【摘要】 目的评价凯时(LipoPGE1)和生长抑素(SS)联合应用对重症急性胰腺炎(SAP)的治疗效果, 并试图揭示两者联合应用的作用机制。方法依据Ranson标准、APACHEⅡ评分或Balthazar CT积分,将确诊为SAP的患者分为SS治疗组和SS联合LipoPGE1治疗组,对比观察临床症状的缓解和血清学指标的变化情况。结果两组患者入院时年龄、性别、病因构成及SAP严重度评分诸方面差异均无显著性。与单用 SS治疗组相比,SS联合LipoPGE1治疗组患者的血清白蛋白于入院2周后显著升高,但血清淀粉酶和乳酸脱氢酶(LDH)活性于治疗后无明显差别;自入院后第3天开始,血浆MDA显著降低、SOD显著升高、肿瘤坏死因子TNF-α及白细胞介素IL-6水平明显降低;血清胰岛素样生长因子(IGF-1)水平于入院后2周显著升高;APACHEⅡ评分及Binder合并症积分明显改善;并发症和平均住院时间明显缩短,死亡率降低。住院费用两组差异无显著性。结论 SS和LipoPGE1联合应用可显著改善SAP患者的预后,缩短住院时间,其可能的作用机制是通过减轻急性期炎症介质和细胞因子的过度释放、减轻过氧化反应、促进IGF-1释放, 促进胰腺细胞的再生等多途径阻断SAP时的高应激反应,避免并发多器官功能障碍。更多还原

【Abstract】 Objective To assess the therapeutic efficacy of somatostatin (SS) combined with LipoPGE1 in patients with severe acute pancreatitis (SAP) and to elucidate its possible mechanisms. Methods Thirty-two patients with diagnosis of SAP based on Ranson’s criteria, APACHE Ⅱ or Balthazar CT scoring, were allocated in SS group and SS combined with LipoPGE1 group. Clinic symptoms and serum parameters were determinated. Results There were no statistic differences between two groups in age, gender, etiology and severity of SAP. Compared with SS group, patients in SS combined with LipoPGE1 group had a significant increasing of serum albumin level two weeks later, however, serum amylase and lactate dehydrogenase activity kept in the same level between two groups; a marked decreasing of serum TNF-α , IL-6 and MDA levels and a notable increasing of SOD after 3 days; a significant upregulation in serum level of insulin like growth factor on day 14. Obviously improvement in APACHE Ⅱ and Binder’s scoring and a extremely reduction in complication, hospitalization days and mortality can be seen in combined group. There was no statistical difference in the cost between two groups. Conclusion The present study indicates that such combined therapy can improve the prognosis of SAP. The possible mechanisms may involve in inhibition of the production and release of cytokines and in reduction of peroxide reaction as well as in release of IGF-1.As result, the high stress response in SAP is blocked and multiple organ failure is prevented.更多还原