促炎和抗炎因子在急性胰腺炎发病机制中的研究进展

Therapeutic effects of Qingyi decoction against severe acute pancreatitis

AIM: To assess the therapeutic effects of Qingyi decoction against severe acute pancreatitis and to explore the underlying mechanisms.

METHODS: Ninety patients with severe acute pancreatitis were randomly divided into either an experiment group or a control group. The control group was treated with conventional Western medicine, while the experiment group was additionally given Qingyi decoction on the basis of conventional Western medicine. The body temperature, leucocyte count, blood glucose, the time to recovery of liver function, hospital stay, APACHE Ⅱ score and clinical effects were compared between the two groups.

RESULTS: The body temperature, leucocyte count, blood glucose, the time to recovery of liver function, and hospital stay in the experiment group were significantly lower than those in the control group (7.41 d ± 1.07 d vs 10.23 d ± 1.24 d, 11.21 d ± 1.94 d vs 14.89 d ± 1.52 d, 12.85 d ± 1.99 d vs 15.58 d ± 2.26 d, 12.89 d ± 2.93 d vs 17.15 d ± 2.95 d, 23.02 d ± 1.27 d vs 28.58 d ± 2.33 d, P < 0.05). APACHE Ⅱ score at 2 weeks post-treatment in the experiment group was significantly lower than pretreatment value (8.30 ± 2.92 vs 11.62 ± 1.16, P < 0.05). APACHE Ⅱ score at 3 weeks post-treatment in the control group was significantly lower than pretreatment value (10.42 ± 3.99 vs 11.64 ± 1.08, P < 0.05). APACHE Ⅱ score at 1 week post-treatment in the experiment group was significantly lower than that in the control group (8.30 ± 2.92 vs 10.42 ± 3.99, P < 0.05). There were no significant differences in APACHE Ⅱ scores between the two group at 3 or 8 wk (3.88 ± 0.72 vs 4.19 ± 0.47, 3.36 ± 0.88 vs 3.55 ± 0.61, P > 0.05). The cure rate and total effective rate in the experiment group were significantly higher than those in the control group (44.44% vs 6.67%, 95.56% vs 71.11%, P < 0.05). The complication rate in the experiment group was significantly lower than that in the control group (6.67% vs 22.22%, P < 0.05).

CONCLUSION: Qingyi decoction can improve clinical symptoms, shorten the time to recovery of biochemical indicators, and reduce complications in patients with severe acute pancreatitis.

Efficacy and safety of omeprazole combined with somatostatin in treatment of severe acute pancreatitis

AIM: To investigate the efficacy and safety of omeprazole combined with somatostatin in the treatment of severe acute pancreatitis (SAP).

METHODS: One hundred and forty patients with SAP treated at our hospital from March 2008 to June 2013 were randomly divided into either a study group or a control group. The control group received conventional treatment, and the study group was treated with omeprazole and somatostatin on the basis of conventional therapy. The efficacy and the incidence of complications were compared between the two groups.

RESULTS: The response rate was significantly higher in the study group than in the control group (94.29% vs 77.14%, P < 0.05). Compared with the control group, the time to gastrointestinal function recovery (18.4 d ± 1.3 d vs 25.3 d ± 1.7 d) and the hospitalization time (2.1 d ± 1.2 d vs 3.6 d ± 1.5 d) were significantly shorter in the study group (P < 0.05 for both). The overall incidence of complications (7.14% vs 25.71%), mortality (2.86% vs 11.43%) and the incidence of organ failure also differed significantly between the two groups (P < 0.05 for all).

CONCLUSION: Omeprazole combined with somatostatin could accelerate recovery and reduce the incidence of complications in SAP patients.

Therapeutic effect of ulinastatin vs gabexate mesilate in management of acute pancreatitis

AIM: To compare the therapeutic effect of ulinastatin vs gabexate mesilate in the management of acute pancreatitis.

METHODS: One hundred and twenty-four patients with acute pancreatitis who were treated by gabexate mesilate and/or ulinastatin were enrolled. The time required for the relief of symptoms, signs and for the recovery of laboratory parameters after medication were compared between the two groups.

