血滤清除白细胞介素6治疗重症急性胰腺炎

目的 探讨早期短时血滤清除血清白介素-6(IL-6)在重症急性胰腺炎治疗中的作用及机制.方法 根据诊断标准对重症急性胰腺炎患者进行前瞻性对照研究,将上海交通大学医学院附属第三人民医院普外科收治的178例重症急性胰腺炎患者随机分组:血滤组(HF组)85人,非血滤组(NHFF组)93人.比较两组患者的症状、APACHE II评分、住院时间和费用、MODS发病率和病死率,并比较各时相点促炎细胞因子血清IL-6的测定值.数据以SPSS统计软件处理,采用SNK-q检验和X2检验进行数据分析.结果 HF组与NHF组比较:腹痛腹胀持续时间为(18.8±4.2)h vs.(89.7±28.1)h(P<0.05);治疗后第10天APACHE Ⅱ积分为(5.5±3.6)分vs.(13.8±3.8)分(P<0.05);住院天数和医疗费为(28.2±12.4)d vs.(42.4±11.2)d和(4.38±2.8)万元vs.(7.46±2.2)万元,(P<0.05).治疗后各时相点血清IL-6检测结果:HF组较NItF组显著降低(P<0.05);MODS发病率和病死率分别为12.47%vs.36.28%和4.28%vs.12.82%,两者差异有统计学意义(P<0.05).结论 早期短时血滤有利于纠正重症急性胰腺炎患者血清促炎细胞因子过度释放,使病情减轻,降低MODS发病率和病死率,提高疗效.

The value of early short-time veno-venous hemodialysis in reducing IL-6 in patients with severe acute pancreatitis

Objective To study the therapeutic effect and mechanism of IL-6 reduced by the early shortlime veno-venous hemodialysis (BVVH) for the treatmnent of severe acute pancreatitis (SAP).Method One hundred and seventy-eight cases with SAP,in depagtment of general surgery,the Third People Hospital,Shanghai Jiao Tong University School of Medicine,were divided inlo hemodialysis group (HF,85 cases) and non-hemodialysis group (NHF,93 cases).The local and systemic manifestations,APACHE Ⅱ scores,average hospitalizing stay,mean cost of therapy,morbidity of MODS and the mortality of patients were compared between two groups.And the concentration of serum inflammatory factor IL-6 was assayed at different observation intervals.All data were managed by SPSS software and analyzed by using SNK-q test or X2 test.Results The duration for abdominal pain and distension in patiergs of HF group was (18.8+=4.2) h vs.(89.7±28.1) h in those of NHF group,P<0.05.The APACHE Ⅱ scores at the 10th day were (5.5±3.6) vs.(13.8±3.8) (P<0.05).The average hospitalizing stay and the mean costs of medical care were (28.2+ 12.4) d vs.(42.4+11.2) d and (43800±28000) vs.(74600±22000) RMB(P<0.05) respectively.The concontrafion of serum inflammatory factor IL-6 in HF group decreased significantly(P<0.05) in comparison with those in NHF group.And the morbidity such as MODS and the mortality in HF group were significantly less than those in NHF group(P<0.05).Conclusions By BWH,the excessive release of serum inflammatory factor IL-6 could he removed at early stage of SAP.So,it could result in an improving on the severity of the disease and raise the therapeutic efficacy.