Wang J, Jin J, Huang J, Li D R, Hao Y, Kong J D, Chu Z Y, Fu J H, Huang F
Department of Surgical Intensive Care Unit, the First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Zhonghua Yi Xue Za Zhi. 2017 Apr 25;97(16):1252-1255. doi: 10.3760/cma.j.issn.0376-2491.2017.16.015.
To observe the clinical efficacy and the effects on serum inflammatory factors of early use of ulinastatin in patients with moderately severe or severe acute pancreatitis (MSAP/SAP). This prospective, randomized, controlled trial was conducted in the First Affiliated Hospital of Soochow University from September 2013 to May 2016. A total of 42 cases were enrolled and assigned into either observation group or conventional treatment group (=21 each). The conventional treatment group received somatostatin, while the observation group received somatostatin combined with ulinastatin. After treatment, clinical characteristics, serum indicators, clinical complications and serum level of inflammatory factors were analyzed. Intra-abdominal pressure and relief time of abdominal pain were significantly decreased in observation group [ (10.4±2.1) cmH(2)O; (2.5±1.2) d ] compared with the conventional treatment group [ (11.7±2.2) cmH(2)O; (3.33± 1.2) d ], <0.05. White blood cells (WBC) were lower in observation group than those in conventional treatment group [ (11.2±1.8) ×10(9)/L vs (12.5±2.3) ×10(9)/L; <0.05 ]. After treatment serum levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-α(TNF-α) in observation group [ (30.5±3.3), (34.7± 6.5), (22.6±4.0) μg/L] were significantly lower than those in conventional treatment group [ (39.6±4.0), (40.9±3.4), (33.1±6.6) μg/L], <0.05. There were no differences between the two groups in modified CT severity index (MCTSI), recovery time of defecation, ICU length of stay, serum amylase, C-reactive protein (CRP) and incidence rates of clinical complications. The early use of ulinastatin in the patients with MSAP/SAP can down-regulated the levels of TNF-α, IL-6 and IL-8, reduce the inflammatory response, decrease intra-abdominal pressure and shorten abdominal pain time. It was beneficial and worthy of wider popularization.
观察乌司他丁早期应用于中重度或重度急性胰腺炎（MSAP/SAP）患者的临床疗效及对血清炎症因子的影响。本前瞻性、随机、对照试验于2013年9月至2016年5月在苏州大学附属第一医院进行。共纳入42例患者，分为观察组和传统治疗组（每组21例）。传统治疗组给予生长抑素，观察组给予生长抑素联合乌司他丁。治疗后，分析临床特征、血清指标、临床并发症及血清炎症因子水平。与传统治疗组相比，观察组腹内压和腹痛缓解时间显著降低[（10.4±2.1）cmH₂O；（2.5±1.2）d]，传统治疗组为[（11.7±2.2）cmH₂O；（3.33±1.2）d]，P<0.05。观察组白细胞（WBC）低于传统治疗组[（11.2±1.8）×10⁹/L对（12.5±2.3）×10⁹/L；P<0.05]。治疗后，观察组血清白细胞介素-6（IL-6）、IL-8和肿瘤坏死因子-α（TNF-α）水平[（30.5±3.3）、（34.7±6.5）、（22.6±4.0）μg/L]显著低于传统治疗组[（39.6±4.0）、（40.9±3.4）、（33.1±6.6）μg/L]，P<0.05。两组在改良CT严重指数（MCTSI）、排便恢复时间、ICU住院时间、血清淀粉酶、C反应蛋白（CRP）及临床并发症发生率方面无差异。MSAP/SAP患者早期应用乌司他丁可下调TNF-α、IL-6和IL-8水平，减轻炎症反应，降低腹内压，缩短腹痛时间。有益且值得更广泛推广。
