高剂量乌司他丁治疗中性粒细胞缺乏脓毒症患者疗效观察  

Analysis of the efficacy of high-dose ulinastatin in the treatment of neutropenic sepsis patients

作　　者：卢冬雪 李海涛[1] 张东阳 李丹丹[1] 付金月 张倩[1] 范圣瑾[1] LU Dongxue;LI Haitao;ZHANG Dongyang;LI Dandan;FU Jinyue;ZHANG Qian;FAN Shengjin(Hematological Intensive Care Unit,the First Affiliated Hospital of Harbin Medical University,Heilongjiang Institute of Hematology&Oncology,Harbin,150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江血液肿瘤研究所,血液肿瘤重症监护病房,哈尔滨150001

出　　处：《临床血液学杂志》2025年第1期25-30,共6页Journal of Clinical Hematology

基　　金：国家自然科学基金项目(No:81430088)。

摘　　要：目的:观察高剂量乌司他丁对中性粒细胞缺乏伴脓毒症(粒缺脓毒症)患者炎症指标、脏器功能以及预后的影响。方法:选取2020年1月—2024年11月哈尔滨医科大学附属第一医院血液肿瘤重症监护病房(hematological intensive care unit,HCU)收治的104例粒缺脓毒症患者,以随机数字表法分为乌司他丁组(UTI组)和非乌司他丁组(对照组),经筛选最终入选UTI组33例,对照组36例。UTI组在常规治疗基础上应用乌司他丁40万U,2次/d,治疗7 d;对照组仅给予常规治疗。比较两组间炎症指标白细胞介素6(IL-6)、C反应蛋白(CRP)和降钙素原(PCT)水平变化,序贯器官衰竭评分(SOFA评分)变化以及预后情况。结果:治疗后第1天,仅UTI组IL-6呈下降趋势,而对照组IL-6、两组PCT和CRP以及SOFA评分均升至峰值;治疗后第2~7天,两组上述指标均呈持续降低趋势。与对照组比较,UTI组CRP水平及SOFA评分下降更明显(P=0.042,P=0.034);两组间PCT和IL-6水平差异无统计学意义。两组28 d死亡率差异无统计学意义,而与对照组比较,UTI组的7 d死亡率较低(P=0.049)。结论:高剂量乌司他丁治疗粒缺脓毒症疗效较好,可改善粒缺脓毒症早期高炎症反应导致的脏器损伤,从而延缓疾病进展,降低粒缺脓毒症患者的7 d死亡率,但未降低28 d死亡率。Objective:This study was conducted to analyze the efficacy of high-dose ulinastatin(UTI)on inflammatory indicators,organ function and prognosis of neutropenic sepsis patients.Methods:A total of 104 neutropenic sepsis patients were selected from January 2020 to November 2024,in the Hematological Intensive Care Unit(HCU),the First Affiliated Hospital of Harbin Medical University.Patients were divided into UTI group and non-ulinastatin group(control group)by random number table method.After screening,the UTI group included 33 cases,and the control group included 36 cases.The patients of UTI group received 400000 U of Ulastatin,twice a day for 7 days.And the control group only received conventional treatment.The changes of IL-6,CRP,PCT and SOFA score were compared between the two groups.Results:On the first day after UTI treatment,only IL-6 in the UTI group showed a decreasing trend,while IL-6 in the control group,PCT,CRP and SOFA score in both groups rose to the peak;From the second day to the seventh day following UTI treatment,both groups displayed a consistent downward trend.The CRP level(P=0.042)and SOFA score(P=0.034)of UTI group dropped more sharply than those of the control group.There was no significant difference in PCT and IL-6 between the two groups.The UTI group had a lower 7-day mortality rate than the control group(P-O.049),however there was no significant difference in the 28-day mortality rate between the two groups.Conclusion:In the early stage of neutropenic sepsis,high-dose ulinastatin could ameliorate the damage to organs caused by high inflammatory response,delay the progression of the disease,and lower the 7-day mortality rate of neutropenic sepsis,but not the 28-day mortality rate.

关 键 词：乌司他丁 中性粒细胞缺乏 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]