低分子肝素联合前列地尔注射液治疗高脂血症性急性胰腺炎患者的临床研究

Clinical trial of low molecular weight heparin combined with alprostadil injection in the treatment of patients with hyperlipidemia acute pancreatitis

目的观察低分子肝素联合前列地尔注射液对高脂血症性急性胰腺炎患者的氧化应激因子和胰腺消化酶的影响。方法将高脂血症性急性胰腺炎患者126例分为对照组和试验组,每组63例。2组均给予常规对症治疗,对照组给予前列地尔注射液10μg,加入0.9%NaCl注射液250 mL,静脉滴注,每天1次。试验组在对照组的基础上给予低分子肝素钙5000 Axa,皮下注射,每天1次。2组均连续治疗10 d。记录2组患者的一般情况及治疗前后氧化应激因子、血流动力学指标、胰腺消化酶指标、血三酰甘油(TG)、血淀粉酶、尿淀粉酶、血小板膜蛋白-140(GMP-140)、红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素-10(IL-10)水平变化,并统计2组胰腺周围假性囊肿形成率、转手术率、病死率。结果试验组和对照组的腹痛消失时间、腹膜炎体征消失时间、血淀粉酶恢复正常时间、住院时间均短于对照组(均P<0.05)。试验组和对照组的血淀粉酶分别为(421.36±55.12)和(457.25±71.02)U·L^(-1),尿淀粉酶分别为(1714.25±285.25)和(1854.25±325.02)U·L^(-1),超氧化物歧化酶(SOD)分别为(85.24±5.36)和(79.36±5.01)U·mL^(-1),丙二醛(MDA)分别为(4.32±0.69)和(5.46±1.02)nmol·L^(-1),胰淀粉酶(PAMY)分别为(102.36±28.11)和(132.36±32.01)U·L^(-1),胰蛋白酶原-2(TPG-2)分别为(16.33±3.47)和(25.33±4.85)ng·mL^(-1),差异均有统计学意义(均P<0.05)。治疗后试验组IL-10高于对照组,TG、GMP-140、ESR、CRP及血流动力学指标低于对照组(均P<0.05)。试验组和对照组的胰腺周围假性囊肿形成率、转手术率、病死率比较,差异均无统计学意义(P>0.05)。试验组和对照组的药物不良反应发生率分别为9.52%(6例/63例)和12.70%(8例/63例),差异无统计学意义(P>0.05)。结论低分子肝素联合前列地尔注射液治疗高脂血症性急性胰腺炎可降低胰腺消化酶的水平,改善血流动力学,减轻氧化应激反应。

Objective To observe the effects of low molecular weight heparin combined with alprostadil injection on oxidative stress factors and pancreatic digestive enzymes in patients with hyperlipidemia acute pancreatitis.Methods A total of 126 patients with hyperlipidemia and acute pancreatitis were divided into treatment group and control group,with 63 cases in each group.Both groups were given conventional symptomatic treatment.Control group was treated with alprostadil injection 10μg,added to 0.9%NaCl 250 mL,intravenous drip,once a day.Treatment group was treated with low molecular weight heparin 5000 Axa,injected subcutaneously once daily on the basis of control group.Both groups were treated for 10 d.The general conditions of the two groups were recorded.Before and after treatment,the levels of oxidative stress factors,blood rheology indexes,pancreatic digestive enzyme indexes,blood triacylglycerol(TG),blood amylase,urine amylase,platelet membrane protein-140(GMP-140),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),interleukin-10(IL^(-1)0)were observed,and the formation rate of pseudocysts around the pancreas,the rate of transfer to surgery,case fatality rate were recored.Results The disappearance time of abdominal pain,the disappearance time of peritonitis signs,the time for blood amylase to return to normal and hospital stay time in treatment group were all shorter than control group(all P<0.05).The blood amylase in treatment group and control group were(421.36±55.12)and(457.25±71.02)U·L^(-1),the urine amylase were(1714.25±285.25)and(1854.25±325.02)U·L^(-1),the oxide dismutase(SOD)were(85.24±5.36)and(79.36±5.01)U·mL^(-1),malondialdehyde(MDA)were(4.32±0.69)and(5.46±1.02)nmol·L^(-1),pancreatic amylase(PAMY)were(102.36±28.11)and(132.36±32.01)U·L^(-1),trypsinogen-2(TPG-2)were(16.33±3.47)and(25.33±4.85)ng·mL^(-1).There were statistical differences between the two groups(all P<0.05).After treatment,IL^(-1)0 in treatment group was higher than that in control group,the TG,GMP-140,ESR,CRP and blood rheology indexes in treatment group were lower than control group(all P<0.05).The formation rate of pseudocysts around the pancreas,the conversion rate and the fatality rate in treatment group and control group were not significant(P>0.05).During the treatment period,the incidence of adverse drug reactions in treatment group and control group were 9.52%(6 cases/63 cases)and 12.70%(8 cases/63 cases),respectively,and the difference was no statistically significant(P>0.05).Conclusion Low molecular weight heparin combined with alprostadil injection in the treatment of hyperlipidemia acute pancreatitis can reduce the level of pancreatic digestive enzymes,improve blood rheology,reduce oxidative stress.