罗沙替丁联合血浆置换对高脂血症性胰腺炎的影响
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摘要
目的:探讨罗沙替丁联合血浆置换对高脂血症性胰腺炎患者的影响。方法:将120例高脂血症胰腺炎患者分为A、B、C3组,A组给予常规治疗、B组在A组基础上给予血浆置换(plasma exchange,PE)治疗,C组在B组基础上给予罗沙替丁治疗,比较3组三酰甘油(triglyceride,TG)、血淀粉酶(amylase,AMY)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、APCHEⅡ评分、应激性溃疡发生率(incidence of stress ulcer,ISU)、ICU住院时间。结果:3组患者治疗前基本资料,TG、AMY、TNF-α、APCHEⅡ评分差异无显著性(P>0.05),治疗后3组指标较治疗前均有所改善(P<0.05),治疗后3组TG、AMY、TNF-α比较,B组C组较A组降低,差异有显著性(P<0.05),B组C组差异无显著性(P>0.05);ISU比较,A组与B组无统计学差异(P>0.05),C组较A组B组降低,差异有显著性(P<0.05);APCHEⅡ评分、ICU住院时间比较,与A组比较,B组、C组减少,差异有显著性(P<0.05),C组较B组减少,差异有显著性(P<0.05)。结论:血浆置换治疗能有效降低TG、AMY、TNF-α,控制APCHEⅡ评分与ICU住院时间,联合罗沙替丁治疗可更好地降低APCHEⅡ评分与ICU住院时间,减少ISU。
OBJECTIVE To evaluate the effects of roxatidine combined with plasma exchange(PE)on hyperlipidemic pancreatitis.METHODS Totally 120 patients with hyperlipidemic pancreatitis were randomly divided into three groups.Patients in group A received conventional treatment.Patients in group B were treated with plasma exchange(PE)and conventional remedy.Patients in group C had roxatidine combined with plasma exchange(PE)in addition to conventional treatment.Triglyceride(TG),amylase(AMY),tumor necrosis factor-α(TNF-α),APCHE Ⅱscores,incidence of stress ulcer(ISU)and ICU length of patient stay(LOPS)were compared.RESULTS There was no significant difference(P>0.05)in basic information,TG,AMY,TNF-αor APCHE Ⅱ scale before treatment among the three groups.All groups showed improvement(P>0.05)regarding indexes above after treatment.Compared with group A,group B and group C had significant decreases(P<0.05)of TG,AMY,TNF-α without significant difference(P>0.05).Group C demonstrated a significantly lower ISU(P<0.05)whereas there was no significant difference between group A and group B.Compared with group A,group B and group C showed significant reduction of APCHE Ⅱ scores and ICU LOPS,with significantly lower results in group C.CONCLUSIONPlasma exchange(PE)can effectively decrease levels of TG,AMY and TNF-α,and reduce ISU,APCHE Ⅱ scores and ICU LOPS whereas it can further lower APCHEⅡ scores,ICU LOPS and ISU when combined with roxatidine.
OBJECTIVE To evaluate the effects of roxatidine combined with plasma exchange(PE)on hyperlipidemic pancreatitis.METHODS Totally 120 patients with hyperlipidemic pancreatitis were randomly divided into three groups.Patients in group A received conventional treatment.Patients in group B were treated with plasma exchange(PE)and conventional remedy.Patients in group C had roxatidine combined with plasma exchange(PE)in addition to conventional treatment.Triglyceride(TG),amylase(AMY),tumor necrosis factor-α(TNF-α),APCHE Ⅱscores,incidence of stress ulcer(ISU)and ICU length of patient stay(LOPS)were compared.RESULTS There was no significant difference(P>0.05)in basic information,TG,AMY,TNF-αor APCHE Ⅱ scale before treatment among the three groups.All groups showed improvement(P>0.05)regarding indexes above after treatment.Compared with group A,group B and group C had significant decreases(P<0.05)of TG,AMY,TNF-α without significant difference(P>0.05).Group C demonstrated a significantly lower ISU(P<0.05)whereas there was no significant difference between group A and group B.Compared with group A,group B and group C showed significant reduction of APCHE Ⅱ scores and ICU LOPS,with significantly lower results in group C.CONCLUSIONPlasma exchange(PE)can effectively decrease levels of TG,AMY and TNF-α,and reduce ISU,APCHE Ⅱ scores and ICU LOPS whereas it can further lower APCHEⅡ scores,ICU LOPS and ISU when combined with roxatidine.
