乌司他丁联合奥曲肽对急性胰...水平及肠粘膜屏障功能的影响_朱艳平.pdf

92Clinical Research,May 2023,Vol.31 No.05作者简介：朱艳平，女，主治医师，本科。研究方向：脾胃消化方面治疗。及对过氧化脂、丙二醛、生长抑素水平的影响J.中国医师进修杂志,2020,43(2):135-139.8汪鸿志,曹世植.现代消化性溃疡病学M.北京:人民军医出版社,1999:53-55.9陈秀挺,钱柯锦,丁丽英,等.雷贝拉唑联合内镜止血术对女性更年期消化性溃疡患者胃肠功能和炎症细胞因子水平的影响J.中国妇幼保健,2022,37(6):1118-1121.10顾星,吴莺.幽门螺杆菌毒力因子、宿主反应与相关胃肠疾病关系的研究进展J.热带医学杂志,2019,19(2):249-252.11黄如德,仇建光,韩清锡.归脾汤泻心汤与兰索拉唑联合治疗消化道溃疡对患者胃酸分泌情况的影响分析J.中国中西医结合消化杂志,2019,27(1):31-35.12张彧,吴东升,徐寅,等.中药联合三联疗法治疗Hp阳性消化性溃疡临床疗效与安全性的Meta分析J.中国中西医结合消化杂志,2019,27(9):653-661.13袁浩壬,付晓林.Hp感染性胃溃疡患者血清炎症因子、MMP-9和TIMP-1水平变化及其与炎性活动度的相关性J.海南医学,2022,33(8):968-971.14何学君.雷贝拉唑与奥美拉唑四联疗法治疗幽门螺杆菌阳性消化性溃疡患者的疗效及安全性J.医疗装备,2021,34(7):120-121.15王卉,马剡芳,常宇飞,等.卡络磺钠联合法莫替丁治疗急性上消化道出血的临床效果及对患者凝血功能的影响J.广西医学,2020,42(21):2777-2780,2799.16龙丹丹.泮托拉唑治疗消化性溃疡出血的疗效及对血清VEGF、PYY等的影响J.现代消化及介入诊疗,2020,25(5):655-658.17陈伟平,陈钦明,余练.雷贝拉唑与法莫替丁治疗小剂量肠溶型阿司匹林所致胃十二指肠溃疡的疗效对比J.现代诊断与治疗,2019,30(23):4122-4123.18李明,朱飞,江梅.雷贝拉唑联合法莫替丁治疗十二指肠溃疡的效果及对患者氧化应激指标水平的影响J.中国医药,2021,16(5):721-724.19庄辛福,朱长红.雷贝拉唑治疗消化性溃疡出血的临床效果及对TXB2,VEGF的影响J.慢性病学杂志,2021,22(8):1152-1155.20武艳丽.加味黄连解毒汤联合雷贝拉唑对胃溃疡Hp感染患者血清CRP、IL-6水平的影响J.医学理论与实践,2021,34(15):2608-2609.21谢鸿,叶芸.泻心汤合十灰散加减联合雷贝拉唑治疗消化性溃疡伴出血对患者胃液pH值及炎症因子的影响J.四川中医,2021,39(4):110-113.临床治疗乌司他丁联合奥曲肽对急性胰腺炎患者炎症水平及肠粘膜屏障功能的影响朱艳平1，司琳琳2(1.沈丘县中医院 脾胃科，河南 周口，466300；2.郑州人民医院 消化内科，河南 郑州，450000)摘要：目的 探讨乌司他丁联合奥曲肽治疗急性胰腺炎(AP)的临床疗效以及对患者炎症水平及肠粘膜屏障功能的影响。方法 采用随机数表法将沈丘县中医院 2018 年 1 月至 2020 年 12 月收治的 112 例 AP 患者分为对照组(56 例，仅采取奥曲肽治疗)和观察组(56 例，在对照组基础上联合乌司他丁治疗)。两组均持续治疗 7 d。比较两组临床疗效、治疗基本情况、炎性指标 C 反应蛋白(CRP)、白介素-1(IL-1)、单核细胞趋化蛋白(MCP-1)、白介素-8(IL-8)及肿瘤坏死因子-(TNF-)、肠粘膜屏障功能指标、T 淋巴细胞和并发症发生情况。结果 观察组治疗有效率高于对照组，差异有统计学意义(P 0.05)。观察组腹痛、腹胀缓解、首次排便、肠鸣音恢复及住院等时间均短于对照组，差异有统计学意义(P 0.05)。两组治疗前患者炎症指标、淀粉酶水平对比，差异无统计学意义(P 0.05)；治疗 7 d 后，两组患者炎症指标、淀粉酶水平均优于治疗前，且观察组血清 CRP、IL-1、IL-8、MCP-1、TNF-及淀粉酶水平均低于对照组，差异有统计学意义(P 0.05)；两组治疗前患者肠粘膜屏障功能指标比，差异无统计学意义(P 0.05)；治疗 7 d 后，两组患者肠粘膜屏障功能指标均优于治疗前，且观察组血清二胺氧化酶、内毒素及 D-乳糖水平均低于对照组(P 0.05)。两组治疗前患者 T 淋巴细胞指标比较，差异无统计学意义(P 0.05)；治疗 7 d 后，两组患者 T 淋巴细胞指标均优于治疗前，且观察组 CD3、CD4 高于对照组，CD8 水平低于对照组，差异无统计学意义(P 0.05)。两组并发症发生率比较，差异无统计学意义(P 0.05)。结论 乌司他丁联合奥曲肽治疗急性胰腺炎临床疗效确切，优于单一使用奥曲肽治疗，可改善患者炎症、淀粉酶水平及肠粘膜屏障功能，促进患者早日康复。关键词：急性胰腺炎；奥曲肽；乌司他丁；炎症水平；肠粘膜屏障功能中图分类号：R576文献标志码：B DOI：10.12385/j.issn.2096-1278(2023)05-0092-05Effect of Ulinastatin Combined with Octreotide on Inflammatory Level and Intestinal Mucosal Barrier Function in Patients with Acute PancreatitisZHU Yanping1,SI Linlin2(1.Department of Gastroenterology,Shenqiu County Traditional Chinese Medicine Hospital,Zhoukou Henan 466300,China;2.Department of Gastroenterology,Zhengzhou