乌司他丁联合血液净化治疗老年重症急性胰腺炎合并MODS的疗效及对炎症因子的影响

Effect of ulinastatin combined with blood purification on elderly patients with severe acute pancreatitis complicated with MODS and its effect on inflammatory factors

目的探究乌司他丁联合血液净化(CBP)治疗老年重症急性胰腺炎(SAP)合并多器官功能障碍综合征(MODS)的疗效及对炎症因子的影响。方法前瞻性选取2021年5月至2022年5月四川省人民医院收治的100例老年SAP合并MODS患者为研究对象,按随机数字表法分为对照组和观察组,各50例。对照组予以常规对症治疗+CBP治疗,观察组在对照组基础上增加乌司他丁治疗,两组均连续治疗7 d。比较两组临床疗效、症状缓解时间及治疗后脏器功能、炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、降钙素原]及辅助性T细胞17(Th17)、调节性T细胞(Treg)、Th17/Treg水平,观察不良反应发生情况并监测安全性。结果观察组临床总有效率明显高于对照组(92.00%vs.76.00%),差异有统计学意义(P<0.05)。观察组发热、腹痛、恶心呕吐等症状缓解时间及胰淀粉酶恢复正常时间分别为(2.37±0.43)、(3.72±1.06)、(2.32±0.54)、(3.65±1.13)d,均明显短于对照组[(2.91±0.44)、(4.30±1.13)、(3.26±0.73)、(4.28±1.24)d],差异均有统计学意义(P<0.05)。治疗后,观察组肌酸激酶、肌酸激酶同工酶(CK-MB)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、血肌酐水平分别为(48.92±5.95)U/L、(19.72±5.22)U/L、(19.84±3.92)U/L、(61.45±6.72)U/L、(52.35±5.62)mmol/L,均明显高于对照组[(67.34±7.86)U/L、(22.89±6.39)U/L、(23.57±4.87)U/L、(79.32±8.71)U/L、(78.38±7.68)mmol/L],肾小球滤过率(GFR)、动脉血氧分压(PaO 2)、动脉氧合指数(PaO 2/FiO 2)分别为(126.25±10.57)mL/min、(106.35±10.78)mmHg、(308.93±24.52),均明显低于对照组[(102.31±9.86)mL/min、(97.45±11.27)mmHg、(291.30±23.67)],差异均有统计学意义(P<0.05)。治疗后,观察组血清hs-CRP、IL-8、TNF-α、降钙素原水平分别为(34.56±7.92)mg/L、(33.58±5.66)g/L、(32.58±8.37)g/L、(0.97±0.32)ng/mL,均明显低于对照组[(50.33±8.71)mg/L、(48.62±6.15)g/L、(44.62±9.10)g/L、(1.56±0.49)ng/mL],差异均有统计学意义(P<0.05)。观察组Th17、Th17/Treg水平分别为(2.34±0.32)%、0.81±0.15,明显低于对照组[(2.73±0.40)%、0.96±0.18],Treg为(3.15±0.27)%,明显高于对照组[(2.89±0.38)%],差异均有统计学意义(P<0.05)。两组均未发生严重不良反应,各常规检查结果均无恶化。结论乌司他丁联合CBP治疗老年SAP合并MODS疗效显著,可促进患者临床症状缓解,改善脏器功能,调节炎症因子及Th17、Treg水平,且安全性较好。

Objective To investigate the efficacy of ulinastatin combined with blood purification(CBP)in the treatment of elderly patients with severe acute pancreatitis(SAP)complicated with multiple organ dysfunction syndrom(MODS)and its effect on inflammatory factors.Methods A total of 100 elderly SAP patients with MODS admitted to Sichuan Provincial People's Hospital from May 2021 to May 2022 were selected and randomly divided into the control group and the observation group according to the random number table method,with 50 cases in each group.The control group was treated with conventional symptomatic treatment+CBP treatment,and the observation group was treated with ulinastatin on the basis of the control group,both groups were treated for 7 d.The clinical efficacy,remission time of symptoms,and organ functions,inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)and procalcitonin]auxiliary T cells 17(Th17),regulatory T cells(Treg),and Th17/Treg levels after treatment were compared between the two groups.Adverse reactions and monitor safety were observed.Results The total effective rate of the observation group was significantly higher than that of the control group(92.00%vs.76.00%),the difference was statistically significant(P<0.05).The remission time of fever,abdominal pain,nausea and vomiting and the recovery time of amylase in the observation group were(2.37±0.43),(3.72±1.06),(2.32±0.54),(3.65±1.13)d,which were significantly shorter than those in the control group[(2.91±0.44),(4.30±1.13),(3.26±0.73),(4.28±1.24)d],the differences were statistically significant(P<0.05).Creatine kinase,creatine kinase isoenzyme(CK-MB),alanine aminotransferase(ALT),alkaline phosphatase(ALP)and serum creatinine in the observation group after treatment were(48.92±5.95)U/L,(19.72±5.22)U/L,(19.84±3.92)U/L,(61.45±6.72)U/L,(52.35±5.62)mmol/L,which were significantly higher than those in the control group[(67.34±7.86)U/L,(22.89±6.39)U/L,(23.57±4.87)U/L,(79.32±8.71)U/L,(78.38±7.68)mmol/L],while glomerular filtration rate(GFR),arterial partial pressure of oxygen(PaO 2)and arterial oxygenation index(PaO 2/FiO 2)were(126.25±10.57)mL/min,(106.35±10.78)mmHg,(308.93±24.52),which were significantly lower than those in the control group[(102.31±9.86)mL/min,(97.45±11.27)mmHg,(291.30±23.67)],the differences were statistically significant(P<0.05).After treatment,the levels of serum high-sensitivity hs-CRP,IL-8,TNF-αand procalcitonin in the observation group were(34.56±7.92)mg/L,(33.58±5.66)g/L,(32.58±8.37)g/L,(0.97±0.32)ng/mL,which were significantly lower than those in the control group[(50.33±8.71)mg/L,(48.62±6.15)g/L,(44.62±9.10)g/L,(1.56±0.49)ng/mL],the differences were statistically significant(P<0.05).The levels of Th17 and Th17/Treg in the observation group were(2.34±0.32)%,0.81±0.15,which were significantly lower than those in the control group[(2.73±0.40)%,0.96±0.18],and the Treg was(3.15±0.27)%,which was significantly higher than that in the control group[(2.89±0.38)%],the differences were statistically significant(P<0.05).There were no serious adverse reactions in the two groups,and no deterioration of routine examination results.Conclusion Ulinastatin combined with CBP is effective in the treatment of elderly SAP complicated with MODS,which can promote the remission of clinical symptoms,improve organ function,regulate inflammatory factors and Th17 and Treg levels,and the safety is good.