丙氨酰—谷氨酰胺聯合烏司他丁與生長抑素治療急性重癥胰腺炎臨床療效評價

朱春霞　陸蓉丹　胡桂梅　呂雪幼　馮雪峰　汪建華

[摘要] 目的 觀察并評估丙氨酰-谷氨酰胺聯合烏司他丁與生長抑素治療急性重癥胰腺炎（SAP）的臨床治療效果。方法 選取2014年1月～2016年6月期間寧波大學醫學院附屬醫院收治的86例急性重癥胰腺炎患者，依據隨機數字表法分為研究組和對照組，每組各43例。對照組患者采用烏司他丁+生長抑素方案治療，而研究組患者在此基礎上加用丙氨酰-谷氨酰胺，靜脈滴注0.4 g/kg，評估并比較兩組患者的臨床治療效果。 結果 經治療，研究組獲得95.35%的臨床總療效，顯著高于對照組的81.40%，差異具有統計學意義（P<0.05）。研究組患者腹痛緩解時間、腸功能恢復時間、血淀粉酶恢復正常時間及平均住院日均顯著短于對照組；治療后研究組患者血C反應蛋白（CRP）、白細胞介素-8（IL-8）及腫瘤壞死因子-α（TNF-α）水平均顯著低于對照組。 結論 丙氨酰-谷氨酰胺聯合烏司他丁與生長抑素是治療急性重癥胰腺炎的有效方法，可有效緩解臨床癥狀，提高臨床療效，改善患者預后。

[關鍵詞] 丙氨酰-谷氨酰胺；烏司他丁；生長抑素；急性重癥胰腺炎

[中圖分類號] R576 [文獻標識碼] B [文章編號] 1673-9701（2017）13-0095-04

[Abstract] Objective To observe and evaluate the therapeutic effects of alanyl-glutamine combined with ulinastatin and somatostatin in treatment of severe acute pancreatitis（SAP）. Methods Eighty-six patients with SAP were selected from January 2014 to June 2016 admitted to the Affiliated Hospital of Ningbo University School of Medicine. They were divided into research group（n=43） and control group（n=43） according to the random number table. The patients of the control group received the routine therapy of ulinastatin and somatostatin while the research group received an additional treatment of alanyl-glutamine， intravenous infusion by 0.4 g/kg， then the clinical therapeutic effect of the two groups was evaluated and compared. Results After treatment， clinical total curative effect of the research group was 95.35%， which was significantly higher than the control group of 81.40%， the difference was statistically significant（P<0.05）. The recovery time of abdominal pain， bowel function， blood urinary amylase and average hospitalized time in research group were significantly shorter than those in control group. Levels of C reactive protein（CRP）， interleukin-8（IL-8）， tumor necrosis factor-α（TNF-α） in research group after treatment were significantly lower than those in control group. Conclusion Alanyl-glutamine combined with ulinastatin and somatostatin is an effective method in treating SAP， which can effectively relieve clinical symptoms， improve clinical effect and prognosis of patients.

[Key words] Alanyl-glutamine； Ulinastatin； Somatostatin； Severe acute pancreatitis

急性重癥胰腺炎（severe acute pancreatitis，SAP）屬于急性胰腺炎的特殊類型，是一種病情兇險、并發癥多、病死率高的急腹癥，其發病率占所有急性胰腺炎的20%～30%[1-3]。近年來，隨著胰腺炎規范化治療的進展，急性重癥胰腺炎治愈率有所提高，但總體死亡率仍高達22.7%[2]。目前研究認為，除胰酶在急性重癥胰腺炎發病過程中存在重要作用外，炎癥反應也貫穿了急性重癥胰腺炎的發生與發展[4]。谷氨酰胺（Gln）是一種條件必需氨基酸，是人體免疫細胞的主要能量合成底物，可以增加腸道分泌型免疫球蛋白A（SIgA）的分泌量和免疫細胞的生成，維持組織中抗氧化劑的貯備，增強腸道和機體的免疫功能，能有效保護腸黏膜屏障，減少腸道細菌和內毒素的易位，從而減輕或避免大量炎癥介質的釋放[5，6]。……