Clinical effect of somatostatin combined with alprostadil for patients with severe acute pancreatitis and its effect on the serum inflammatory factors

doi:10.3877/cma.j.issn.2095-2015.2018.02.004

Abstract

Abstract:

Objective

To observe the clinical effect of somatostatin combined with alprostadil in the treatment of severe acute pancreatitis and its influence on serum inflammatory factors.

Methods

Seventy-three patients with severe acute pancreatitis were enrolled in this study from May 2015 to May 2017 in Department of Hepatobiliary Surgery of Third People′s Hospital of Yunnan Province.These patients were randomly divided into observation group and control group according to the random number table method.The patients in control group were treated with routine treatment combined with somatostatin, and the patients in observation group were treated with routine treatment combined with somatostatin and alprostadil for 2 weeks.The clinical efficacy, symptom remission time, serum inflammatory factor level, adverse reaction rate and mortality rate of the two groups were observed.

Results

The total effective rate was 87.5%(28/32)in observation group and 75.6%(31/41)in control group, and the difference was statistically significant(P<0.05). The recovery time of bowel pain, recovery time of intestinal function, recovery time of blood amylase(AMY)and the average hospitalization time of observation group were shorter than those of control group [(3.2±1.2)d vs.(4.9±1.1)d, (3.7±1.1)d vs.(5.4±1.4)d, (5.8±1.1)d vs.(7.5±1.3)d, (14.8±5.2)d vs.(18.6±4.6)d], and the differences were statistically significant(P<0.05). The levels of acute physiology and chronic health evaluationⅡ(APACHEⅡ), white blood count(WBC), C-reactive protein(CRP), AMY, alanine aminotransferase(ALT)and serum creatinine(Cr)in the two groups after treatment declined significantly.The levels of APACHEⅡ, WBC, CRP, AMY, ALT and Cr in observation group were lower than those in control group at 7 days and 14 days after treatment [(9.2±2.2) vs.(10.5±1.5), (12.2±3.2)×10⁹/L vs.(13.9±2.9)×10⁹/L, (72.3±17.3)mg/L vs.(106.5±20.1)mg/L, (389.6±57.6)U/L vs.(1 066.3±152.4)U/L, (62.9±8.8)U/L vs.(80.4±11.5)U/L, (82.5±18.6)μmol/L vs.(108.6±20.5)μmol/L; (6.8±2.0) vs.(8.3±2.4), (7.5±1.2)×10⁹/L vs.(8.6±1.4)×10⁹/L, (24.2±8.6)mg/L vs.(52.7±15.2)mg/L, (72.6±15.2)U/L vs.(138.2±25.6)U/L, (22.5±6.4)U/L vs.(42.6±12.8)U/L, (46.2±10.4)μmol/L vs.(70.1±16.2)μmol/L], and the differences were statistically significant(P<0.05). The levels of endotoxin, tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the two groups declined significantly after treatment.The levels of endotoxin, TNF-αand IL-6 in observation group were lower than those in control group [(45.3±9.8)Eu/ml vs.(53.2±10.3)Eu/ml, (62.5±13.7)ng/L vs.(76.3±14.2)ng/L, (60.3±11.4)ng/L vs.(81.2±20.9)ng/L], and the differences were statistically significant(P<0.05). The mortality rate was 12.5%(4/32)in observation group and 25.4%(10/41)in control group, and the difference was statistically significant(P<0.05).

Conclusion

The effect of somatostatin combined with alprostadil in the treatment of severe acute pancreatitis is obvious, and this treatment can reduce effectively the levels of serum inflammatory factors, which is worthy to be popularized.

Key words: Severe acute pancreatitis, Alprostadil, Somatostatin, Interleukin-6

Dehong Yang, Qinhua Shao. Clinical effect of somatostatin combined with alprostadil for patients with severe acute pancreatitis and its effect on the serum inflammatory factors[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2018, 08(02): 61-65.

