血必净联合血液灌流对SAP患者线粒体炎症通路及血脂水平的影响

Effect of Xuebijing combined with hemoperfusion on mitochondrial inflammatory pathway and blood lipid levels in patients with severe acute pancreatitis

目的观察血必净联合血液灌流(HP)对重症急性胰腺炎(SAP)患者线粒体炎症通路及血脂水平的影响。方法选取2020年3月至2023年1月南阳市第一人民医院收治的100例SAP患者进行随机对照试验,以数字随机表法将其分为观察组和对照组,各50例。观察组男30例、女20例,年龄43~77(60.22±5.17)岁,实施血必净联合常规HP治疗;对照组男29例、女21例,年龄45~75(61.32±5.33)岁,对照组实施常规HP治疗。比较两组患者治疗前后线粒体炎症通路中相关蛋白表达水平、血脂水平、炎症指标变化情况。统计学方法采用t检验和χ^(2)检验。结果治疗后,观察组的甲酰肽受体1(FPR1)、寡聚化结构域样受体3(NLPR3)阳性表达评分均低于对照组[(15.41±5.23)分比(18.77±5.63)分、(31.44±10.24)分比(39.62±10.13)分],差异均有统计学意义(t=3.09、4.02,均P<0.05)。治疗后,观察组的线粒体素-泛素氧化还原酶链(MT-ND)1、MT-ND3、MT-ND6相对表达量均低于对照组[(0.42±0.11)比(1.17±0.25)、(1.31±0.25)比(1.86±0.36)、(0.92±0.45)比(1.44±0.27)],差异均有统计学意义(t=19.42、8.87、7.01,均P<0.05)。治疗后,观察组的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)水平均低于对照组[(4.11±1.25)mmol/L比(5.33±1.76)mmol/L、(2.47±0.27)mmol/L比(3.05±0.79)mmol/L、(1.95±0.77)mmol/L比(2.56±0.61)mmol/L],差异均有统计学意义(t=4.00、4.91、4.39,均P<0.05)。治疗后,观察组的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、血清淀粉酶(AMS)水平均低于对照组[(75.52±10.41)ng/L比(81.44±10.39)ng/L、(70.33±10.49)ng/L比(76.62±10.37)ng/L、(255.36±50.61)IU/L比(282.45±50.11)IU/L],差异均有统计学意义(t=2.85、3.02、2.69,均P<0.05)。结论血必净能有效抑制SAP患者的线粒体炎症通路相关蛋白表达水平,与HP相结合能显著下调患者血脂水平并减轻炎症反应。

Objective To observe the effect of Xuebijing combined with hemoperfusion(HP)on the mitochondrial inflammatory pathway and blood lipid levels in patients with severe acute pancreatitis(SAP).Methods One hundred patients with SAP treated at Nanyang First People's Hospital from March 2020 to January 2023 were selected for the randomized controlled trial.The patients were divided into an observation group and a control group using the random number table method,with 50 cases in each group.There were 30 males and 20 females in the observation group;they were 43-77(60.22±5.17)years old.There were 29 males and 21 females in the control group;they were 45-75(61.32±5.33)years old.The observation group took Xuebijing and HP,and the control group took HP.The expression levels of related proteins in the mitochondrial inflammatory pathway,blood lipid levels,and levels of inflammatory indicators before and after the treatment were compared between the two groups.t and χ^(2) tests were applied.Results After the treatment,the positive expression scores of formyl peptide receptor 1(FPR1)and nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)in the observation group were lower than those in the control group[(15.41±5.23)vs.(18.77±5.63)and(31.44±10.24)vs.(39.62±10.13)],with statistical differences(t=3.09 and 4.02;both P<0.05).After the treatment,the expression levels of mitochondrial ubiquitin-oxidoreductase(MT-ND)1,MT-ND3,and MT-ND6 in the observation group were lower than those in the control group[(0.42±0.11)vs.(1.17±0.25),(1.31±0.25)vs.(1.86±0.36),and(0.92±0.45)vs.(1.44±0.27)],with statistical differences(t=19.42,8.87,and 7.01;all P<0.05).After the treatment,the levels of total cholesterol(TC),triacylglycerol(TG),and low-density lipoprotein cholesterol(LDL-C)in the observation group were lower than those in the control group[(4.11±1.25)mmol/L vs.(5.33±1.76)mmol/L,(2.47±0.27)mmol/L vs.(3.05±0.79)mmol/L,and(1.95±0.77)mmol/L vs.(2.56±0.61)mmol/L],with statistical differences(t=4.00,4.91,and 4.39;all P<0.05).After the treatment,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and serum amylase(AMS)in the observation group were lower than those in the control group[(75.52±10.41)ng/L vs.(81.44±10.39)ng/L,(70.33±10.49)ng/L vs.(76.62±10.37)ng/L,and(255.36±50.61)IU/L vs.(282.45±50.11)IU/L],with statistical differences(t=2.85,3.02,and 2.69;all P<0.05).Conclusions Xuebijing can effectively inhibit the expression levels of mitochondrial inflammatory pathway related proteins in SAP patients;Xuebijing combined with HP can significantly reduce the patients'levels of blood lipids and inflammatory reaction.