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目的探讨乌司他丁治疗急性重症胰腺炎(SAP)的疗效及患者血清炎症因子水平变化情况。方法将62例SAP患者按照治疗方式随机分为对照组(30例)与观察组(32例),二组均给予常规治疗,观察组在此基础上采用乌司他丁治疗。比较二组临床疗效、一般资料、治疗前后血清免疫球蛋白水平变化、治疗前后内毒素、炎性因子水平变化、治疗前后生化指标水平变化及治疗前后凝血指标水平变化。结果经治疗,观察组临床总有效率为84.38%,显著高于对照组(70.00%)(P<0.05);观察组入住ICU时间、14d APACHEII评分、14d Binder评分、中转手术率及28d病死率均显著小于对照组(P<0.05);二组治疗后IgG及IgM水平均显著高于治疗前(P<0.05),且观察组治疗后上述水平也均显著高于对照组(P<0.05);二组治疗后内毒素、TNF-α、IL-6及CRP较治疗前均显著降低,IL-10较治疗前显著升高,且二组治疗后上述指标差异均具有统计学意义(P<0.05);二组治疗后淀粉酶及LDH水平均显著低于治疗前(P<0.05),且二组治疗后淀粉酶、LDH及ALB水平差异均具有统计学意义(P<0.05);二组治疗后TT、PT、APTT、D-二聚体及FIB水平均显著小于治疗后1d(P<0.05),治疗后PLT水平显著大于治疗后1d(P<0.05)。结论乌司他丁治疗SAP的临床疗效显著,其作用机制可能与减轻炎性因子与细胞因子的大量释放、改善胰腺的微循环以及纠正高凝状态等方面的因素有关。
Objective To investigate the efficacy of ulinastatin in the treatment of acute severe pancreatitis (SAP) and the changes of serum inflammatory cytokines in patients. Methods Sixty-two patients with SAP were randomly divided into control group (n = 30) and observation group (n = 32) according to the method of treatment. The two groups were given routine treatment. The observation group was treated with ulinastatin. The clinical efficacy, general information, serum immunoglobulin levels before and after treatment, endotoxin and inflammatory cytokines levels before and after treatment were compared between the two groups. The changes of biochemical indexes before and after treatment and the changes of coagulation indexes before and after treatment were compared. Results After treatment, the total effective rate in observation group was 84.38%, significantly higher than that in control group (70.00%) (P <0.05). ICU time, 14-day APACHEII score, 14d Binder score, (P <0.05). The levels of IgG and IgM in the two groups were significantly higher than those before treatment (P <0.05), and the levels in the observation group were also significantly higher than those in the control group (P <0.05) The levels of endotoxin, TNF-α, IL-6 and CRP in the two groups after treatment were significantly lower than those before treatment, while the levels of IL-10 in the two groups were significantly higher than those before treatment, and the differences were statistically significant between the two groups after treatment (P < 0.05). The levels of amylase and LDH in the two groups were significantly lower than those before treatment (P <0.05), and there were significant differences in the levels of amylase, LDH and ALB between the two groups after treatment (P <0.05) The levels of TT, PT, APTT, D-dimer and FIB after treatment were significantly lower than those on the 1st day after treatment (P <0.05). After treatment, the PLT levels were significantly greater than those on the 1st day after treatment (P <0.05). Conclusion The clinical efficacy of ulinastatin in the treatment of SAP is significant. Its mechanism may be related to the reduction of massive release of inflammatory cytokines and cytokines, improvement of microcirculation of the pancreas and correction of hypercoagulability.