乌司他丁联合短程小剂量甲泼尼龙对脓毒症合并ARDS患者临床结局及炎症因子水平的影响

Effects of ulinastatin combined with short-term low-dose methylprednisolone on clinical outcomes and inflammatory factor levels in septic patients with ARDS

目的探讨乌司他丁联合短程小剂量甲泼尼龙对脓毒症合并急性呼吸窘迫综合征(ARDS)患者临床结局及炎症因子水平的影响。方法将2013-2016年山西医科大学第一医院收治的142例脓毒症合并ARDS患者作为研究对象,按照随机数字表法分为对照组(常规疗法,62例)和观察组(常规疗法+乌司他丁+小剂量甲泼尼龙,80例)。比较两组治疗前后APACHEⅡ评分、氧合指数、IL-8、TNF-α、IL-10、内皮细胞特异性分子-1(endocan)、血管内皮生长因子(VEGF)、白细胞数、中性粒细胞数等指标,并对死亡病例和存活病例的endocan、VEGF表达水平进行比较。结果治疗后,观察组与对照组死亡率(8.8%vs 21.0%)、APACHEⅡ[(23.1±6.5)分vs(29.6±5.9)分]、氧合指数[(384.5±45.9)mmHg vs(243.1±42.8)mmHg]比较,差异均有统计学意义(P<0.05);观察组与对照组IL-8[(208.5±28.7)pg/m vs(274.6±27.2)pg/ml]、TNF-α[(23.5±5.9)μg/ml vs(30.4±6.3)μg/ml]、IL-10[(64.9±13.4)pg/ml vs(44.2±12.8)pg/ml]、endocan[(4.1±2.5)μg/L vs(6.8±2.8)μg/l]、VEGF[(116.7±15.1)mg/ml vs(124.3±15.4)mg/ml]表达水平比较,差异均有统计学意义(P<0.05)。死亡患者endocan和VEGF表达水平均高于存活患者(P<0.05);观察组白细胞数、中性粒细胞数均少于对照组(P<0.05)。结论乌司他丁联合小剂量甲泼尼龙有助于降低endocan、VEGF表达水平,减少炎症细胞浸润,降低炎症反应,提高脓毒症合并ARDS患者的临床疗效及生存率。

Objective To investigate the effect of ulinastatin combined with short-term low-dose methylprednisolone on clinical outcomes and inflammatory factor levels in septic patients with acute respiratory distress syndrome(ARDS).Methods A total of 142 septic patients with ARDS admitted to the First Affiliated Hospital of Shanxi Medical University between 2013 and 2016 were included and assigned to the control group(on conventional therapy,n=62)and the study group(on conventional therapy+ulinastatin+low-dose methylprednisolone,n=80)according to random number table.The two groups were compared for APACHE II score,oxygenation index,levels of IL-8,TNF-α,IL-10,endothelial cell specific molecule-1(endocan),vascular endothelial growth factor(VEGF),and counts of white blood cells and neutrophils,at baseline and after treatment.The levels of endocan and VEGF were also compared between the death and surviving cases.Results After treatment,there were statistically significant differences in the mortality(8.8%vs 21.0%),APACHE II score[(23.1±6.5)vs(29.6±5.9)],and oxygenation index[(384.5±45.9)mmHg vs(243.1±42.8)mmHg]between the study and the control groups(P<0.05).Statistical differences were also noted in levels of IL-8[(208.5±28.7)pg/m vs(274.6±27.2)pg/mL],TNF-α[(23.5±5.9)μg/mL vs(30.4±6.3)μg/mL],IL-10[(64.9±13.4)pg/mL vs(44.2±12.8)pg/mL],endocan[(4.1±2.5)μg/L vs(6.8±2.8)μg/L]and VEGF[(116.7±15.1)mg/mL vs(124.3±15.4)mg/mL](P<0.05).The expression levels of endocan and VEGF were higher in death cases than those in surviving cases(P<0.05).The study group had lower counts of white blood cells and neutrophils compared with the control group(P<0.05).Conclusion Ulinastatin combined with low-dose methylprednisolone can help reduce the expression levels of endocan and VEGF,ameliorate inflammatory infiltration and response,improve the clinical efficacy and survival of septic patients with ARDS.