低分子肝素联合胰岛素可降低高甘油三酯型重症急性胰腺炎患者血脂和炎症水平

Low molecular weight heparin combined with insulin could reduce the level of blood lipid metabolism,inflammatory response in patients with high triglyceride severe acute pancreatitis

目的:探讨低分子肝素联合胰岛素对高甘油三酯型重症急性胰腺炎患者器官功能的保护作用。方法:前瞻性收集高甘油三酯型重症急性胰腺炎患者90例,随机分为观察组和对照组,各45例,观察组给予低分子肝素联合胰岛素治疗,对照组仅给予胰岛素治疗,同时2组均给予常规治疗,包括抑酸、抑酶、抗感染、早期液体复苏等对症支持治疗,观察2组患者器官功能、炎症因子水平和预后情况。结果:2组患者入院时C反应蛋白(CRP)和肿瘤坏死因子(TNF-α)水平比较,差异无统计学意义(P均>0.05),7d后,2组均较治疗前降低,且观察组显著低于对照组[(13.65±3.81)mg/L vs(15.48±4.26)mg/L,(90.94±26.05)ng/L vs(105.02±28.53)ng/L,P=0.034、0.016]。2组患者入院时多器官功能衰竭评分(SOFA)比较,差异无统计学意义(P>0.05),7 d后,2组均较治疗前降低,且观察组显著低于对照组(P<0.05)。观察组新发脏器功能衰竭发生率低于对照组(26.67%vs 44.44%,P=0.030)。2组患者入院时总胆固醇、甘油三酯水平比较,差异无统计学意义(P均>0.05),7 d后,观察组较对照组显著降低[(8.57±2.51)mmol/L vs(9.84±2.14)mmol/L,(3.28±1.27)mmol/L vs(4.63±1.43)mmol/L,P=0.011、0.000]。2组患者死亡率、腹腔出血率比较,差异无统计学意义(P均>0.05)。观察组住院时间短于对照组[(41.49±6.41)d vs(44.38±7.12)d,P=0.046]。结论:低分子肝素联合胰岛素有利于降低血脂和炎症水平,保护高甘油三酯型重症急性胰腺炎患者器官功能,缩短住院时间。

Objective:To investigate the protective effect of low molecular weight heparin combined with insulin on organ function in patients with hypertriglyceride-induced severe acute pancreatitis(SAP).Methods:A total of 90 patients with hypertriglyceride-induced SAP were prospectively collected.All the patients were randomly assigned to an observation group and a control group with 45 cases in each group.The observation group was treated with low molecular weight heparin combined with insulin,while the control group was treated with insulin only.At the same time,both groups were given routine treatment,including acid suppression,enzyme inhibition,anti-infection and early fluid resuscitation.The organ function,inflammatory factors and prognosis of the two groups were observed.Results:There was no significant difference in C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)between the two groups at admission(P>0.05).As compared with the control group,CRP and TNF-αin the observation group decreased significantly after 7 days[(13.65±3.81 vs 15.48±4.26 mg/L,P=0.034)and(90.94±26.05 vs 105.02±28.53 ng/L,P=0.016)].There was no significant difference in SOFA score between the two groups at admission(P>0.05).After 7 days,as compared with the control group,the SOFA score in the observation group decreased(P<0.05).The incidence of new organ failure in the observation group was lower than that in the control group(26.67%vs 44.44%,P=0.030).There was no significant difference in total cholesterol and triglyceride between the two groups at admission(P>0.05).After 7 days,as compared with the control group,the total cholesterol and triglyceride in the observation group decreased significantly[(8.57±2.51 vs 9.84±2.14 mmol/L,P=0.011)and(3.28±1.27 vs 4.63±1.43 mmol/L,P=0.000)].There was no significant difference in mortality and abdominal bleeding rate between the two groups(P=0.270).The discharge time of the observation group was shorter than that of the control group(41.49±6.41 vs 44.38±7.12 d,P=0.046).Conclusion:Low molecular weight heparin combined with insulin can reduce blood lipid and inflammation levels,protect organ function and shorten discharge time in patients with hypertriglyceride-induced SAP.