环氧化酶-2抑制剂对急性胰腺炎全身炎症反应综合征影响的回顾性分析

Retrospective analysis of COX-2 inhibitors on SIRS in acute pancreatitis

目的探讨环氧化酶(COX)-2抑制剂帕瑞昔布在急性胰腺炎(AP)患者中对全身炎症反应综合征(SIRS)的影响。方法回顾性分析2021年4月至2022年4月就诊于山西白求恩医院的206例AP患者。根据镇痛药物使用情况分组:接受过COX-2抑制剂治疗的患者为A组(n=100),接受过其他镇痛药治疗的患者为B组(n=106)。再将A、B组入院时已发生SIRS者分别分入A1组(n=48)、B1组(n=49),未发生SIRS者分别分入A2组(n=52)、B2组(n=57)。比较各组SIRS发生情况,比较A组和B组住院第4天器官衰竭评分和血清CRP水平以及住院天数、费用、并发症发生情况。多因素Logistic回归分析入院时未发生SIRS患者发生SIRS的危险因素。结果A1组短SIRS患者比例高于B1组,A1组长SIRS患者比例低于B1组(P<0.05);A1组患者的第4天SIRS评分比B1组患者低(P<0.01),两组第8天SIRS评分差异无统计学意义(P>0.05)。A2组SIRS发生率低于B2组,差异有统计学意义(32.65%vs 52.63%,χ^(2)=5.328,P=0.021)。A组患者第4天器官衰竭评分、血清CRP水平低于B组(P<0.05),住院天数、住院费用更少于B组(P<0.05)。对入院时未发生SIRS患者进行的多因素logistic回归分析显示,COX-2抑制剂的使用是与SIRS发生相关的保护性因素(P<0.05)。结论COX-2抑制剂帕瑞昔布降低AP患者SIRS的发生率,与AP患者SIRS及器官衰竭的改善密切相关而与阿片类药物镇痛效果无明显差异,可降低患者血清CRP,且具有良好的成本效益。COX-2抑制剂的使用是与SIRS发生相关的独立保护性因素。

Objective To investigate the effect of cyclooxygenase-2(COX-2)inhibitor parecoxib on systemic inflammatory response syndrome(SIRS)in patients with acute pancreatitis(AP).Methods A retrospective analysis was performed on 206 AP patients who were treated in Shanxi Norman Bethune Hospital from April 2021 to April 2022.The patients treated with COX-2 inhibitors were assigned to group A(n=100),and the patients treated with other analgesics were assigned to group B(n=106).The patients with SIRS at admission in group A and B were divided into A1 group(n=48)and B1 group(n=49),and those without SIRS were divided into A2 group(n=52)and B2 group(n=57).The incidence of SIRS in each group was compared,including SIRS duration and rating.The organ failure score(Sequential Organ Failure Assessment,SOFA)and serum CRP level on the 4th day of hospitalization,as well as the length of hospitalization,cost,and incidence of complications between group A and group B were compared.Multivariate logistic regression analysis of risk factors for SIRS in patients who did not experience SIRS at admission.Results Compared with those in group B1,the proportion of patients with SIRS duration<3 days in group A1 increased,and the proportion of patients with SIRS duration≥3 days decreased in group A1(P<0.05).On the 4th day,SIRS score in group A1 was statistically lower than that in group B1(P<0.01),and there was no statistical difference in it between two groups on the 8th day(P>0.05).The incidence of SIRS in group A2 was significantly lower than that in group B2(32.65%vs 52.63%,χ^(2)=5.328,P=0.021).In group A,the organ failure assessment score and the serum CRP were statistically lower than those in group B on the 4th day(P<0.05),and the hospital stay and the hospitalization costs were significantly lower than those in group B(P<0.05).Multivariable logistic regression of patients without SIRS at admission showed that COX-2 inhibitor was a protective factor associated with the occurrence of SIRS(P<0.05).Conclusion For patients with AP,COX-2 inhibitor pareoxib can reduce the incidence of SIRS,which is closely related to the improvement of SIRS and organ failure,but has no significant difference with the analgesic effect of opioids.It can reduce serum CRP and has good cost-effectiveness.COX-2 inhibitor parecoxib is an independent protective factor for the occurrence of SIRS.