甲磺酸加贝酯联合CBP治疗SAP的效果及对炎症“瀑布效应”相关因子的影响  

Effects of Gabexate mesilate combined with CBP on SAP and its influenceon related factors of inflammation “cascade effect”

作　　者：张健 刘贤 郭雅丽[1] 李亚强[1] 徐宝宏[1] ZHANG Jian;LIU Xian;GUO Ya-li;LI Ya-qiang;XU Bao-hong(Department of Gastroenterology,Affiliated Beijing Luhe Hospital of Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京潞河医院消化内科,北京101100

出　　处：《河北医科大学学报》2020年第3期272-275,281,共5页Journal of Hebei Medical University

摘　　要：目的探讨甲磺酸加贝酯联合连续性血液净化(continuous blood purification,CBP)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的效果及其对炎症“瀑布效应”相关因子的影响。方法将60例SAP患者按完全随机法分为观察组与对照组各30例。对照组给予CBP治疗,观察组在对照组基础上联合甲磺酸加贝酯,比较2组疗效、临床治疗情况、炎症“瀑布效应”相关因子[肿瘤坏死因子(tumour necrosis factorα,TNF-α)、可溶性肿瘤坏死因子受体(soluble tumor necrosis factor receptor,sTNFR)、核转录因子κB(nuclear factor-κB,NF-κB)、白细胞介素6(interleukin 6,IL-6)、白细胞介素8(interleukin 8,IL-8)]及并发症发生率。结果观察组临床疗效优于对照组(P<0.05),2组总有效率差异无统计学意义(P>0.05)。观察组腹痛缓解时间、胃肠减压时间、住院时间均短于对照组(P<0.05),2组28 d病死率差异无统计学意义(P>0.05)。2组TNF-α、sTNFR、NF-κB、IL-6、IL-8均呈降低趋势,观察组TNF-α、sTNFR、NF-κB、IL-6、IL-8降低幅度大于对照组,组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.01)。2组总并发症发生率差异无统计学意义(P>0.05)。结论SAP患者在CBP治疗基础上联合甲磺酸加贝酯或可取得更佳症状缓解获益,对炎症“瀑布效应”相关因子的改善更显著,且未显著增加并发症风险,值得临床推广。Objective To analyze the effects of Gabexate mesilate combined with continuous blood purification(CBP)on severe acute pancreatitis(SAP)and its influence on related factors of inflammation“cascade effect”.Methods A total of 60 SAP patients were divided into observation group and control group according to the completely random method.Control group was given CBP,and observation group was combined with Gabexate mesilate.The efficacy,clinical treatment,inflammation“cascade effect”related factors[tumor necrosis factorα(TNF-α),soluble tumor necrosis factor receptor(sTNFR),nuclear factor-κB(NF-κB),interleukin-6(IL-6),interleukin-8(IL-8)]and incidence rate of complications were compared between two groups.Results There were no significant differences in the total effective rate,28 d mortality rate and incidence rate of complications between two groups(P>0.05).However,the cure rate in observation group was significantly higher than that in control group,and the relief times of clinical symptoms and hospital stay were shorter than those in control group(P<0.05).The related factors of inflammation“cascade effect”in two groups after treatment were significantly decreased compared with those at d1 time point,but the levels of related factors of inflammation“cascade effect”in observation group at d3-d7 time points were significantly lower than those in control group(P<0.01).There was no significant difference of complication between two groups(P>0.05).Conclusion Gabexate mesilate on the basis of CBP in SAP patients can achieve better symptom relief,and more significantly improve the related factors of inflammation“cascade effect”,and it does not significantly increase the risk of complications.Thus it is worthy of clinical recommendation.

关 键 词：胰腺炎 甲磺酸加贝酯 连续性血液净化 

分 类 号：R576[医药卫生—消化系统]