大黄承气汤联合乌司他丁治疗重症急性胰腺炎的疗效和对患者免疫功能的影响

Effect of Using Dahuang Chengqi Decoction Combined with Ulinastatin in the Treatment of Severe Acute Pancreatitis and the Impact on Immune Function

目的:探讨大黄承气汤联合乌司他丁治疗重症急性胰腺炎(SAP)的临床疗效,以及对患者免疫功能的影响。方法:选择2015年1月~2017年1月住院且符合标准的患者50例,按照随机数字表法分为观察组和对照组各25例。两组患者均给予常规治疗,观察组加用乌司他丁及大黄承气汤,对照组加用乌司他丁及生理盐水,观察两组患者临床症状,APACHEⅡ评分,CD_4^+T及CD_8^+T淋巴细胞水平,以及血清IgG、IgA、IgM水平变化。结果入院时,两组患者APACHEⅡ评分相似,差异无显著性(P>0.05),但治疗7天、14天时,观察组患者APACHEⅡ评分均低于对照组,差异有显著性(P<0.05)。两组患者14天内外周血CD_4^+T淋巴细胞亚群比例均升高,CD_8^+T淋巴细胞亚群比例均降低,CD_4^+/CD_8^+比值增加,但是观察组患者改善幅度更显著,差异具有显著性(P<0.05)。治疗7天,两组患者血清IgG、IgA、IgM水平均低于入院时,治疗14天,观察组血清IgG、IgA、IgM明显回升并高于入院时,而对照组仍低于入院时,差异有统计学意义(P<0.05)。观察组患者总有效率96.00%,高于对照组的76.00%,差异有显著性(P<0.05)。结论大黄承气汤联合乌司他丁治疗SAP,能充分发挥二者的协同优势,临床疗效优于单独应用乌司他丁,能快速缓解患者的临床症状,提高机体免疫力。

Objective: To investigate the clinical efficacy of using Dahuang Chengqi Decoction combined with Ulinastatin in the treatment of severe acute pancreatitis( SAP) and the effects on the immune function. Methods: Totally 50 eligible inpatients from January 2015 to January 2017 were selected and divided into observation group and controlled group according to random digits table method,with 25 patients in each group. Both groups were given conventional therapies. The observation group was given Ulinastatin and Dahuang Chengqi Decoction additionally,while the controlled group was given Ulinastatin and physiological saline additionally.The clinical symptoms,APACHE Ⅱ scores,changes in CD_4^+T and CD_8^+T lymphocyte levels as well as serum levels of IgG,IgA,and IgM were observed in the two groups. Results: On admission,the two groups had insignificantly different APACHEⅡscores( P>0. 05); but after 7 days and 14 days of treatment,the observation group had significantly lower APACHE Ⅱ scores than the controlled group( both P<0. 05). After 14 days of treatment,both groups had significantly increased percentage of CD_4^+T lymphocyte subgroup,significantly decreased percentage of CD_8^+T lymphocyte subgroup,and significantly increased CD_4^+/CD_8^+ratio in the peripheral blood,but the observation group had significantly greater improving extents( P< 0. 05). After 7 days of treatment,both groups had significantly lower serum levels of IgG,IgA,and IgM than those on admission; after 14 days of treatment,the observation group had significantly higher serum levels of IgG,IgA,and IgM than those on admission,while the controlled group still had significantly lower serum levels of IgG,IgA,and IgM than those on admission( P<0. 05). The observation group had a significantly higher overall response rate than the controlled group( 96. 00% vs. 76. 00%,P < 0. 05). Conclusion: Dahuang Chengqi Decoction combined with Ulinastatin in treatment of SAP can sufficiently exert the synergistic effects of the two drugs,has better clinical efficacy than single Ulinastatin,and can rapidly relieve the clinical symptoms and elevate the immunity.