血必净注射液联合奥曲肽、乌司他丁治疗急性重症胰腺炎的疗效及对免疫功能的影响
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摘要
目的:探讨血必净注射液联合奥曲肽、乌司他丁治疗急性重症胰腺炎的疗效及对免疫功能的影响。方法:急性重症胰腺炎患者78例,按照随机数字的方法将患者分为对照组和观察组,每组均为39例,对照组在常规治疗的基础上使用奥曲肽联合乌司他丁的方法进行治疗,观察组在对照组治疗方法的基础上联合使用血必净注射液进行治疗,对治疗的效果进行对比。结果:经过治疗后,对照组的白细胞计数(WBC)、血清C反应蛋白(CRP)浓度、白细胞介素-6(IL-6)浓度和肿瘤坏死因子-α(TNF-α)浓度分别从(26.37±3.86)×10~9/L、(255.36±38.69)mg/L、(75.39±7.43)ng/L、(87.49±6.27)ng/L下降到(15.38±4.27)×10~9/L、(27.38±5.55)mg/L、(35.17±4.29)ng/L、(45.52±7.28)ng/L。观察组的WBC、血清CRP浓度、IL-6浓度和TNF-α浓度分别从(26.84±4.01)×10~9/L、(263.84±39.58)mg/L、(76.28±6.47)ng/L、(88.06±5.94)ng/L,下降到(11.08±3.66)×10~9/L、(9.38±2.39)mg/L、(25.16±5.12)ng/L、(27.25±3.64)ng/L。各项数据的下降幅度均为观察组大于对照组,数据差异均具有统计学意义(t=4.775,18.603,9.359,14.018,P<0.05),观察组的腹痛消失时间[(5.53±1.02)d VS(3.25±0.81)d]、体温恢复正常时间[(7.08±2.12)d VS(4.68±1.21)d]、腹胀恢复正常时间[(5.21±0.98)d VS(3.02±1.08)d]、恶心呕吐恢复正常时间[(4.82±1.32)d VS(3.38±0.81)d]、上腹部压痛恢复时间均短于对照组[(7.36±1.82)d VS(4.41±1.51)d],数据差异均具有统计学意义(t=10.932,6.140,9.378,5.807,7.790,P<0.05),观察组的治疗效果优于对照组,数据差异具有统计学意义(z=-5.090,P<0.05),观察组出现呼吸窘迫综合征、肾衰竭、休克的比例低于对照组,数据差异具有统计学意义(χ~2=5.014,6.500,6.155,P<0.05),两组的多脏器衰竭,败血症的发生比例数据差异不具有统计学意义(χ~2=1.013,0.214,P>0.05)。结论:使用血必净注射液联合奥曲肽、乌司他丁治疗急性重症胰腺炎的患者,可以改善患者的症状,提升治疗效果,值得在临床工作中使用。
Objective:To investigate the effect of Xuebijing Injection combined with octreotide and ulinastatin on acute severe pancreatitis and its influence on immune function. Methods:Seventy-eight patients with severe acute pancreatitis were divided into the control group and the observation group according to random number,39 cases in each group. The patients in the control group were treated with octreotide and ulinastatin on the basis of routine treatment. The patients in the observation group were treated with Xuebijing Injection on the basis of the control group, and the effect of the treatment was compared. Results: After treatment, the leukocyte count(WBC), serum C reactive protein(CRP) concentration, interleukin-6(IL-6) concentration and tumor necrosis TNF-α(TNF-α) concentration respectively from(26.37±3.86)×10~9/L,(255.36±38.69)mg/L,(75.39±7.43)ng/L and(87.49±6.27)ng/L decreased to(15.38±4.27)×10~9/L,(27.38±5.55)mg/L,(35.17±4.29)ng/L,(45.52±7.28)ng/L. WBC, serum CRP concentration, IL-6 concentration and TNF-α concentration in the observation group decreased from(26.84±4.01)×10~9/L,(263.84±39.58)mg/L,(76.28±6.47)ng/L and(88.06±5.94)ng/L to(11.08±3.66)×10~9/L,(9.38±2.39)mg/L,(25.16±2.39)ng/L. The decrease of all data in the observation group was greater than that of the control group, and the difference was statistically significant(t=4.775, 18.603, 9.359, 14.018, P<0.05). The disappearance time of abdominal pain in the observation group and control group was(5.53±1.02) days VS(3.25±0.81) days, the body temperature return to normal time(7.08±2.12) days VS(4.68±1.21) days, and the abdominal distention return to normal time(5.21±0.98) days VS(3.02±1.08) days, and nausea and vomiting return to normal time(4.82±1.32) days VS(3.38±0.81) days. The recovery time of abdominal tenderness was shorter than that of the control group[(7.36±1.82) days VS(4.41±1.51) days]. The difference was statistically significant(t=10.932, 6.140, 9.378, 5.807, 7.790, P<0.05). The treatment effect of the observation group was better than that of the control group, and the difference was statistically