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References 22

1	王春友，杨明．急性胰腺炎诊治指南(2014)解读——急性胰腺炎外科诊治难点分析[J]．临床外科杂志，2015，8(1): 11-13.
2	刘建，李非．急性胰腺炎患者的诊治及预后[J]．中华肝胆外科杂志，2016，22(10): 714-718.
3	刘莉，王芳，於健，等．不同剂量生长抑素对老年重症急性胰腺炎疗效及胃肠动力的影响[J]．山东医药，2014，12(24): 62-63.
4	姜素伟，程子安．生长抑素联合泮托拉唑钠治疗重症急性胰腺炎的临床观察[J]．中国药房，2015，8(18): 2493-2495.
5	吴林，孔晓霞，郑永平．前列地尔联合腹腔灌洗治疗高脂血症性重症胰腺炎的临床疗效[J]．世界华人消化杂志，2015，23(22): 3624-3628.
6	中华医学会消化病学分会胰腺疾病学组．中国急性胰腺炎诊治指南(2013年，上海)[J]．中华消化杂志，2013，33(4): 656-660.
7	王海波．不同剂量前列地尔的应用安全性探讨[J]．临床医药文献电子杂志，2016，3(7): 1380-1381.
8	郭晓钟，吴春燕．重视急性胰腺炎的病因诊断[J]．中国实用内科杂志，2014，34(9): 836-838.
9	伏添，王学莉，童智慧，等．三种评分法对重症急性胰腺炎病人并发胰腺感染预测价值的比较研究[J]．肠外与肠内营养，2016，23(3): 129-132.
10	Qi Q, Wang R, Liu L, et al.Comparative effectiveness and tolerability of esomeprazole and omeprazole in gastro-esophageal reflux disease: A systematic review and meta-analysis[J]. Int J Clin Pharmacol Ther, 2015, 53(10): 803-810.
11	陈曦，孙霞，夏兴洲，等．埃索美拉唑联合生长抑素治疗重症胰腺炎的临床研究[J]．中国临床药理学杂志，2016，32(14): 1279-1282.
12	杨美荣，刘斌，张国顺，等．生长抑素联合早期血液灌流治疗急性重症胰腺炎临床分析[J]．中华实用诊断与治疗杂志，2017，31(2): 145-147.
13	Chen P, Wang W, Zhang Y, et al.Decreased MIZ1 expression in severe experimental acute pancreatitis: A rat study[J]. Dig Dis Sci, 2016, 61(3): 758-766.
14	蔡红慧，邓小梅．前列地尔注射液联合奥曲肽治疗急性重症胰腺炎的疗效及对患者血清TNF-α、IL-6、IL-18、闭合蛋白水平的影响[J]．中国生化药物杂志，2017，37(4): 323-325.
15	王华丽，肖江华．生长抑素联合前列地尔治疗重症急性胰腺炎126例疗效分析[J]．中国医药指南，2015，13(30): 18-19.
16	张丽贤，袁双珍，孙建顺，等．不同剂量前列地尔在急性胰腺炎患者中的疗效观察[J]．河北医药，2014，36(24): 3794-3795.
17	Wang WY, Chen Y, Su X, et al.Resistin-like molecule-αcauses lung injury in rats with acute pancreatitis by activating the PI-3K/Akt-NF-κB pathway and promoting inflammatory cytokine release[J]. Curr Mol Med, 2016, 16(7): 677-687.
18	Shi Q, Chen C, Deng WH, et al.Hydrogen-Rich saline attenuates acute hepatic injury in acute necrotizing pancreatitis by inhibiting inflammation and apoptosis, involving JNK and p38 mitogen-activated protein kinase-dependent reactive oxygen species[J]. Pancreas, 2016, 45(10): 1424-1431.
19	Gillies N, Pendharkar SA, Asrani VM, et al.Interleukin-6 is associated with chronic hyperglycemia and insulin resistance in patients after acute pancreatitis[J]. Pancreatology, 2016, 16(5): 748-755.
20	李卫，周筱筠，卢先州，等．重症急性胰腺炎大鼠血清Apelin、C反应蛋白及肿瘤坏死因子-α水平变化及临床意义[J]．中国老年学杂志，2016，36(9): 2080-2082.
21	徐兆军，别华容，田敏，等．生长抑素联合前列地尔对重症急性胰腺炎患者的疗效及对TNF-α、IL-6的影响[J]．河北医学，2016，22(2): 266-269.
22	李敏利，张晓华，金鑫鑫，等．前列地尔对重症急性胰腺炎患者早期促炎因子的影响及疗效观察[J].2017，42(2): 140-143.

