文章摘要

生长抑素联合丙氨酰谷氨酰胺对脓毒症患者肠道功能的保护作用

作者: 1许超, 1李伯恩, 1邢明尧, 1李芳, 1吴克松
1 蚌埠医学院第二附属医院重症医学科,安徽 蚌埠 233080
通讯: 许超 Email: icuxuchao@163.com
DOI: 10.3978/j.issn.2095-6959.2021.05.007
基金: 蚌埠医学院转化医学重点专项项目(BYTM2019051)。

摘要

目的:探讨生长抑素(somatostatin,SS)联合丙氨酰谷氨酰胺对脓毒症患者肠道功能的保护作用。方法:选择2019年9月至2020年7月蚌埠医学院第二附属医院重症医学科(intensive care unit,ICU)收治的70例脓毒症患者作为研究对象,患者序贯器官衰竭评分(sequential organ failure assessment,SOFA)较基线水平提高≥2分。采用区组随机化方法分成对照组与联合组,每组均35例。患者均按照最新脓毒症指南给予基础对症治疗,对照组给予丙氨酰谷氨酰胺治疗,联合组给予SS联合丙氨酰谷氨酰胺治疗,均持续治疗7 d。检测2组入住ICU当天和治疗7 d内血清降钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)和血清细菌内毒素(bacterial endotoxin,BE)、二胺氧化酶(diamine oxidase,DAO)和D-乳酸(D-lactic acid,D-Lac)水平,并比较2组急性生理与慢性健康评分系统(Acute Physiology and Chronic Health Evaluation II,APACHE II)评分、ICU住院时间和28 d病死率。结果:2组ICU治疗1 d、3 d、7 d后血清PCT、CRP和BE、DAO、D-Lac水平均较入ICU当天明显下降(P<0.05),ICU治疗1 d后上述指标比较,组间差异无统计学意义(P>0.05),联合组ICU治疗3 d、7 d后上述指标均明显低于对照组(P<0.05)。对照组ICU治疗3 d、7 d后APACHE II评分均显著低于ICU当天(P<0.05),联合组ICU治疗1 d、3 d、7 d后APACHE II评分明显低于ICU当天(P<0.05),且联合组ICU治疗7 d后APACHE II评分、ICU住院时间均少于对照组(P<0.05),组间28 d病死率比较无明显差异(P>0.05)。结论:SS联合丙氨酰谷氨酰胺能更充分抑制脓毒症患者炎症反应和降低BE、DAO、D-Lac水平,肠道功能保护作用显著。
关键词: 脓毒症;生长抑素;丙氨酰谷氨酰胺;肠道保护作用;急性生理与慢性健康评分系统

Protective effect of somatostatin combined with alanyl glutamine on intestinal function in patients with sepsis

Authors: 1XU Chao, 1LI Bo’en, 1XING Mingyao, 1LI Fang, 1WU Kesong
1 Department of Intensive Care Unit, Second Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233080, China

CorrespondingAuthor: XU Chao Email: icuxuchao@163.com

DOI: 10.3978/j.issn.2095-6959.2021.05.007

Foundation: This work was supported by the Key Special Project of Translational Medicine in Bengbu Medical College, China (BYTM2019051).

Abstract

Objective: To investigate the protective effect of somatostatin (SS) combined with alanyl glutamine on intestinal function in patients with sepsis. Methods: Seventy patients with sepsis admitted to intensive care unit (ICU) of the Second Affiliated Hospital of Bengbu Medical College from September 2019 to July 2020 were selected as the research objects. The sequential organ failure assessment (SOFA) score was increased by 2 points or more than 2 points compared with the baseline level. The patients were randomly divided into a control group and a combination group with 35 cases in each group. All patients were given basic symptomatic treatment according to the latest sepsis guidelines. The control group was given alanyl glutamine treatment, and the combination group was given SS combined with alanyl glutamine treatment, all of which lasted for 7 days. The levels of serum procalcitonin (PCT), C-reactive protein (CRP), serum bacterial endotoxin (BE), diamine oxidase (DAO) and D-lactic acid (D-Lac) were detected on the day of ICU admission and within 7 days of treatment. The acute physiology and chronic health score (APACHE II), ICU stay and 28-day mortality rate were compared between the two groups. Results: The levels of serum PCT, CRP, BE, DAO, and D-Lac in the two groups after 1 day, 3 days and 7 days of treatment were significantly lower than those on the day of ICU admission (P<0.05), and there was no significant difference between the two groups after 1 d of ICU treatment (P>0.05). After 3 d and 7 d of ICU treatment, the above indexes in the combination group were significantly lower than those in the control group (P<0.05). The APACHE II score of the control group was significantly lower than that of the day of ICU admission after 3 and 7 days of ICU treatment (P<0.05), and the APACHE II score of the combination group was significantly lower than that of the day of ICU admission after 1 day, 3 days and 7 days of ICU treatment (P<0.05), and the APACHE II score and ICU hospitalization time of the combination group were lower than those of the control group after 7 d of ICU treatment (P<0.05), with no significant difference in 28-day mortality between the two groups (P>0.05). Conclusion: SS combined with alanyl glutamine can more fully inhibit the inflammatory reaction and reduce the levels of BE, DAO and D-Lac in patients with sepsis, with a significant protective effect of intestinal function.
Keywords: sepsis; somatostatin; alanyl glutamine; intestinal protection; acute physiology and chronic health score system