases in each group.The control group was treated with esomeprazole,while the combined group was treated with Chaiqinchengqi decoction on the basis of the control group.The treatment course of the two groups was 14 days.The therapeutic effect and the recovery of gastrointestinal function of the two groups were compared.The changes of inflammatory factors and intestinal mucosal barrier function were observed before and after 14 days of treatment.Results The total effective rate of the combined group was 93.55%(29/31),which was higher than that of the control group[67.74%(21/31)],the difference was statistically significant(χ^2=6.613,P<0.05).The recovery time of abdominal distention[(2.61±0.32)d],abdominal pain[(4.78±1.24)d]and bowel sounds[(1.96±0.37)d]in the combined group were shorter than those in the control group[(5.23±1.21)d,(8.63±1.49)d and(4.12±1.17)d],the differences were statistically significant(t=11.655,11.058,9.801,all P<0.05).The serum levels of TNF-α[(29.74±6.13)ng/L],IL-6[(35.46±8.71)ng/L]and CRP[(62.13±10.48)mg/L]in the combined group were lower than those in the control group[(49.65±8.76)ng/L,(59.73±6.63)ng/L and(98.74±15.36)mg/L],the differences were statistically significant(t=10.368,12.345,10.962,all P<0.05).The levels of DAO[(1.72±0.62)ng/L],D-lactate[(7.85±1.43)mg/L]and endotoxin[(2.13±0.46)Iu/L]in the combinedgroup were lower than those in the control group[(3.20±0.56)ng/L,(11.27±3.10)mg/L and(4.25±0.51)Iu/L],the differences were statistically significant(t=9.863,5.578,17.186,all P<0.05).Conclusion Chaiqinchengqi decoction combined with esomeprazole is effective in the treatment of severe acute pancreatitis,which can reduce the cellular inflammatory response and improve the intestinal mucosal barrier function.