组别	例数	显效	有效	无效	总有效率
观察组	32	16(50.0)	12(37.5)	4(12.5)	28(87.5)
对照组	41	18(43.9)	13(31.7)	10(24.4)	31(75.6)

组别	例数	显效	有效	无效	总有效率
观察组	32	16(50.0)	12(37.5)	4(12.5)	28(87.5)
对照组	41	18(43.9)	13(31.7)	10(24.4)	31(75.6)

组别	例数	腹痛缓解时间	肠功能恢复时间	血AMY恢复正常时间	平均住院时间
观察组	32	3.2±1.2	3.7±1.1	5.8±1.1	14.8±5.2
对照组	41	4.9±1.1	5.4±1.4	7.5±1.3	18.6±4.6
t值	?	7.768	8.214	11.157	5.279
P值	?	<0.05	<0.05	<0.01	<0.05

组别	例数	腹痛缓解时间	肠功能恢复时间	血AMY恢复正常时间	平均住院时间
观察组	32	3.2±1.2	3.7±1.1	5.8±1.1	14.8±5.2
对照组	41	4.9±1.1	5.4±1.4	7.5±1.3	18.6±4.6
t值	?	7.768	8.214	11.157	5.279
P值	?	<0.05	<0.05	<0.01	<0.05

时间点	组别	例数	APACHEⅡ评分	WBC(10⁹/L)	CRP(mg/L)	AMY(U/L)	ALT(U/L)	Cr(μmol/L)
治疗前	观察组	32	15.6±3.1	19.8±3.2	135.7±10.8	4 872.5±576.7	128.7±22.4	212.4±25.6
治疗前	对照组	41	15.4±4.6	19.6±3.3	138.2±11.3	4 799.8±609.5	137.2±28.4	208.6±21.7
?	t值	?	1.137	0.046	0.052	0.174	0.104	0.085
?	P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
治疗后3 d	观察组	32	12.1±3.3	17.5±2.6	115.4±15.8	2 985.6±355.1	93.2±20.4	137.1±21.0
治疗后3 d	对照组	41	12.4±2.7	16.9±3.3	119.2±21.6	3 166.9±284.5	98.6±18.6	145.6±18.5
?	t值	?	1.521	0.695	0.548	1.109	0.907	1.212
?	P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
时间点	组别	例数	APACHEⅡ评分	WBC(10⁹/L)	CRP(mg/L)	AMY(U/L)	ALT(U/L)	Cr(μmol/L)
治疗后7 d	观察组	32	9.2±2.2	12.2±3.2	72.3±17.3	389.6±57.6	62.9±8.8	82.5±18.6
治疗后7 d	对照组	41	10.5±1.5	13.9±2.9	106.5±20.1	1 066.3±152.4	80.4±11.5	108.6±20.5
?	t值	?	7.456	4.447	6.513	25.997	16.527	7.748
?	P值	?	<0.05	<0.05	<0.05	<0.01	<0.01	<0.05
治疗后14 d	观察组	32	6.8±2.0	7.5±1.2	24.2±8.6	72.6±15.2	22.5±6.4	46.2±10.4
治疗后14 d	对照组	41	8.3±2.4	8.6±1.4	52.7±15.2	138.2±25.6	42.6±12.8	70.1±16.2
?	t值	?	6.641	8.453	21.986	25.014	12.853	14.316
?	P值	?	<0.05	<0.05	<0.01	<0.01	<0.05	<0.05

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