丙氨酰谷氨酰胺辅助奥曲肽与乌司他丁治疗老年急性胰腺炎的效果

Effect of Alanyl Glutamine-assisted Octreotide and Ulinastatin on Acute Pancreatitis in Elderly Patients

目的探讨丙氨酰谷氨酰胺(Ala-Gln)辅助奥曲肽与乌司他丁治疗老年急性胰腺炎的临床效果。方法选取2017年3月至2019年3月延安市人民医院消化内科和延安市中医医院消化内科收治的96例老年急性胰腺炎患者纳入研究,根据治疗方法不同分为对照组(奥曲肽联合乌司他丁治疗,48例)和观察组(奥曲肽联合乌司他丁+Ala-Gln,48例),观察两组治疗效果、病情改善情况、治疗前以及治疗7 d后微循环、氧化应激指标变化。结果观察组总有效率高于对照组[95.83%(46/48)比81.25%(39/48)](P<0.05);观察组症状消失时间、体温及血淀粉酶恢复正常时间、胃肠减压时间及住院时间明显短于对照组(P<0.01);治疗前后灌注血管密度(PVD)、灌注血管比例(PPV)、微血管流动指数(MFI)的主效应差异有统计学意义(P<0.01);不考虑测量时间,两组间PVD、PPV、MFI的主效应差异有统计学意义(P<0.01);PVD、PPV、MFI的时点间与组间存在交互作用(P<0.01),且观察组PVD、PPV、MFI变化幅度较对照组明显;两组治疗前后超氧化物歧化酶(SOD)、丙二醛(MDA)、活性氧类(ROS)的主效应差异有统计学意义(P<0.01);不考虑测量时间,两组间SOD、MDA、ROS的主效应差异有统计学意义(P<0.01);SOD、MDA、ROS的时点间与组间存在交互作用(P<0.01),且观察组SOD、MDA、ROS变化幅度较对照组明显(P<0.05)。结论Ala-Gln辅助奥曲肽与乌司他丁可明显改善老年急性胰腺炎患者的微循环及氧化应激,促进病情转归。

Objective To explore the clinical effect of alanyl glutamine(Ala-Gln)-assisted octreotide and ulinastatin in the treatment of acute pancreatitis(AP)in the elderly.Methods A total of 96 elderly patients with AP admitted to Department of Gastroenterology,Yan'an People's Hospital and Department of Gastroenterology,Yan'an Traditional Chinese Medicine Hospital from Mar.2017 to Mar.2019 were enrolled in the study.According to different treatment methods,96 cases were divided into a control group(octreotide and ulinastatin treatment,48 cases)and an observation group(octreotide and ulinastatin+Ala-Gln,48 cases).The therapeutic effect,the condition improvement,the changes of microcirculation and oxidative stress index before and 7 days after treatment of the two groups were observed.Results The total effective rate was in the observation group was higher than that of the control group[95.83%(46/48)vs 81.25%(39/48)](P<0.05).The time of symptoms disappearance,body temperature and blood amylase returning to normal,gastrointestinal decompression and hospitalization time in the observation group were significantly shorter than those of the control group(P<0.01).The main effects of perfusion vessel density(PVD),proportion of perfused vessels(PPV)and microvascular flow index(MFI)levels of the two groups before and after treatment were statistically significant(P<0.01),regardless of the measure time,the main effects of PVD,PPV,MFI of the two groups were statistically significant(P<0.01);there were interactions in PVD,PPV,MFI between time points and groups(P<0.01),and the changing amplitudes in the observation group were more obvious;the main effects of superoxide dismutase(SOD),malondialdehyde(MDA),reactive oxygen species(ROS)of the two groups before and after treatment were statistically significant(P<0.01);regardless of measure time,the main effects of SOD,MDA,ROS of the two groups were statistically significant(P<0.01);there were interactions in SOD,MDA,ROS between time points and groups(P<0.01),and the changing amplitudes in the observation group were more obvious(P<0.05).Conclusion Ala-Gln-assisted octreotide and ulinastatin in the treatment of elderly AP can significantly promote the microcirculation and oxidative stress,and the prognosis of the disease.