significant(z=-5.090, P<0.05). The incidence of respiratory distress syndrome, renal failure and shock in the observation group was lower than in the control group. The difference of data was statistically significant(χ~2=5.014, 6.500, 6.155, P<0.05). There was no statistically significant difference in the incidence of multiple organ failure or sepsis between the two groups(χ~2=1.013, 0.214, P>0.05). Conclusion: The use of Xuebijing Injection combined with octreotide and ulinastatin in the treatment of acute severe pancreatitis can improve the symptoms and the therapeutic effect, worthy of using in clinical work.
Objective:To investigate the effect of Xuebijing Injection combined with octreotide and ulinastatin on acute severe pancreatitis and its influence on immune function. Methods:Seventy-eight patients with severe acute pancreatitis were divided into the control group and the observation group according to random number,39 cases in each group. The patients in the control group were treated with octreotide and ulinastatin on the basis of routine treatment. The patients in the observation group were treated with Xuebijing Injection on the basis of the control group, and the effect of the treatment was compared. Results: After treatment, the leukocyte count(WBC), serum C reactive protein(CRP) concentration, interleukin-6(IL-6) concentration and tumor necrosis TNF-α(TNF-α) concentration respectively from(26.37±3.86)×10~9/L,(255.36±38.69)mg/L,(75.39±7.43)ng/L and(87.49±6.27)ng/L decreased to(15.38±4.27)×10~9/L,(27.38±5.55)mg/L,(35.17±4.29)ng/L,(45.52±7.28)ng/L. WBC, serum CRP concentration, IL-6 concentration and TNF-α concentration in the observation group decreased from(26.84±4.01)×10~9/L,(263.84±39.58)mg/L,(76.28±6.47)ng/L and(88.06±5.94)ng/L to(11.08±3.66)×10~9/L,(9.38±2.39)mg/L,(25.16±2.39)ng/L. The decrease of all data in the observation group was greater than that of the control group, and the difference was statistically significant(t=4.775, 18.603, 9.359, 14.018, P<0.05). The disappearance time of abdominal pain in the observation group and control group was(5.53±1.02) days VS(3.25±0.81) days, the body temperature return to normal time(7.08±2.12) days VS(4.68±1.21) days, and the abdominal distention return to normal time(5.21±0.98) days VS(3.02±1.08) days, and nausea and vomiting return to normal time(4.82±1.32) days VS(3.38±0.81) days. The recovery time of abdominal tenderness was shorter than that of the control group[(7.36±1.82) days VS(4.41±1.51) days]. The difference was statistically significant(t=10.932, 6.140, 9.378, 5.807, 7.790, P<0.05). The treatment effect of the observation group was better than that of the control group, and the difference was statistically significant(z=-5.090, P<0.05). The incidence of respiratory distress syndrome, renal failure and shock in the observation group was lower than in the control group. The difference of data was statistically significant(χ~2=5.014, 6.500, 6.155, P<0.05). There was no statistically significant difference in the incidence of multiple organ failure or sepsis between the two groups(χ~2=1.013, 0.214, P>0.05). Conclusion: The use of Xuebijing Injection combined with octreotide and ulinastatin in the treatment of acute severe pancreatitis can improve the symptoms and the therapeutic effect, worthy of using in clinical work.
