【摘要】 目的:分析乌司他丁联合序贯性血液净化疗法对重症急性胰腺炎(SAP)病人血清高迁移率族蛋白-1(HMGB 1)、Toll样受体4(TLR 4)水平变化的影响。方法:选取2016-07～2019-02期间,我院SAP病人108例,治疗方案不同分组。2组均接受常规治疗,在此基础上乌司他丁组(54例)接受乌司他丁治疗,联合组(54例)接受乌司他丁+序贯性血液净化疗法治疗。对比2组疗效、症状缓解时间、治疗前后因子水平[HMGB 1、TLR 4、白细胞介素1β(IL-1β)、肿瘤坏死因子-α(TNF-α)及超敏C反应蛋白(hs-CRP)]。结果:(1)联合组治疗7 d后总有效率90.74%高于乌司他丁组70.37%(P<0.05);(2)联合组住院天数、体温、肠蠕动及血淀粉酶(AMS)恢复时间较乌司他丁组短(P<0.05);(3)联合组治疗7 d后血清TLR 4、HMGB 1水平低于乌司他丁组(P<0.05);(4)联合组治疗7 d后血清IL-1β、TNF-α、hs-CRP水平低于乌司他丁组(P<0.05)。结论:乌司他丁联合序贯性血液净化疗法治疗SAP,疗效显著,能有效缩短症状改善时间,减少血清TLR 4、HMGB 1水平,抑制炎症因子释放。更多还原

【Abstract】 Objective:To analyze the effect of ulinastatin combined with sequential blood purification therapy on serum levels of high mobility group protein-1(HMGB 1)and Toll-like receptor-4(TLR 4)in patients with severe acute pancreatitis(SAP).Methods:108 patients with SAP in our hospital(from July 2016 to February 2019)were selected and divided into different groups.Both groups received routine treatment,on the basis of which the Ulinastatin group(54 cases)received ulinastatin treatment,and the combined group(54 cases)received Ulinastatin + sequential blood purification therapy.The curative effect,symptom relief time,prognostic effect(APACHE II score),factor levels before and after treatment(HMGB 1,TLR 4,interleukin-1 beta,tumor necrosis factor-alpha(TNF-alpha)and hypersensitive C-reactive protein(hs-CRP)were compared between the two groups.Results:(1)The total effective rate of the combined group was90.74%higher than that of the Ulinastatin group(70.37%)(P<0.05);The levels of TNF-a and hs-CRP in the combined group were lower than that in the Ulinastatin group(P<0.05);(5)APACHE II scores in the combined group were lower than that in the Ulinastatin group after 3 and 7 days of treatment(P<0.05).Conclusion:Ulinastatin combined with sequential blood purification therapy is effective in the treatment of SAP.It can effectively shorten the improvement time of symptoms,reduce the levels of serum TLR 4 and HMGB 1,inhibit the release of inflammatory factors,accelerate the recovery process and promote the improvement of prognosis.更多还原