引文
[1]Zuo LL,Cen J,Zhang HR.Recent developments in the management of hyperlipidemic pancreatitis[J].Chin Gen Pract(中国全科医学),2017,20(9):1141-1146.
[2]Nawaz H,Koutroumpakis E,Easler J,et al.Elevated Serum Triglycerides are Independently Associated With Persistent Organ Failure in Acute Pancreatitis[J].Am J Gastroenterol,2015,110(10):1497-1503.
[3]Pancreatic Surgery Group of Surgery Branch of Chinese Medical Assosiation.Guideline of the diagnosis and treatment of acute pancreatitis(2014 edition)[J].Chin J Surgery(中华外科学杂志),2015,114(1):1-5.
[4]Shu ML,Deng MM.The role of free fatty acids in hyperlipidemic pancreatitis[J].Guangdong Med J(广东医学),2014,35(15):2456-2458.
[5]Wang G,Sun B,Jiang HC.Recent developments in the management of hyperlipidemic pancreatitis[J].Chin J Gen Surg(中国普通外科学杂志),2005,14(11):16-859.
[6]Liang ZH,Tang GD.Progress in pathogenesis of hyperlipidemic acute pancreatitis[J].Int J Digestive Diseases(国际消化病杂志),2013,33(1):32-34.
[7]Hackert T,Pfeil D,Hartwig W,et al.Platelet Function in Acute Experimental Pancreatitis[J].Br J Surg,2005,92(6):724-728.
[8]A Uru1uela,S Sevillano,AM de,et al.Time-course of oxygen free radical production in acinar cells during acute pancreatitis induced by pancreatic duct obstruction[J].BBA-Molecular Basis of Disease,2002,1588(2):159-164.
[9]Sha H,Ma Q,Jha RK.Trypsin is the culprit of multiple organ injury with severe acute pancreatitis[J].Medical Hypotheses,2009,72(2):180-182.
[10]He WH,Zhu Y,Zhu Y,et al.Comparison of severity and clinical outcomes between hypertriglyceridemic pancreatitis and acute pancreatitis due to other causes[J].Nat Med J Chin(中华医学杂志),2016,96(32):2569-2572.
[11]Cunha C,Barbosa AL,Pereira S,et al.Plasma exchange in hypertriglyceridaemic acute pancreatitis:case report[J].2016,30(2):140-144.
[12]Valdivielso P,Ramírezbueno A,Ewald N.Current knowledge of hypertriglyceridemic pancreatitis[J].European J Int Med,2014,25(8):689-694.
[13]Xu ZZ.Clinical study of acute pancreatitis complicated with gastric mucosal injury[J].J Qiqihar Univ Med(齐齐哈尔医学院学报),2013,34(9):1326-1327.
[14]Xu S,Zhou X.Research Progress on Mechanism of gastrointestinal injury in severe acute pancreatitis[J].Shandong Med J(山东医药),2015,55(45):102-105.
[15]Ma J,Dai L,Zhao W.Effects of Pyloric Local Calcitonin Generelated Peptide on Bile Acid Reflux to Rat Stomach[J].Hebei Med(河北医学),2007,13(6):637-641.
[16]Tüney D,Altun E,Barlas A,et al.Pancreatico-colonic fistula after acute necrotizing pancreatitis.Diagnosis with spiral CT using rectal water soluble contrast media[J].Jop J Pancreas,2008,9(1):26.