引文
[1] 邓超,李景辉,吴平安,等.奥曲肽联合乌司他丁治疗急性重症胰腺炎的临床研究[J].中国临床药理学杂志,2016,32(18):1653-1656.
[2] 杨国祥,张万里,杜寒松,等.谷氨酰胺联合早期肠内营养对急性重症胰腺炎全身炎症的影响[J].中国生化药物杂志,2014(2):115-117.
[3] 姚振滨,张伟,张天,等.奥曲肽与乌司他汀联合治疗急性重症胰腺炎的效果及机制[J].山东医药,2016,56(41):49-51.
[4] Trikudanathan G,Vege SS.Current concepts of the role of abdominal compartment syndrome in acute pancreatitis:an opportunity or merely an epiphenomenon[J].Pancreatology,2014,14(4):238-243.
[5] Wu L,Li H,Zheng SZ,et al.Da-Huang-Fu-Zi-Tang attenuates liver injury in rats with severe acute pancreatitis[J].J Ethnopharmacol,2013,150(3):960-966.
[6] Zhu H,Liao X,Guo S,et al.Embryonal natural orifice transluminal endoscopic surgery treating severe acute pancreatitis complicated by abdominal compartment syndrome[J].Hepatogastroenterology,2014,61(135):2096-2101.
[7] 孙强,郑正.奥曲肽治疗急性水肿型胰腺炎72 例临床研究[J].中华全科医学,2013,11(5):714-715.
[8] Kim YA,Lee S,Jung JW,et al.Severe acute pancreatitis due to tamoxifen-induced hypertriglyceridemia with diabetes mellitus[J].Chin J Cancer Res,2014,26(3):341-344.
[9] 曾盛才.奥曲肽治疗胰腺炎的临床效果观察[J].医药前沿,2017,7(10):127-128.
[10] 孙文栋,徐诗雄,陈实,等.乌司他丁和奥曲肽联合治疗重症急性胰腺炎的疗效及血流变学观察[J].中国生化药物杂志,2014(5):113-115.
[11] 邱英,张均,白玛乔,等.大剂量乌司他丁联合血必净在急性重症胰腺炎中的应用研究[J].中外医学研究,2015(21):25-27.
[12] Yong FJ,Mao XY,Deng LH,et al.Continuous regional arterial infusion for the treatment of severe acute pancreatitis:a meta-analysis[J].Hepatobiliary Pancreat Dis Int,2015,14(1):10-17.
[13] 郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:299-302.
[14] 杨帆,牛刚,张建,等.急性重型胰腺炎26例临床诊治体会[J].贵阳中医学院学报,2014,36(4):118-120.
[15] 郑永彬,程新生.NGAL和降钙素原预测急性胰腺炎患者急性肾损伤的价值[J].胃肠病学和肝病学杂志,2017,26(2):210-213.
[16] 陈莎燕,赵琳,孙兰菊,等.血清鸢尾素检测对重型急性胰腺炎诊断的价值[J].广东医学,2017,38(23):3617-3619.
[17] Xu W,Zhou YF,Xia SH.Octreotide for primary moderate to severe acute pancreatitis:a meta-analysis[J].Hepatogastroenterology,2013,60(126):1504-1508.
[18] 柴伟.乌司他丁联合奥曲肽在急性胰腺炎中的应用及对细胞因子以及淀粉酶的影响[J].贵州医药,2017,41(3):261-263.
[19] 马维江,尹剑辉,张力君,等.血必净联合乌司他丁治疗急性胰腺炎有效性的Meta分析[J].中国医师杂志,2017,19(1):60-65.
[20] 郭华,陈炅,索冬卫.奥曲肽联合乌司他丁治疗急性重症胰腺炎临床疗效及安全性分析[J].中华医学杂志,2015,95(19):1471-1474.
[21] 黄天生,朱生樑,马淑颖,等.急性胰腺炎中医证型与疾病轻重类型相关性研究[J].江苏中医药,2011,43(8):32-33.
[22] Liu R,Qi H,Wang J,et al.Ulinastatin activates the renin- angiotensin system to ameliorate the pathophysiology of severe acute pancreatitis[J].J Gastroenterol Hepatol,2014,29(6):1328-1337.