Peoples Hospital,Zhengzhou Henan 450000,China)Abstract:Objective To investigate the clinical efficacy of ulinastatin combined with octreotide in the treatment of acute pancreatitis(AP)and its effect on the level of inflammation and intestinal mucosal barrier function of patients.Methods A total of 112 patients with AP admitted to Shenqiu County Hospital of Traditional Chinese Medicine from January 2018 to December 2020 93临床研究 2023 年 05 月第 31 卷第 05 期were divided into control group(56 cases,treated with octreotide only)and observation group(56 cases,treated with ulinastatin on the basis of control group)by random number table method.Both groups were treated continuously for 7 days.Compare the clinical efficacy,basic treatment information,and inflammatory indicators of C-reactive protein(CRP)and interleukin-1 between two groups (IL-1),Monocyte chemotactic protein(MCP-1),interleukin-8(IL-8),and tumor necrosis factor-(TNF-)，Functional indicators of intestinal mucosal barrier,T lymphocytes,and incidence of complications.Results The total effective rate of the observation group was higher than that of the control group,the difference was statistically significant(P 0.05);The observation group had shorter time for abdominal pain,relief of bloating,first bowel movement,recovery of bowel sounds,and hospitalization compared to the control group,with statistically significant differences(P 0.05);There was no statistically significant difference in inflammation indicators and amylase levels between the two groups of patients before treatment(P0.05);After 7 days of treatment,the inflammatory indicators and amylase levels in both groups of patients were better than before treatment,moreover,the serum levels of CRP,IL-1,IL-8,MCP-1,TNF-and amylase in the observation group were all lower than those in the control group,showing statistically significant differences(P 0.05);There was no statistically significant difference in the intestinal mucosal barrier function indicators between the two groups of patients before treatment(P 0.05);After 7 days of treatment,the intestinal mucosal barrier function indicators of both groups of patients were better than before treatment,and the serum diamine oxidase,endotoxin,and D-lactose water levels in the observation group were on average lower than those in the control group,showing statistically significant differences(P 0.05);There was no statistically significant difference in T lymphocyte indicators between the two groups of patients before treatment(P 0.0