RESULTS: Compared to ulinastatin treatment, treatment with gabexate mesilate was associated with shorter time required for the relief of symptom, signs (3.72 d ± 1.84 d vs 6.56 d ± 3.25 d; 5.89 d ± 2.51 d vs 9.58 d ± 3.54 d, both P < 0.05) and for the recovery of amylase, WBC, GR% (4.83 d ± 1.13 d vs 7.52 d ± 2.89 d; 6.23 d ± 2.10 d vs 9.23 d ± 3.56 d; 8.01 d ± 1.58 d vs 12.12 d ± 2.56 d; all P < 0.05) in patients with biliary pancreatitis; however, these parameters showed no significant difference in patients with non-biliary pancreatitis. Combined use of gabexate mesilate and ulinastatin could significantly shorten the time required for the relief of symptoms, signs (3.15 d ± 1.23 d vs 5.78 d ± 2.56 d; 4.12 d ± 0.55 d vs 7.25 d ± 2.12 d, both P < 0.05) and for the recovery of amylase, lipase, WBC, GR% (4.22 d ± 1.77 d vs 7.18 d ± 2.25 d; 8.23 d ± 1.36 d vs 14.56 d ± 2.03 d; 4.23 d ± 2.56 d vs 8.89 d ± 2.35 d; 6.87 d ± 0.79 d vs 11.23 d ± 2.03 d; 7.89 d ± 1.24d vs 11.23 d ± 2.75 d; all P < 0.05) and blood glucose.

CONCLUSION: Both gabexate mesilate and ulinastatin are effective in the management of acute pancreatitis; however, their therapeutic effects differ significantly between patients with biliary pancreatitis and those with non-biliary pancreatitis.

Ulinastatin in combination with glutamine dipeptide reduces serum levels of TNF-α, endotoxin and IL-6 in patients with severe acute pancreatitis

AIM: To evaluate the impact of protease inhibitor ulinastatin in combination with glutamine dipeptide on serum levels of TNF-α, endotoxin, IL-6 and IL-18 in patients with severe acute pancreatitis (SAP).

METHODS: Sixty-four SAP patients were divided into two groups: treatment group (n = 32) and control group (n = 32). The control group was treated with ulinastatin alone, while the treatment group was treated with ulinastatin in combination with glutamine dipeptide. The treatment lasted for 10 days. The changes in serum levels of TNF-α, endotoxin, IL-6 and IL-18 were determined by ELISA.

RESULTS: Compared to the control group, serum levels of TNF-α and endotoxin on days 7 and 10 (7 d: 38.83 ± 14.71 vs 51.92 ± 18.29; 0.46 ± 0.13 vs 0.71 ± 0.19; 10 d: 31.49 ± 12.65 vs 48.36 ± 15.43; 0.22 ± 0.07 vs 0.43 ± 0.15; all P < 0.05) and that of IL-6 on day 7 (117.68 ± 14.87 vs 163.43 ± 19.76, P < 0.05) were significantly lower in the treatment group. There was no significant difference in serum level of IL-18 between the two groups of patients (P > 0.05).

CONCLUSION: Ulinastatin in combination with glutamine dipeptide can reduce serum levels of TNF-α, endotoxin and IL-6 in SAP patients.

Nitric oxide protects against pancreatic and renal injury in rats with acute necrotizing pancreatitis and hyperlipidemia

AIM: To determine whether nitric oxide (NO) protects against pancreatic and renal injury in rats with acute necrotizing pancreatitis (ANP) and hyperlipidemia.

METHODS: Forty male Sprague-Dawley rats were fed a high-fat diet for 4 weeks to induce hyperlipidemia. The rats were randomly divided into three groups: group A (hyperlipidemia + ANP + normal saline), group B ( hyperlipidemia + ANP + L-arg), and group C (hyperlipidemia + ANP + L-Name). ANP was induced by retrograde injection of 3.5% sodium taurocholate into the biliopancreatic duct. Each group was treated 30 min before and 2 h after ANP induction. At 6 h after ANP induction, serum amylase (Amyl), creatinine (Cr), urea nitrogen (BUN), NO, and pancreatic NO and endothelial nitric oxide synthetase (eNOS) were measured; pancreatic histopathology was detected by light microscopy; ultrastructure of glomerular podocytes was observed by election microscopy; and expression of nephrin in glomerular podocytes was examined by immunohistochemistry.

RESULTS: Serum Amyl, Cr and BUN in group B were significantly lower than those in groups A and C (Amyl: 4 219.8 ± 900.0, 6 643.2 ± 1 135.4 vs 2 434.4 ± 831.6; Cr: 15.8 ± 1.6, 22.4 ± 3.3 vs 9.9 ± 0.8; BUN: 135.9 ± 23.6, 206.4 ± 23.4 vs 103.2 ± 13.2; all P < 0.01). Pancreatic injury and changes in glomerular podocytes were milder in group B than in groups A and C. The levels of serum and pancreatic NO (59.46 ± 11.21, 44.84 ± 10.72 vs 78.88 ± 9.76; 5.23 ± 0.48, 4.39 ± 0.45 vs 6.18 ± 0.57; all P < 0.01) and pancreatic eNOS, and expression of nephrin in glomerular podocytes were significantly higher in group B than in groups A and C.

CONCLUSION: NO produced by eNOS can protect against pancreatic and renal injury in rats with ANP and hyperlipidemia.