乌司他丁联合生长抑素治疗重症急性胰腺炎的疗效及对患者血清TNF-a、IL-6、CRP水平的影响

Clinical efficacy of ulinastatin combined with somatostatin on severe acute pancreatitis and its effect on the levels of serum TNF-α,IL-6,and CRP

目的观察乌司他丁联合生长抑素治疗重症急性胰腺炎(SAP)的疗效,并探讨其对患者血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C反应蛋白(CRP)水平的影响。方法前瞻性选取2020年5月至2021年5月榆林市星元医院消化内科收治的48例SAP患者作为研究对象,按照随机数表法分为对照组和研究组各24例。对照组患者治疗14 d,每天连续24 h采用微量泵泵注6 mg/d的生长抑素治疗,研究组患者治疗14 d,每天连续24 h采用微量泵泵注6 mg/d的生长抑素治疗,同时3次/d,每次10万U乌司他丁配比500 mL的生理盐水对患者进行静脉注射。比较两组患者治疗两周后的疗效,以及治疗前后的血清TNF-α、IL-6、CRP水平,血淀粉酶(AMY)、肝肾功能[谷丙转氨酶(ALT)、血肌酐(Cr)]和不良反应发生情况。结果研究组患者的治疗总有效率为95.83%,明显高于对照组的62.5%,差异有统计学意义(P<0.05);治疗前,两组患者的TNF-α、IL-6、CRP水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的TNF-α、IL-6、CRP水平均较治疗前降低,且研究组患者的TNF-α、IL-6、CRP水平分别为(21.41±5.61)ng/L、(26.38±5.72)ng/L、(124.71±22.89)mg/L,明显低于对照组的(37.51±9.58)ng/L、(52.46±6.71)ng/L、(183.61±29.91)mg/L,差异均有统计学意义(P<0.05);治疗前,两组患者的AMY、ALT、Cr水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的AMY、ALT、Cr水平均较治疗前降低,且研究组患者的AMY、ALT、Cr水平分别为(0.61±0.05)U/L、(36.58±6.12)U/L、(95.71±12.89)μmol/L,明显低于对照组的(1.51±0.18)U/L、(82.76±8.71)U/L、(138.61±12.55)μmol/L,差异均有统计学意义(P<0.05);研究组患者治疗期间的不良反应总发生率为4.17%,略低于对照组的8.33%,但差异无统计学意义(P>0.05)。结论乌司他丁联合生长抑素治疗SAP的临床效果好,且能明显降低患者的血清TNF-α、IL-6、CRP及AMY、ALT、Cr水平,具有临床应用价值。

Objective To explore the effect of ulinastatin combined with somatostatin on severe acute pancreatitis(SAP)and its effect on serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and C-reactive protein(CRP).Methods Forty-eight patients with severe acute pancreatitis treated in the Department of Gastroenterology,Yulin Xingyuan Hospital from May 2020 to May 2021 were prospectively selected as the research objects.According to the random number table method,they were divided into a control group and a study group,with 24 patients in each group.Within 14 days of treatment,the patients in the control group were treated with 6 mg/d somatostatin by micro pump for 24 hours a day,and the patients in the study group were,at the same time,treated with 100000 U Ulinastatin and 500 mL normal saline for three times a day,plus 6 mg/d somatostatin by micro pump for 24 hours a day.The changes of serum TNF-α,IL-6 and CRP,the differences of serum amylase(AMY),liver and kidney function[alanine aminotransferase(ALT)and serum creatinine(Cr)]between the two groups before and 2 weeks after treatment,and the curative effect,and incidence of adverse events after 2 weeks of treatment were compared and analyzed.Results The total effective rate of the study group was 95.83%,which was significantly higher than 62.5%of the control group(P<0.05).Before treatment,there was no significant difference in the levels of TNF-α,IL-6,and CRP between the two groups(P>0.05);after treatment,the levels of TNF-α,IL-6,and CRP in the two groups were lower than those before treatment,and the levels of TNF-α,IL-6,and CRP in the study group were(21.41±5.61)ng/L,(26.38±5.72)ng/L,and(124.71±22.89)mg/L,respectively,which were significantly lower than(37.51±9.58)ng/L,(52.46±6.71)ng/L,and(183.61±29.91)mg/L in the control group(P<0.05).Before treatment,there was no significant difference in the levels of AMY,ALT,and Cr between the two groups(P>0.05);after treatment,the levels of AMY,ALT,and Cr in the two groups were lower than those before treatment,and the levels of AMY,ALT,and Cr in the study group were(0.61±0.05)U/L,(36.58±6.12)U/L,and(95.71±12.89)μmol/L,which were significantly lower than(1.51±0.18)U/L,(82.76±8.71)U/L,and(138.61±12.55)μmol/L in the control group(P<0.05).The total incidence of adverse reactions in the study group was 4.17%,which was not significantly different from 8.33%in the control group(P>0.05).Conclusion Ulinastatin combined with somatostatin in the treatment of SAP has good therapeutic effect and can safely reduce the levels of serum TNF-α,IL-6,CRP,AMY,ALT,and Cr,which is worthy of promotion.