乌司他丁不同给药模式联合奥曲肽对老年重症急性胰腺炎患者腹内高压及肠黏膜功能及对p38 MAPK信号通路介导的炎症反应的影响  

The effects of Ulinastatin in two ways of infusion combined with Octreotide on intraperitoneal hypertension and intestinal mucosal function in elderly patients with severe acute pancreatitis and the inflammatory response mediated by p38 MAPK signaling pat

作　　者：杨晓钟[1] 马雯霞[1] 王军艳[2] YANG Xiaozhong;MA Wenxia;WANG Junyan(Department of Pharmacy,the Second Affiliated Hospital of Xi~ an Medical University,Xi ~ an,710038,China;Department of Gastroenterology,the Second Affiliated Hospital of Xi ＇ an Medical University)

机构地区：[1]西安医学院第二附属医院药剂科,西安710038 [2]西安医学院第二附属医院消化内科,西安710038

出　　处：《临床急诊杂志》2018年第8期505-509,共5页Journal of Clinical Emergency

基　　金：陕西省科学技术研究发展计划项目(No:K2015658)

摘　　要：目的：探讨乌司他丁不同给药模式联合奥曲肽治疗老年重症急性胰腺炎（SAP）疗效的差异。方法：将90例老年SAP患者分为研究1组、研究2组及对照组,每组各30例。研究1组应用Seldinger法行区域动脉灌注乌司他丁联合奥曲肽治疗,研究2组给予乌司他丁经静脉全身给药联合奥曲肽治疗,对照组给予奥曲肽治疗。观察并比较3组患者临床疗效、治疗前后腹腔内高压以及肠黏膜屏障功能的改善情况,并检测炎性细胞因子水平,同时取静脉血,分离PBMC,采用实时聚合酶链反应（Real-time PCR）法检测各组p38MAPK mRNA在PBMC的表达;采用Western blot检测各组p38MAPK、P-p38MAPK蛋白在PBMC的表达。结果：3组患者的总有效率分别为93.33%、80.00%和63.33%,差异有统计学意义（χ^2=3.952,P〈0.05）;3组患者治疗后胃肠减压时长、腹痛缓解时长、住院时长、转外科手术率和病死率比较,差异均有统计学意义（均P〈0.05）;3组患者在治疗12d后白细胞计数、IL-6、CRP、AMS、D-乳糖、二胺氧化酶和腹内压力水平均显著下降,组间比较差异有统计学意义（均P〈0.05）;治疗12d后p38 MAPK mRNA、p38和P-p38蛋白相对表达量均明显降低,组间比较差异有统计学意义（均P〈0.05）。结论：乌司他丁可能通过抑制p38-MAPK信号通路介导的炎症反应来发挥治疗SAP的作用,而区域动脉灌注乌司他丁较静脉注射疗效更佳。Objective：To explore the difference of therapeutic effect of Urinastatin in two ways of infusion combined with Octreotide in the treatment of severe acute pancreatitis（SAP）.Method：Ninety cases of SAP patients were divided into group 1,group 2 and control group（30 cases for each group）.The regional arterial perfusion of Urinastatin using Seldinger method combined with Octreotide were given to the paitients in group 1,intravenous infusion of Urinastatin combined with Octreotide in group 2,and Octreotide therapy in control group.Observe and compare the clinical efficacy of the three groups,the improvement of intra-abdominal hypertension and intestinal mucosal barrier function before and after treatment,and detect the level of inflammatory cytokines.The expression of p38 MAPK mRNA in PBMC was detected by Real-time PCR,and the expression of p-38,P-p38 proteins were detected by Western blot in three groups.Result：The total effective rate of the three groups was93.33%,80.00% and 63.33% respectively,and the difference was statistically significant（χ2=3.952,P〈0.05）.There was a statistically significant difference between the time of gastrointestinal decompression,the time of abdominal pain relief,the length of hospital stay,the rate of surgery,and the mortality rate in three groups（both P〈0.05）.After 12 days of treatment,white blood cell count,IL-6,CRP,AMS,D-galactose,diamine oxidase,intro-abdominal pressure levels,and the relative expression of p38 MAPK mRNA,p38 and P-p38 were significantly decreased comparing with those prior treatment（all P〈0.05）.Conclusion：Ulinastatin may play a role in the treatment of SAP by inhibiting the inflammatory response mediated by p38-MAPK signaling pathway,and the regional arterial perfusion of ulinastatin is better than intravenous injection.

关 键 词：乌司他丁 奥曲肽 重症胰腺炎 腹内高压 炎症因子 

分 类 号：R576[医药卫生—消化系统]