摘要
目的探讨乌司他丁联合早期肠内营养治疗重症急性胰腺炎的疗效及对核因子κB(NF-κB)和Toll样受体4(TLR4)的影响。方法选择山东省利津县中心医院2016年1月至2020年1月诊治的重症急性胰腺炎患者90例,按随机数字表法分为U+EEN组(乌司他丁联合早期肠内营养治疗)和EEN组(早期肠内营养治疗),每组45例,两组治疗前一般临床资料比较差异无统计学意义(P>0.05)。比较两组患者治疗后的疗效、并发症及治疗前后营养指标、免疫球蛋白及炎性因子水平的差异。Western blot法检测并比较两组患者胰腺组织NF-κB和TLR4蛋白的表达情况。结果U+EEN组住院时间、住ICU时间、肠道通气时间、住院费用和器官功能衰竭、胰腺囊肿、糖尿病、慢性胰腺炎、败血症发生率低于EEN组[(2.1±0.4)个月比(2.4±0.6)个月、(16.9±2.1)d比(21.7±2.8)d、(23.7±3.8)d比(27.4±4.1)d、(11.4±1.5)万元比(14.1±2.1)万元和8.9%(4/45)比20.0%(9/45)、13.3%(6/45)比28.9%(13/45)、11.1%(5/45)比24.4%(11/45)、8.9%(4/45)比26.7%(12/45)、6.7%(3/45)比22.2%(10/45)],差异有统计学意义(P<0.05)。U+EEN组治疗后血清前白蛋白(PA)、白蛋白(ALB)和总蛋白(TP)水平高于EEN组[(107.4±6.5)mg/L比(102.8±4.7)mg/L、(46.1±3.5)g/L比(43.4±2.8)g/L、(55.9±3.4)g/L比(53.7±3.1)g/L],差异有统计学意义(P<0.05)。U+EEN组治疗后IgG、IgA、IgM水平高于EEN组[(10.5±1.6)g/L比(9.5±1.3)g/L、(8.9±1.4)mg/L比(8.3±1.2)mg/L、(60.5±3.6)mg/L比(55.9±3.4)mg/L],肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6和IL-8水平低于EEN组[(25.1±2.9)mg/L比(30.6±4.1)mg/L、(20.1±1.9)mg/L比(24.6±1.5)mg/L、(17.8±1.9)mg/L比(20.1±2.3)mg/L],差异有统计学意义(P<0.05)。U+EEN组胰腺组织中NF-κB和TLR4蛋白表达水平低于EEN组(0.3±0.2比0.5±0.2、0.2±0.1比0.5±0.1),差异有统计学意义(P<0.05)。结论乌司他丁联合早期肠内营养可显著提高重症急性胰腺炎患者营养状况及免疫功能并改善预后,可能与乌
Objective To study the effect of ulinastatin combined with early enteral nutrition on severe acute pancreatitis and its effect on nuclear factor-κB(NF-κB)and Toll-like receptor 4(TLR4).Methods Ninety severe acute pancreatitis patients who were treated in Central Hospital of Lijin County from January 2016 to January 2020 were selected and were divided into U+EEN group(ulinastatin combined with early enteral nutrition therapy)and EEN group(early enteral nutrition therapy)by random number table method,with 45 patients in each group.Curative effect,complications,nutritional indicators,immunoglobulins and inflammatory factors were detected and compared with analysis of variance.Western blot was used to detect the expression of NF-κB and TLR4 in pancreatic tissue in two groups.Results The hospitalization time,ICU admission time,intestinal ventilation time,hospitalization costs and organ failure rate,pancreatic cysts,diabetes,chronic pancreatitis,incidence of sepsis in U+EEN group were lower than those in EEN group:(2.1±0.4)months vs.(2.4±0.6)months,(16.9±2.1)d vs.(21.7±2.8)d,(23.7±3.8)d vs.(27.4±4.1)d,(11.4±1.5)thousand Yuan vs.(14.1±2.1)thousand Yuan and 8.9%(4/45)vs.20.0%(9/45),13.3%(6/45)vs.28.9%(13/45),11.1%(5/45)vs.24.4%(11/45),8.9%(4/45)vs.26.7%(12/45),6.7%(3/45)vs.22.2%(10/45),and the differences were statistically significant(P<0.05).The levels of prealbumin(PA),albumin(ALB)and total protein(TP)after treatment in U+EEN group were higher than those in EEN group:(107.4±6.5)mg/L vs.(102.8±4.7)mg/L,(46.1±3.5)g/L vs.(43.4±2.8)g/L,(55.9±3.4)g/L vs.(53.7±3.1)g/L,and the differences were statistically significant(P<0.05).The levels of IgG,IgA,IgM after treatment in U+EEN group were higher than those in EEN group:(10.5±1.6)g/L vs.(9.5±1.3)g/L,(8.9±1.4)mg/L vs.(8.3±1.2)mg/L,(60.5±3.6)mg/L vs.(55.9±3.4)mg/L,the levels of tumor necrosis factor(TNF)-α,interleukin(IL)-6 and IL-8 in U+EEN group were lower than those in EEN group:(25.1±2.9)mg/L vs.(30.6±4.1)mg/L,(20.1±1.9)mg/L vs.(24.6±1.5)mg/L,(17.
作者
隆志强
陈静
陈岩
马明
Long Zhiqiang;Chen Jing;Chen Yan;Ma Ming(Department of Intensive Care Unit,Central Hospital of Lijin County,Shandong Lijin 257400,China;Department of Endocrinology and Nephrology,Central Hospital of Lijin County,Shandong Lijin 257400,China;Department of International Special Needs Medicine,Shengli Oil Field Central Hospital,Shandong Dongying 257034,China)
出处
《中国医师进修杂志》
2021年第2期153-157,共5页
Chinese Journal of Postgraduates of Medicine
关键词
胰腺炎
疗效比较研究
乌司他丁
核因子-ΚB
TOLL样受体4
Pancreatitis
Comparative effectiveness research
Ulinastatin
Curative effect
Nuclear factor-κB
Toll-like receptor 4
