生长抑素联合早期血液灌流治疗急性重症胰腺炎临床分析

Combination of somatostatin with blood perfusion in the treatment of severe acute pancreatitis

目的探讨生长抑素联合早期血液灌流对急性重症胰腺炎(severe acute pancreatitis,SAP)的治疗作用。方法108例SAP患者随机分为生长抑素组、血液灌流组和联合组,每组36例;生长抑素组给予常规治疗+生长抑素治疗,血液灌流组给予常规治疗+血液灌流治疗,联合组给予常规治疗+生长抑素+血液灌流治疗。比较3组治疗第1、3、7天血清白细胞介素(interleukin,IL)-10、IL-18、肿瘤坏死因子(tumor necrosis factor,TNF)-α水平的变化。结果生长抑素组治疗第1、3、7天IL-10为[(10.78±0.52)、(19.27±1.62)、(17.25±1.52)ng/L],IL-18为[(476.27±185.12)、(376.34±98.42)、(204.81±84.32)ng/L],TNF-α为[(197.28±51.24)、(121.38±29.17)、(91.27±29.35)ng/L],与血液灌流组[(IL-10(11.03±0.49)、(20.13±1.46)、(18.13±1.37)ng/L,IL-18(455.87±172.36)、(367.25±87.32)、(187.34±65.16)ng/L,TNF-α(211.35±49.28)、(123.46±27.15)、(87.38±25.41)ng/L]比较差异无统计学意义(P>0.05);联合组治疗第3、7天IL-10[(21.85±1.71)、(19.85±1.28)ng/L]高于生长抑素组和血液灌流组,IL-18[(352.28±71.28)、(165.17±49.31)ng/L]及TNF-α[(105.37±25.42)、(74.32±21.49)ng/L]低于生长抑素组和血液灌流组,差异有统计学意义(P<0.05);联合组住院时间[(27±8)d]较生长抑素组[(35±9)d]和血液灌流组[(34±10)d]短(P<0.05),病死率(2.8%)低于生长抑素组(13.9%)和血液灌流组(11.1%)(P<0.05),生长抑素组与血液灌流组比较差异无统计学意义(P>0.05)。结论生长抑素联合早期血液灌流可有效清除SAP患者血清IL-18、TNF-α,阻断炎症级联反应,对SAP有较好治疗作用。

Objective To investigate the therapeutic effect of somatostatin combined with early hemoperfusion on severe acute pancreatitis(SAP).Methods A total of 108 SAP patients were randomly divided into somatostatin group receiving somatostatin + conventional therapy,hemoperfusion group receiving hemoperfusion + conventional therapy,and combined group receiving hemoperfusion + somatostatin + conventional therapy,with 36 patients in each group.The levels of serum interleukin(IL)-10,serum IL-18 and tumor necrosis factor-α(TNF-α)were detected and compared among three groups after 1-,3-and 7-day treatment.Results The levels of IL-10((10.78±0.52),(19.27±1.62),(17.25±1.52)ng/L),IL-18((476.27±185.12),(376.34±98.42),(204.81±84.32)ng/L),TNF-α((197.28±51.24),(121.38±29.17),(91.27±29.35)ng/L)after 1-,3-and 7-day treatment in somatostatin group showed no significant differences in comparison with those in hemoperfusion group(IL-10:(11.03±0.49),(20.13±1.46),(18.13±1.37)ng/L;IL-18:(455.87±172.36),(367.25±87.32),(187,34±65.16)ng/L;TNF-α:(211.35±49.28),(123.46±27.15),(87.38±25.41)ng/L)(P>0.05).The levels of IL-10((21.85±1.71),(19.85±1.28)ng/L)were significantly higher,and the levels of IL-18((352.28±71.28),(165.17±49.31)ng/L)and TNF-α((105.37±25.42),(74.32±21.49)ng/L)were significantly lower in combined group than those in somatostatin group and hemoperfusion group after 3-and 7-day treatment(P<0.05).The hospitalization stay was significantly shorter and fatality rate was significantly lower in combined group((27±8)d,2.8%)than those in somatostatin group((35±9)d,13.9%)and hemoperfusion group((34±10)d,11.1%)(P<0.05),and there were no significant differences between somatostatin group and hemoperfusion group(P>0.05).Conclusion Somatostatin combined with early hemoperfusion could effectively treat SAP by clearing IL-18 and TNF-αand blocking the inflammatory cascade reaction.