清胰通腑汤联合低分子肝素在高脂血症性急性胰腺炎治疗中的应用研究  

Application of qingyi tongfu decoction combined with low molecular weight heparin in the treatment of hyperlipidemic acute pancreatitis

作　　者：马璐璐 马红梅 许立增 王敏 MA Lulu;MA Hongmei;XU Lizeng;WANG Min(Department of Emergency Medicine,Affiliated Hospital of Shandong Second Medical University,Weifang 261031,China)

机构地区：[1]山东第二医科大学附属医院急诊科,山东潍坊261031

出　　处：《山东第二医科大学学报》2025年第1期12-16,共5页Journal of Shandong Second Medical University

基　　金：潍坊市卫生健康委员会中医药科研项目(项目编号:WFZYY2024-4-119)。

摘　　要：目的 探讨清胰通腑汤联合低分子肝素对高脂血症性急性胰腺炎(HLAP)患者的临床疗效。方法 选取2022年10月~2024年10月山东第二医科大学附属医院急诊综合病房收治的80例HLAP患者为研究对象,随机分为低分子肝素组和联合治疗组,每组40例。低分子肝素组接受常规治疗(禁食、胃肠减压、口服降脂药、止痛、抑制胰酶分泌、营养支持、抗感染等)和皮下注射低分子肝素钠;联合治疗组在上述治疗基础上加用清胰通腑汤灌肠(1次/d,连续治疗7 d)。用双抗体酶联免疫吸附试验检测两组患者的C-反应蛋白(CRP)、降钙素原(PCT)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、血淀粉酶、血脂肪酶、活化部分凝血激酶时间(APTT)、凝血酶原时间(PT)和D-二聚体。用SPSS 26.0软件进行统计分析,采用两样本的t检验、秩和检验比较组间差异,绘制ROC曲线并比较曲线下面积(AUC)。结果 两组患者入院24 h内CRP、PCT、TG、TC、血淀粉酶、血脂肪酶、APTT、PT、D-二聚体无明显差异(P>0.05);治疗7 d后,联合治疗组炎性指标(CRP、PCT)、血脂代谢指标(TG、TC、LDL)、胰腺代谢指标(血淀粉酶、血脂肪酶)以及D-二聚体水平低于低分子肝素组(P<0.05),但两组凝血指标APTT、PT差异无统计学意义(P>0.05);联合治疗组患者治疗后第7天的血清TG浓度界值为3.055 mmol/L,曲线下面积为0.987,敏感度为95%(P<0.05)。结论 清胰通腑汤与低分子肝素联合治疗能显著改善HLAP患者血脂水平及血清胰腺炎指标,下调炎性因子和D-二聚体表达,提高治疗效果。Objective To investigate the clinical efficacy of Qingyi Tongfu Decoction combined with low-molecular-weight heparin in patients with hyperlipidemic acute pancreatitis(HLAP).Methods Eighty HLAP patients admitted to the emergency comprehensive ward of the Affiliated Hospital of Shandong Second Medical University from October 2022 to October 2024 were selected as the research subjects.They were randomly divided into a low-molecular-weight heparin group and a combined treatment group,with 40 cases in each group.The low-molecular-weight heparin group received conventional treatment including fasting,gastrointestinal decompression,oral lipid-lowering drugs,pain relief,inhibition of pancreatic enzyme secretion,nutritional support,and anti-infection treatment,etc.and subcutaneous injection of low-molecular-weight heparin sodium.The combined treatment group,based on the treatment of the low-mo-lecular-weight heparin group,received an additional enema of Qingyi Tongfu Decoction(once a day for 7 consecutive days).The levels of C-reactive protein(CRP),procalcitonin(PCT),triglycerides(TG),total cholesterol(TC),low-den-sity lipoprotein(LDL),serum amylase,lipase,activated partial thromboplastin time(APTT),prothrombin time(PT),and D-dimer were measured using the double-antibody enzyme-linked immunosorbent assay(ELISA).Statistical analyses were performed using SPSS 26.0 software to compare the differences between groups.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)was compared.Results①There were no significant differences in CRP,PCT,TG,TC,serum amylase,lipase,APTT,PT,and D-dimer between the two groups within 24 hours(P>0.05).②After 7 days of treatment,the levels of CRP,PCT,TG,TC,serum amylase,lipase,and D-dimer in the combined treatment group were lower than those in the low-molecular-weight heparin group(P<0.05),while there were no statistical differences in APTT and PT(P>0.05).③In the combined treatment group,the cut-off value of serum TG concentration on day 7 was 3.055 mmol

关 键 词：清胰通腑汤 低分子肝素 高脂血症性急性胰腺炎 血脂 凝血功能 

分 类 号：R259[医药卫生—中西医结合]