ω-3鱼油脂肪乳剂和乌司他丁对重症急性胰腺炎合并腹腔高压患者免疫功能的影响  

Effect of ω-3 fish oil emulsion and ulinastatin on inflammation-immune response in patients with severe acute pancreatitis and intra-abdominal hypertension

作　　者：汪易岚 许春阳 叶宏伟 郑峰 Wang Yilan;Xu Chunyang;Ye Hongwei;Zheng Feng(Department of Intensive Care Unit, Changshu Hospital Affiliated to Suzhou Univeresity, Changshu 215500, China)

机构地区：[1]苏州大学附属常熟医院重症医学科,江苏常熟215500

出　　处：《中国实用医刊》2018年第12期14-17,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨应用ω--3鱼油脂肪乳剂及乌司他丁对重症急性胰腺炎（SAP）患者腹内压的影响及对炎症反应作用、免疫调节功能及预后的影响。方法选取医院入住ICU的符合SAP诊断标准且合并腹腔高压（IAH）或腹腔间隔室综合征（ACS）的患者62例，随机分为对照组、鱼油组、乌司他丁组。在治疗前及第6天，分别监测三组患者血清CD4＋／CD8＋、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平及微小RNA-216（miR-216）和微小RNA-92（miR-92），并进行急性生理学与慢性健康状况评分Ⅱ（APACHⅡ）评分。同时在治疗前及治疗第48小时监测三组患者的腹内压水平。结果在治疗第48小时，鱼油组和乌司他丁组的IAP较治疗前均有明显下降（P〈0．05）。与同组治疗前相比及与同期对照组相比，鱼油组CD4＋／CD8＋值治疗第6天显著下降（P〈0．05）；鱼油组及乌司他丁组IL-6、TNF—α在治疗第6天明显降低（P〈0．05）。与同组治疗前相比，三组血清miR-216和miR-92水平治疗第6天明显下降（P〈0．05），鱼油组和乌司他丁组的APACHEⅡ评分有显著下降（P〈0．05）。组间比较可见治疗第6天鱼油组血清miR-216和miR-92水平明显低于乌司他丁组（P〈0，05）。结论乌司他丁与ω-3鱼油脂肪乳剂对重症急性胰腺炎合并腹内高压的患者均有较好的免疫调节作用，ω-3鱼油脂肪乳剂相对于乌司他丁，有更强的抑制炎症基因表达、增强细胞免疫的作用。Objective To investigate the efficacy of ω-3 fish oil emulsion and ulinastatin on inflammation-immune response and prognosis in patients with severe acute pancreatitis and intra-abdominal hypertension. Methods Sixty-two patients with MSAP/SAP and IAH were enrolled in this study and divided into three groups equally and randomly： ω-3 fish oil emulsion group, ulinastatin group and control group. The levels of CD4 ＋/CD8 ＋ , IL-6, TNF-α, miR-216 and miR-92 were measured on admission day and six days after treatment. APACHE Ⅱ was used for disease assessment. The levels of intra-abdominal pressure were messured on admission day and 48 hours after treatment. Results The levels of intraabdominal pressure in both ω-3 fish oil emulsion group and ulinastatin group significantly reduced on 48 hours after treatment（P 〈0. 05）. The levels of CD4^＋/CD8^＋ in ω-3 fish oil emulsion group were lower than those in control group in the 6th day of treatment （P 〈 0. 05 ）. The levels of IL-6, TNF-α, miR- 216, miR-92 and APACHE Ⅱ in both ω-3 fish oil emulsion group and ulinastatin group all significantly reduced in the 6th day of treatment （P 〈 0. 05 ）, and the levels of miR-216, miR-92 in ω-3 fish oil emulsion group were lower than those in ulinastatin group （P 〈 0.05 ）. Conclusions ω-3 fish oil emulsion and ulinastatin both can significantly improve the immune functions in patients with severe acute pancreatitis and intra-abdominal hypertension, ω-3 fish oil emulsion have more significantly effect on inhibiting inflammatory gene expression and enhance the cellular immune.

关 键 词：鱼油 乌司他丁 重症急性胰腺炎 腹内压 微小RNA-216 微小RNA-92 

分 类 号：R576[医药卫生—消化系统]