[2] 杨国祥,张万里,杜寒松,等.谷氨酰胺联合早期肠内营养对急性重症胰腺炎全身炎症的影响[J].中国生化药物杂志,2014(2):115-117.
[3] 姚振滨,张伟,张天,等.奥曲肽与乌司他汀联合治疗急性重症胰腺炎的效果及机制[J].山东医药,2016,56(41):49-51.
[4] Trikudanathan G,Vege SS.Current concepts of the role of abdominal compartment syndrome in acute pancreatitis:an opportunity or merely an epiphenomenon[J].Pancreatology,2014,14(4):238-243.
[5] Wu L,Li H,Zheng SZ,et al.Da-Huang-Fu-Zi-Tang attenuates liver injury in rats with severe acute pancreatitis[J].J Ethnopharmacol,2013,150(3):960-966.
[6] Zhu H,Liao X,Guo S,et al.Embryonal natural orifice transluminal endoscopic surgery treating severe acute pancreatitis complicated by abdominal compartment syndrome[J].Hepatogastroenterology,2014,61(135):2096-2101.
[7] 孙强,郑正.奥曲肽治疗急性水肿型胰腺炎72 例临床研究[J].中华全科医学,2013,11(5):714-715.
[8] Kim YA,Lee S,Jung JW,et al.Severe acute pancreatitis due to tamoxifen-induced hypertriglyceridemia with diabetes mellitus[J].Chin J Cancer Res,2014,26(3):341-344.
[9] 曾盛才.奥曲肽治疗胰腺炎的临床效果观察[J].医药前沿,2017,7(10):127-128.
[10] 孙文栋,徐诗雄,陈实,等.乌司他丁和奥曲肽联合治疗重症急性胰腺炎的疗效及血流变学观察[J].中国生化药物杂志,2014(5):113-115.
[11] 邱英,张均,白玛乔,等.大剂量乌司他丁联合血必净在急性重症胰腺炎中的应用研究[J].中外医学研究,2015(21):25-27.
[12] Yong FJ,Mao XY,Deng LH,et al.Continuous regional arterial infusion for the treatment of severe acute pancreatitis:a meta-analysis[J].Hepatobiliary Pancreat Dis Int,2015,14(1):10-17.
[13] 郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:299-302.
[14] 杨帆,牛刚,张建,等.急性重型胰腺炎26例临床诊治体会[J].贵阳中医学院学报,2014,36(4):118-120.
[15] 郑永彬,程新生.NGAL和降钙素原预测急性胰腺炎患者急性肾损伤的价值[J].胃肠病学和肝病学杂志,2017,26(2):210-213.
[16] 陈莎燕,赵琳,孙兰菊,等.血清鸢尾素检测对重型急性胰腺炎诊断的价值[J].广东医学,2017,38(23):3617-3619.
[17] Xu W,Zhou YF,Xia SH.Octreotide for primary moderate to severe acute pancreatitis:a meta-analysis[J].Hepatogastroenterology,2013,60(126):1504-1508.
[18] 柴伟.乌司他丁联合奥曲肽在急性胰腺炎中的应用及对细胞因子以及淀粉酶的影响[J].贵州医药,2017,41(3):261-263.
[19] 马维江,尹剑辉,张力君,等.血必净联合乌司他丁治疗急性胰腺炎有效性的Meta分析[J].中国医师杂志,2017,19(1):60-65.
[20] 郭华,陈炅,索冬卫.奥曲肽联合乌司他丁治疗急性重症胰腺炎临床疗效及安全性分析[J].中华医学杂志,2015,95(19):1471-1474.
[21] 黄天生,朱生樑,马淑颖,等.急性胰腺炎中医证型与疾病轻重类型相关性研究[J].江苏中医药,2011,43(8):32-33.
[22] Liu R,Qi H,Wang J,et al.Ulinastatin activates the renin- angiotensin system to ameliorate the pathophysiology of severe acute pancreatitis[J].J Gastroenterol Hepatol,2014,29(6):1328-1337.