【摘要】 目的 观察谷氨酰胺联合乌司他丁、亚胺培南对急性重症胰腺炎患者免疫功能和炎性反应的影响。方法 选取2015年3月至2018年3月收治的急性重症胰腺炎患者80例,随机分为对照组和治疗组,每组40例。对照组给予乌司他丁、亚胺培南治疗,治疗组在对照组基础上给予谷氨酰胺治疗。疗程均为2周。观察2组外周血T淋巴细胞亚群（CD₃⁺、CD₄⁺、CD₈⁺、CD₄⁺/CD₈⁺）、免疫球蛋白（IgM、IgA、IgG）、血白细胞计数、血浆内毒素、血清炎性因子（IL-6、IL-8、TNF-α、hs-CRP）水平变化。结果 治疗前2组外周血CD₃⁺、CD₄⁺、CD₈⁺、CD₄⁺/CD₈⁺、IgM、IgA、IgG、血白细胞计数、血浆内毒素、血清白介素-6（IL-6）、IL-8、肿瘤坏死因子-α（TNF-α）、超敏C-反应蛋白（hs-CRP）比较差异无统计学意义（P>0.05）。治疗后2组外周血CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺、IgM、IgA、IgG均显著升高,CD₈⁺、血白细胞计数、血浆内毒素、血清IL-6、IL-8、TNF-α、hs-CRP均显著降低,差异有统计学意义（P<0.05）,且治疗组CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺、IgM、IgA、IgG高于对照组,CD₈⁺、血白细胞计数、血浆内毒素、血清IL-6、IL-8、TNF-α、hs-CRP低于对照组（P<0.05）。结论 谷氨酰胺联合乌司他丁、亚胺培南治疗急性重症胰腺炎疗效确切,能够有效抑制全身炎性反应,增强机体免疫功能,从而维持内环境稳定。更多还原

【Abstract】 Objective To observe the effects of glutamine combined with ulinastatin and imipenem on immune function and inflammatory response in patients with acute severe pancreatitis（ASP）.Methods Eighty patients with ASP who were admitted and treated in our hospital from March 2015 to March 2018 were randomly divided into control group and treatment group, with 40 cases in each group. The patients in control group were treated by ulinastatin and imipenem,however,the patients in treatment group, on the basis of the control group,were treated by glutamine,with a treatment course of 2 weeks for both groups. The changes of peripheral blood T lymphocyte subsets（CD₃⁺, CD₄⁺, CD₈⁺, and CD₄⁺/CD₈⁺）, immunoglobulin（IgM, IgA, and IgG）, white blood cell（WBC） count, plasma endotoxin, serum inflammatory factors [IL-6, IL-8, tumor necrosis factor-α（TNF-α）, and hypersensitive C-reactive protein（hs-CRP）] levels were observed and compared between the two groups.Results Before treatment there were no significant differences in the levels of peripheral blood CD₃⁺, CD₄⁺, CD₈⁺, CD₄⁺/CD₈⁺, IgM, IgA, IgG, WBC count, plasma endotoxin,and the serum levels of IL-6, IL-8, TNF-αand high-sensitivity C-reactive protein（hs-CRP） between the two groups（P>0.05）. After treatment, the levels of peripheral blood CD₃⁺, CD₄⁺, CD₄⁺/CD₈⁺, IgM, IgA, and IgG in both goups were significantly increased, however, the levels of CD₈⁺, WBC count, plasma endotoxin, serum IL-6, IL-8, TNF-α, and hs-CRP were significantly decreased in both two groups（P<0.05）.Moreover the levels of CD₃⁺, CD₄⁺, CD₄⁺/CD₈⁺, IgM, IgA, and IgG in treatment group were significantly higher than those in control group, whereas the levels of CD₈⁺, WBC count, plasma endotoxin, serum IL-6, IL-8, TNF-α and hs-CRP were significantly lower than those in control group（P<0.05）.Conclusion Glutamine combined with ulinastatin and imipenem is effective in the treatment of ASP, which can effectively inhibit systemic inflammatory response and enhance immune function, thus maintaining the stability of internal environment.更多还原