乌司他丁对全身炎症反应综合征的治疗作用
邵义明 张良清 邓烈华 姚华国【摘要】 目的: 探讨乌司他丁在阻断全身炎症反应综合征(SIRS)向多器官功能障碍综合征(MODS)发展中的作用及其机制。方法 60例符合SIRS诊断标准3项以上的患者随机分为试验组(n=30)和对照组(n=30)，并选取15名正常体检者作为正常组。试验组接受常规抗感染治疗，对照组在试验组用药基础上静脉注射乌司他丁100 kU，8 h 1次，连用5 d。常规监测患者心率(HR)、呼吸频率(RR)、体温(T)、白细胞计数(WBC)、SIRS症状改善时间和病死率；并于治疗前和治疗后5 d抽取静脉血检测血清白细胞介素-6(IL-6)、IL-10、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平。正常组于体检时抽血检测的结果作为正常对照。结果: 试验组T、RR、HR及WBC治疗后改善情况均明显优于对照组(P<0.05或P<0.01)。SIRS患者入院时炎性细胞因子水平均明显高于正常组(P均<0.01)；两组患者治疗后5 d的CRP、IL-6和TNF-α水平均较治疗前明显下降(P<0.05或P<0.01)，但试验组下降较对照组更为明显。试验组治疗后5 d的IL-10较治疗前上升，治疗前后自身对照差异有显著性 (P<0.01)；对照组治疗后5 d的IL-10水平与治疗前比较差异无显著性(P>0.05)。另外,试验组患者治疗后SIRS炎性指标超过3 d无明显改善者明显少于对照组(P<0.01)，转为MODS者较对照组明显减少(10.00%比36.67%，P<0.05)，病死率也明显减少(3.33%比20.00%，P<0.05)。结论: 乌司他丁可能通过上调抗炎因子和下调促炎因子，调控机体炎症反应过程，从而阻断SIRS向MODS的发展。
【关键词】 乌司他丁； 全身炎症反应综合征； C反应蛋白； 肿瘤坏死因子； 白细胞介素
Clinical study on effects of ulinastatin on patients with systemic inflammatory response syndrome
SHAO Yi-ming, ZHANG Liang-qing, DENG Lie-hua, YAO Hua-guo.
Department of Intensive Care Unit, Affiliated Hospital of Guangdong Medical College, Zhanjiang 524001， Guangdong, China
【Abstract】 OBJECTIVE:To evaluate the value of ulinastatin in hindering systemic inflammatory response syndrome (SIRS) to proceed to multiple organ dysfunction syndrome (MODS). METHODS:Sixty patients were randomly divided into routine treatment group (n=30) and ulinastatin treatment group (n=30). Both groups were given routine treatment, while the patients of the ulinastatin treatment group were given ulinastatin (100 kU intraveneusly drip, once every 8 hours, and continued for 5 days) in addition. Additionally, 15 healthy persons were enrolled as normal control group. Temperature (T), heart rate (HR), respiration rate (RR) and white blood cell (WBC) count were observed everyday. The duration of SIRS, the number of organ dysfunction, and mortality were also compared. Serum C reactive protein(CRP), tumor necrosis factor-α (TNF-α), interleukin-6(IL-6) and IL-10 levels were measured before treatment and 5 days after in ulinastatin treatment group, routine treatment group, and in normal control group at the time of health examination. RESULTS:All of the SIRS markers were not different both in ulinastatin group and routine treatment group before treatment. T, RR, HR and WBC were reduced significantly after 3 days in ulinastatin group (P<0.05 or P<0.01), but HR was not lowered significantly after 5 days and WBC after 7 days of treatment in regular treatment group (P<0.05 or P<0.01). All of the cytokines in ulinastatin treatment group and routine treatment group were higher than normal control group before treatment. Serum CRP ......
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