奥曲肽联合乌司他丁治疗老年急性胰腺炎患者的疗效及对血清Beclin-1和LC3水平的影响

Effects of octreotide combined with ulinastatin on elderly patients with acute pancreatitis and its effects on serum Beclin-1 and LC3 levels

目的探讨奥曲肽联合乌司他丁治疗老年急性胰腺炎的临床疗效患者及对血清Beclin-1和微管相关蛋白1轻链3(LC3)水平的影响。方法采用回顾性研究,将2019年3月至2022年2月空军军医大学第一附属医院收治的103例老年急性胰腺炎患者按照入院单双号分为对照组(n=52)和观察组(n=51)。对照组采用25μg/h醋酸奥曲肽静脉泵注治疗,1次/d;观察组在对照组治疗基础上给予10万单位乌司他丁静脉滴注,2次/d,均连续治疗7 d。比较两组患者临床疗效、临床症状消失时间、血和尿中淀粉酶恢复正常时间、白细胞水平恢复正常时间、不良反应情况以及治疗前后炎症因子[白细胞介素(IL)-6、IL-10和肿瘤坏死因子α(TNF-α)]、Beclin-1和LC3水平。结果观察组治疗总有效率为94.12%,显著高于对照组(71.15%),差异有统计学意义(P<0.05)。观察组患者临床症状消失时间以及血淀粉酶、尿淀粉酶和白细胞恢复正常水平时间为(4.87±0.51)、(3.46±0.47)、(3.83±0.56)、(4.52±0.63)d,均显著少于对照组[(7.14±0.74)、(6.02±0.58)、(6.46±0.63)、(6.73±0.74)d],差异均有统计学意义(P<0.05)。两组患者治疗第3天和第7天时的外周血IL-6和TNF-α水平均随时间延长显著降低,IL-10水平以及Beclin-1和LC3水平随时间延长显著升高,差异均有统计学意义(P<0.05)。观察组患者治疗第3天和第7天时的外周血IL-6和TNF-α水平显著低于对照组,IL-10水平以及Beclin-1和LC3水平显著高于对照组,差异均有统计学意义(P<0.05)。观察组和对照组患者不良反应发生率比较(9.80%vs.7.69%),差异无统计学意义(P>0.05)。结论奥曲肽联合乌司他丁能够显著提高老年急性胰腺炎患者的临床疗效,改善临床症状和免疫功能,减轻炎性反应,增强细胞自噬反应,安全性高。

Objective To investigate the clinical efficacy of octreotide combined with ulinastatin in the treatment of senile acute pancreatitis and its effects on the levels of serum Beclin-1 and microtubule-associated protein 1 light chain 3(LC3).Methods A total of 103 elderly patients with acute pancreatitis admitted to the First Affiliated Hospital of Air Force Military Medical University from March 2019 to February 2022 were retrospectively divided into control group(n=52)and observation group(n=51)according to the admission odd and even numbers.The control group was given 25μg/h octreotide acetate intravenous infusion therapy,once a day;the observation group was given 100,000 units of ulinastatin intravenous drip on the basis of the treatment of the control group,twice a day,both were treated continuously for 7 days.The clinical efficacy,disappearance time of clinical symptoms,recovery time of amylase in blood and urine,recovery time of leukocyte level,adverse reactions and inflammatory factors levels[interleukin(IL)-6,IL-10 and tumor necrosis factor-α(TNF-α)],Beclin-1 and LC3 levels before and after treatment were compared between the two groups.Results The total effective rate of the observation group was 94.12%,which was significantly higher than that of the control group(71.15%),the difference was statistically significant(P<0.05).The disappearance time of clinical symptoms and the recovery time of blood amylase,urinary amylase and leukocyte in the observation group were(4.87±0.51),(3.46±0.47),(3.83±0.56),(4.52±0.63)d,which were significantly less than those in the control group[(7.14±0.74),(6.02±0.58),(6.46±0.63),(6.73±0.74)d],the differences were statistically significant(P<0.05).IL-6 and TNF-αin peripheral blood of the two groups on the 3rd and 7th day of treatment,and the levels of IL-10,Beclin-1,LC3 decreased significantly with time,the differences were statistically significant(P<0.05).The levels of peripheral blood IL-6 and TNF-αin the observation group on the 3rd and 7th day of treatment were lower than those in control group,the levels of IL-10,Beclin-1 and LC3 were significantly higher than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(9.80%vs.7.69%,P>0.05).Conclusion Octreotide combined with ulinastatin can significantly improve the clinical efficacy of elderly patients with acute pancreatitis,improve clinical symptoms and immune function,reduce inflammatory and autophagy reaction,and has high safety.