高剂量乌司他丁辅助两路早期补液对急性胰腺炎患者早期康复及细胞免疫功能的研究

Effect of high-dose ulinastatin-assisted two routes of early fluid infusion on early rehabilitation and cellular immune function of patients with acute pancreatitis

目的探讨高剂量乌司他丁辅助两路早期补液对急性胰腺炎(SAP)患者早期康复及细胞免疫功能的影响。方法选取我院2019年12月至2022年3月SAP住院患者72例,随机数字表法分为研究组36例与对照组36例。入院后给予2组常规干预,在此基础上对照组采取两路早期补液,研究组于对照组基础上采取高剂量乌司他丁,均治疗14 d。统计2组症状缓解情况、临床疗效、治疗前及治疗14 d后细胞免疫功能、炎性指标[白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)水平、病情严重程度评分急性生理与慢性健康评分(APACHEⅡ)]、靶器官损伤及治疗情况。结果(1)症状缓解情况:研究组呕吐恶心、腹痛、腹胀缓解用时、首次排便时间、体温恢复时间短于对照组(P<0.05);(2)临床疗效:研究组总有效率(86%)高于对照组(64%)(P<0.05)。(3)细胞免疫功能:治疗前2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)间差异无统计学意义(P>0.05),治疗14 d后观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)较治疗前增高(P<0.05),且研究组高于对照组(P<0.05)。(4)炎性因子:治疗前2组WBC、血清PCT、CRP、IL-6、IL-8、TNF-α水平间差异无统计学意义(P>0.05),治疗14 d后2组血清IL-6、IL-8、TNF-α水平较治疗前降低(P<0.05),且研究组低于对照组(P<0.05);(5)APACHEⅡ评分:治疗前2组APACHEⅡ评分间差异无统计学意义(P>0.05),治疗14d后2组APACHEⅡ评分较治疗前降低(P<0.05),且研究组低于对照组(P<0.05)。(6)靶器官损伤及治疗情况:研究组患者靶器官损伤率低于对照组,差异有统计学意义(P<0.05);对照组1例并发MODS患者救治无效死亡,2组其余并发靶器官损伤患者均经对症支持治疗后好转。结论采取高剂量乌司他丁辅助两路早期补液治疗SAP,可有效缓解患者临床症状,减轻病情严重程度及炎性反应程度,并改善患者机体细胞免疫功能状态,提升疾病整体治疗疗效,降低靶器官损伤率。

Objective To explore the effect of high-dose ulinastatin-assisted two routes of early fluid infusion on early rehabilitation and cellular immune function of patients with acute pancreatitis(SAP).Methods Seventy-two patients with SAP in our hospital from December 2019 to March 2022 were randomly divided into study group(n=36)and control group(n=36).After admission,routine interventions were given to the two groups.On this basis,the control group was given two routes of early fluid infusion.The study group was given high-dose ulinastatin on the basis of the control group,all of which were treated for 14 days.The remission of symptoms,clinical efficacy,cell immune function,levels of inflammatory factors,including white blood cells(WBC),procalcitonin(PCT),C-reactive protein(CRP),tumor necrosis factor(TNF)-α,interleukin(IL)-6 and IL-8 and severity score of disease(APACHE II)before and 14 days after treatment and target organ injury and treatment were analyzed.Results(1)Symptom relief:the time of vomiting,nausea,abdominal pain,abdominal distension relief,first defecation time and body temperature recovery in the study group were shorter than those in the control group(P<0.05).(2)Clinical efficacy:The total effective rate of the study group(86%)was higher than that of the control group(64%)(P<0.05).(3)Cell immune function:there was no significant difference in CD3^(+),CD4^(+),CD4^(+)/CD8^(+)between two groups before treatment(P>0.05).After 14 days treatment,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the two groups increased compared with before treatment(P<0.05),and those in the study group were higher than those in the control group(P<0.05).(4)Inflammatory factors:there was no significant differences in serum WBC,PCT,CRP,IL-6,IL-8 and TNF-αlevels between the two groups before treatment(P>0.05).After 14 days of treatment,the levels of WBC,PCT,CRP,IL-6,IL-8 and TNF-αin the two groups were lower than those before treatment(P<0.05),and those in the study group were lower than those in the control group(P<0.05).(5)APACHEⅡscore:there was no significant difference in APACHEⅡscore between the two groups before treatment(P>0.05).After 14 days of treatment,APACHEⅡscore of the two groups was lower than that before treatment(P<0.05),and that of the study group was lower than that of the control group(P<0.05).(6)Target organ injury and treatment:the target organ injury rate of the study group was lower than that of the control group,the difference was statistically significant(P<0.05).In the control group,one patient died of multiple organ dysfunction syndrome(MODS)and the other two patients with target organ injury improved after symptomatic support.Conclusion High-dose ulinastatin supplemented with two routes of early rehydration therapy for SAP can effectively alleviate the clinical symptoms,reduce the severity of the disease and the degree of inflammatory reaction,improve the cell immune function of patients,and enhance the overall therapeutic effect of the disease,reduce the target organ injury rate.