[Clinical value of the early use of ulinastatin in patients with moderately severe or severe acute pancreatitis]

The combination of ulinastatin and somatostatin reduces complication rates in acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials

Currently, there is no specific pharmaceutical agent for treating acute pancreatitis (AP). Somatostatin and its analogues have been used to prevent the autolysis of the pancreas in AP, however, their effectiveness has not been confirmed. This investigation aimed to examine the efficacy of ulinastatin, a protease inhibitor, combined with somatostatin analogues in the treatment of AP. We conducted a systematic database search in 4 databases to identify randomized controlled trials in which the efficacy of ulinastatin in combination with somatostatin analogue was compared to somatostatin analogue alone in patients with AP. Since the patient populations of analysed papers were slightly different, we used random effect models to pool odds ratios (OR) and mean differences (MD) and the corresponding 95% confidence intervals (CI). A total of 9 articles comprising 1037 patients were included in the meta-analysis. The combination therapy significantly reduced the complication rates for acute respiratory distress syndrome, acute kidney injury, and multiple organ dysfunction. Symptoms were relieved threefold with the combination therapy compared to somatostatin alone, and combination therapy significantly shortened the length of hospital stay. The decrease in mortality was not statistically significant..

Efficacy of ulinastatin combined with octreotide for patients with severe pancreatitis: Effect on clinical symptoms, serological markers and safety

AIM

To evaluate the efficacy of ulinastatin combined with octreotide in the treatment of severe pancreatitis and the effect on clinical symptoms, serological indicators and safety.

METHODS

Ninety-four patients with severe pancreatitis who were treated at Guangdong Provincial People's Hospital from February 2016 to January 2018 were randomly divided into an experimental group (46 cases) and a reference group (48 cases). The reference group was treated with octreotide alone, and the experimental group was treated with octreotide combined with ulinastatin. The treatment lasted 2 wk in both groups. Clinical curative effect, serological parameters, amylase, intestinal mucosal function index and complications were compared between the two groups.

RESULTS

The total effective rate in the experimental group was 95.65%, which was significantly higher than that of the reference group (83.33%; P < 0.05). Time to disappearance of abdominal pain, nausea, vomiting and peritoneal irritation, time to first defecation, time to bowel sound recovery and hospital stay in the experimental group were significantly shorter than those of the reference group (P < 0.05), and the mortality rate was significantly lower than that of the reference group (P < 0.05). There was no significant difference in serum C-reactive protein, tumor necrosis factor-α, interleukin-18, interleukin-6, blood amylase, urine amylase, occludin, diamine oxidase or endotoxin levels between the two groups before treatment (P > 0.05). After treatment intervention, the above-mentioned indicators improved significantly in both groups, and the experimental group improved significantly better than those of the reference group (P < 0.05). The incidence of acute respiratory distress syndrome, acute renal failure and shock in the experimental group was significantly lower than that of the reference group (P < 0.05). There was no significant difference in the incidence of pancreatic encephalopathy syndrome or metabolic dysfunction between the two groups (P > 0.05).

CONCLUSION

Ulinastatin combined with octreotide has good clinical effects in severe pancreatitis patients and can improve treatment efficiency, clinical symptoms and serological indicators, protect the intestinal mucosal function, and reduce the incidence of complications.

Ulinastatin is effective in reducing mortality for critically ill patients with sepsis: a causal mediation analysis

Ulinastatin has been found to have anti-inflammatory effect for patients with sepsis. However, its clinical effects were conflicting. The study aimed to investigate the cost-effectiveness of ulinastatin and to perform mediation analysis to explore the proportion of the total effects that can be explained by inflammatory responses. This is a retrospective study involving critically ill patients with sepsis from January 2014 to July 2017. A total of 263 patients were included in the study, involving 179 patients in the ulinastatin group and 84 in the control group. Ulinastatin group showed significantly lower 28-day mortality rate than that in the control group (31% vs. 55%; p < 0.001). Both total (46330 [26000,83500] vs. 19870 [8747,41140] RMB; p < 0.01) and drug cost (18210 [9492,31920] vs. 7230 [2675,19270] RMB; p < 0.01) were significantly higher in the ulinastatin group than the control group. In multivariable model, the adjusted odds ratio for ulinastatin was 0.304 (95% CI: 0.152 to 0.592; p = 0.001). The mediation analysis showed that the use of ulinastatin was able to reduce the probability of death by 23.5%. The average causal mediation effect of delta C-reactive protein (CRP) was 8%, accounting for 35% of the total effect.

Value of continuous blood purification combined with Qingyi Lidan granules in treatment of severe acute pancreatitis

AIM

To observe the effect of continuous blood purification combined with Qingyi Lidan granules in patients with severe acute pancreatitis with regard to biochemical indexes, inflammatory indexes, and therapeutic effects.

METHODS

The clinical data of 150 patients with severe acute pancreatitis treated at Shaoxing Second Hospital from April 2012 to April 2017 were retrospectively analyzed. Among them, 70 patients were given continuous blood purification therapy as a control group, and the other 80 patients were given continuous blood purification combined with Qingyi Lidan granules based on conventional therapy, as an observation group. Biochemical indicators, inflammatory indicators, APACHE Ⅱ score, CTSI score, and therapeutic effects were compared between the two groups.

RESULTS

After treatment, APACHE II score was significantly lower in the observation group than in the control group (10.22 ± 2.58 vs 14.03 ± 2.91, P < 0.05). The time to disappearance of abdominal distension and abdominal pain and hospital stay were significantly shorter in the observation group than in the control group (P < 0.05). AMS, LPS, Cr, AST, ALT, and PCT in the observation group were significantly lower than those in the control group (P < 0.05). The levels of IL-8, IL-6, TNF-α, HSP70, HSP72, and HMGB1 in the observation group were also significantly lower than those in the control group (P < 0.05). The total effective rate was significantly higher in the observation group than in the control group (93.75% vs 71.43%, P < 0.05). The mortality rate did not differ significantly between the control group and observation group (8.57% vs 6.25%). The incidence of complications in the control group was significantly higher than that of the observation group (28.57% vs 12.5%, P < 0.05).

CONCLUSION

Continuous blood purification combined with Qingyi Lidan granules in patients with severe acute pancreatitis can significantly reduce the inflammatory response and improve biochemical indexes and therapeutic effects.