谷氨酰胺联合异甘草酸镁治疗重症急性胰腺炎的临床研究

Clinical Study of Glutamine Combined with Magnesium Isoglycyrrhizinate on Severe Acute Pancreatitis

关键词:  谷氨酰胺  异甘草酸镁  重症急性胰腺炎  炎症  肠黏膜屏障功能

Key words:  glutamine  magnesium isoglycyrrhizinate  severe acute pancreatitis  inflammation  intestinal mucosal barrier function

摘要:

目的 探究谷氨酰胺联合异甘草酸镁治疗重症急性胰腺炎（severe acute pancreatitis，SAP）疗效及对炎症因子、肠黏膜屏障功能的影响。方法 选取2014年2月—2017年2月收治的SAP患者80例，随机分为对照组和联合组，各40例。2组均给予常规治疗，对照组在肠内营养基础上加用谷氨酰胺0.3 g·kg^-1·d^-1，联合组在对照组基础上静脉滴注含150 mg异甘草酸镁的5%葡萄糖注射液250 mL，每天1次。2组均连续治疗14 d。比较2组临床疗效，治疗前，治疗3，7，14 d后急性生理及慢性健康评分Ⅱ（APACHE Ⅱ），IL-6、IL-8、IL-10、TNF-α等炎症因子水平，二胺氧化酶（diamine oxidase，DAO）、D-乳酸、内毒素（endotoxin，ET）等肠黏膜屏障功能指标。结果 联合组总有效率为92.50%，明显高于对照组的75.00%（P<0.05）。治疗3，7，14 d后，联合组APACHEⅡ评分均明显低于同期对照组（P<0.05）；联合组血清TNF-α、IL-6、IL-8水平均明显低于同期对照组（P<0.05），血清IL-10水平明显高于同期对照组（P<0.05）；联合组血清DAO、D-乳酸、ET水平均明显低于同期对照组（P<0.05）。结论 谷氨酰胺联合异甘草酸镁治疗SAP患者能有效缓解炎症反应，改善肠黏膜屏障功能，提高临床疗效。

Abstract:

OBJECTIVE To explore the clinical efficacy of glutamine combined with magnesium isoglycyrrhizinate in the treatment of severe acute pancreatitis(SAP) and its effects on inflammatory factors and intestinal mucosal barrier function. METHODS A total of 80 patients with SAP from February 2014 to February 2017 were enrolled and randomly divided into control group and combination group, 40 cases in each group. Both groups were given routine treatment. Control group were given glutamine 0.3 g·kg^-1·d^-1 on the basis of enteral nutrition, while combination group were given intravenous infusion of magnesium isoglycyrrhizinate 150 mg added into 5% glucose injection 250 mL on the basis of control group, once daily. Both groups were treated for 14 d. The efficacy and APACHE Ⅱ score, level of IL-6, IL-8, IL-10 and TNF-α, intestinal mucosal barrier function index of diamine oxidase(DAO), D-lactate, endotoxin(ET) were compared before treatment and 3th,7th,14th day of treatment in two groups.RESULTS The total effective rate in combination group was 92.50%, which was significantly higher than that of 75.00% in control group(P<0.05). On the 3th, 7th, 14th day of treatment, the scores of APACHE Ⅱ in combination group was significantly lower than that in control group(P<0.05). The levels of serum TNF-α, IL-6, IL-8 in combination group were significantly lower than those in control group while the level of serum of IL-10 was significantly higher(P<0.05). The levels of serum DAO, D-lactate, ET in combination group were significantly lower than those in control group(P<0.05). CONCLUSION Glutamine combined with magnesium isoglycyrrhizinate in the treatment of SAP can improve clinical efficacy, which can effectively reduce inflammation, improve intestinal mucosal barrier function.