目的:本研究旨在探讨乌司他丁联合生长抑素对重症胰腺炎患者病情控制及血清炎症因子的影响。
方法:对2020年5月至2022年4月江西医学院第一附属医院收治的80例重症胰腺炎患者的临床资料进行回顾性分析。其中,将36例患者在标准治疗的基础上单独使用生长抑素(在50mL生理盐水中加入3mg生长抑素)分为对照组,另外44例同时接受乌司他丁(100,000U乌司他丁注射液加入250mL5%葡萄糖溶液)和生长抑素(3mg生长抑素加入50mL生理盐水)治疗的患者被纳入研究组。血清炎症因子(白细胞介素-1β(IL-1β),白细胞介素-6(IL-6),和可溶性细胞间粘附分子-1(sICAM-1)),生化指标(C反应蛋白,白细胞计数,并对两组患者治疗前后的血清淀粉酶)和胃肠功能指标(胃动素和胃泌素)进行分析比较。此外,临床症状的缓解,比较两组患者的治疗反应和不良反应发生情况。评估患者治疗后1个月内的死亡率,通过logistic回归分析影响预后的危险因素。
结果:治疗前,两组IL-1β水平无显著差异,IL-6和sICAM-1(P>0.05),治疗后,3个因子水平均显著降低(P<0.0001),与对照组相比,研究组下降更明显(P<0.0001)。治疗前,两组C反应蛋白水平无显著差异,白细胞计数,血清淀粉酶(P>0.05),治疗后,这三个水平在两组中均显著下降(P<0.0001),研究组的水平明显低于对照组(P<0.0001)。治疗前,两组胃动素和胃泌素水平差异无统计学意义(P>0.05),治疗后,两组胃动素显著升高,胃泌素显著降低(P<0.0001),研究组胃动素水平明显高于对照组,胃泌素水平明显低于对照组(P<0.0001)。研究组腹胀、腹痛消失时间明显早于对照组,住院时间明显短于对照组(P<0.0001)。此外,研究组总有效率明显高于对照组(P=0.029),不良反应发生率明显低于对照组(P=0.036)。根据单变量分析,年龄,发病时间,急性生理学和慢性健康评价II评分和治疗方案是影响患者预后的因素。根据物流回归分析,治疗方案是影响预后的独立危险因素。
结论:与单用生长抑素相比,乌司他丁联合生长抑素治疗重症胰腺炎更有效。能显著缓解炎症反应,改善患者胃肠功能和临床症状,不增加不良反应。因此,乌司他丁联合生长抑素值得临床推广。
OBJECTIVE: This study was designed to explore the effects of ulinastatin combined with somatostatin on disease control and serum inflammatory factors in patients with severe pancreatitis.
METHODS: The data of 80 patients with severe pancreatitis treated in the First Affiliated Hospital of Jiangxi Medical College from May 2020 to April 2022 were analyzed retrospectively. Among them, 36 patients treated with somatostatin alone (3 mg somatostatin added in 50 mL normal saline) on the basis of standard treatment were assigned to a control group, and the other 44 patients treated with both ulinastatin (100,000 U of ulinastatin injection added in 250 mL 5% glucose solution) and somatostatin (3 mg somatostatin added in 50 mL normal saline) were enrolled into a study group. The levels of serum inflammatory factors (interleukin-1β (IL-1β), interleukin-6 (IL-6), and soluble intercellular adhesion molecule-1 (sICAM-1)), biochemical indexes (C-reactive protein, white blood cell count, and serum amylase) and gastrointestinal function indexes (motilin and gastrin) in the two groups were analyzed and compared before and after treatment. Additionally, the alleviation of clinical symptoms, treatment response and occurrence of adverse reactions were compared between the two groups. The mortality rate of patients within 1 month after the treatment was evaluated, and the risk factors affecting the prognosis were analyzed through logistics regression.
RESULTS: Before treatment, there was no significant difference between the two groups in the levels of IL-1β, IL-6 and sICAM-1 (P>0.05), while after treatment, the levels of all three factors decreased significantly in both groups (P<0.0001), with more notable decreases in the study group than those in the control group (P<0.0001). Before treatment, the two groups were not significantly different in the levels of C-reactive protein, white blood cell count, and serum amylase (P>0.05), while after treatment, all the three levels decreased notably in both groups (P<0.0001), with notably lower levels in the study group than those in the control group (P<0.0001). Before treatment, the levels of motilin and gastrin in the two groups were not significantly different (P>0.05), while after treatment, motilin increased significantly and gastrin decreased significantly in both groups (P<0.0001), and the study group showed a notably higher motilin level and a notably lower gastrin level than the control group (P<0.0001). The study group experienced a significantly earlier disappearance time of abdominal distension and abdominal pain and a significantly shorter hospitalization time than the control group (P<0.0001). Moreover, the study group showed a notably higher overall response rate than the control group (P=0.029), and presented a notably lower incidence of adverse reactions than the control group (P=0.036). According to univariate analysis, age, onset time, Acute Physiology and Chronic Health Evaluation II score and therapeutic regimen were the factors impacting the patients\' prognosis. According to logistics regression analysis, therapeutic regimen was an independent risk factor affecting the prognosis.
CONCLUSIONS: Compared with somatostatin alone, ulinastatin combined with somatostatin is more effective in the treatment of severe pancreatitis. The combination can substantially alleviate the inflammatory response and improve the gastrointestinal function and clinical symptoms of patients, without increasing adverse reactions. Therefore, ulinastatin combined with somatostatin is worthy of clinical promotion.