[17]Huang JQ,Lv JL,Hu X.Pharmacological action and clinical evaluation of rothetidine acetate[J].Chin J New Drugs(中国新药杂志),2014(14):1601-1605.
[18]Shikama N,Ichikawa T,Iwai T,et al.Different effects of two types of H2-receptor antagonists,famotidine and roxatidine,on the mucus barrier of rat gastric mucosa[J].Biomedical Res,2012,33(1):45.
[2]Nawaz H,Koutroumpakis E,Easler J,et al.Elevated Serum Triglycerides are Independently Associated With Persistent Organ Failure in Acute Pancreatitis[J].Am J Gastroenterol,2015,110(10):1497-1503.
[3]Pancreatic Surgery Group of Surgery Branch of Chinese Medical Assosiation.Guideline of the diagnosis and treatment of acute pancreatitis(2014 edition)[J].Chin J Surgery(中华外科学杂志),2015,114(1):1-5.
[4]Shu ML,Deng MM.The role of free fatty acids in hyperlipidemic pancreatitis[J].Guangdong Med J(广东医学),2014,35(15):2456-2458.
[5]Wang G,Sun B,Jiang HC.Recent developments in the management of hyperlipidemic pancreatitis[J].Chin J Gen Surg(中国普通外科学杂志),2005,14(11):16-859.
[6]Liang ZH,Tang GD.Progress in pathogenesis of hyperlipidemic acute pancreatitis[J].Int J Digestive Diseases(国际消化病杂志),2013,33(1):32-34.
[7]Hackert T,Pfeil D,Hartwig W,et al.Platelet Function in Acute Experimental Pancreatitis[J].Br J Surg,2005,92(6):724-728.
[8]A Uru1uela,S Sevillano,AM de,et al.Time-course of oxygen free radical production in acinar cells during acute pancreatitis induced by pancreatic duct obstruction[J].BBA-Molecular Basis of Disease,2002,1588(2):159-164.
[9]Sha H,Ma Q,Jha RK.Trypsin is the culprit of multiple organ injury with severe acute pancreatitis[J].Medical Hypotheses,2009,72(2):180-182.
[10]He WH,Zhu Y,Zhu Y,et al.Comparison of severity and clinical outcomes between hypertriglyceridemic pancreatitis and acute pancreatitis due to other causes[J].Nat Med J Chin(中华医学杂志),2016,96(32):2569-2572.
[11]Cunha C,Barbosa AL,Pereira S,et al.Plasma exchange in hypertriglyceridaemic acute pancreatitis:case report[J].2016,30(2):140-144.
[12]Valdivielso P,Ramírezbueno A,Ewald N.Current knowledge of hypertriglyceridemic pancreatitis[J].European J Int Med,2014,25(8):689-694.
[13]Xu ZZ.Clinical study of acute pancreatitis complicated with gastric mucosal injury[J].J Qiqihar Univ Med(齐齐哈尔医学院学报),2013,34(9):1326-1327.
[14]Xu S,Zhou X.Research Progress on Mechanism of gastrointestinal injury in severe acute pancreatitis[J].Shandong Med J(山东医药),2015,55(45):102-105.
[15]Ma J,Dai L,Zhao W.Effects of Pyloric Local Calcitonin Generelated Peptide on Bile Acid Reflux to Rat Stomach[J].Hebei Med(河北医学),2007,13(6):637-641.
[16]Tüney D,Altun E,Barlas A,et al.Pancreatico-colonic fistula after acute necrotizing pancreatitis.Diagnosis with spiral CT using rectal water soluble contrast media[J].Jop J Pancreas,2008,9(1):26.
[17]Huang JQ,Lv JL,Hu X.Pharmacological action and clinical evaluation of rothetidine acetate[J].Chin J New Drugs(中国新药杂志),2014(14):1601-1605.
[18]Shikama N,Ichikawa T,Iwai T,et al.Different effects of two types of H2-receptor antagonists,famotidine and roxatidine,on the mucus barrier of rat gastric mucosa[J].Biomedical Res,2012,33(1):45.