国产甲磺酸加贝酯治疗急性水肿型胰腺炎556例临床研究

自1993年5月－1994年5月，我们应用国产注射用甲磺酸加贝酯（gabexate mesllate,GM;日本商品为Foy)治疗556例急性水肿型胰腺炎。380例单独应用GM（GA组），176例除GM外合并应用H2受体拮抗剂（GB组），另设C组为对照组。三组基础治疗相同，疗程7－10天。治疗结果：GA组血，尿淀粉酶3天内复常者占70．24％，55．79％。GB组占74．43％，50％。7天内复常者两组分别为96．58％，92．37％，97．16％，90．35％。主要症状如恶心，呕吐，上腹部痛，三天内消失率GA组分别为83．8％，87．11％，47％；GB组分别为：88．7％，96．48％，47．7％。7天内消失率两组为94．100％。化验检查及主要症状的恢复两组相比（P＞0．05）差异无显著性。与对照组相比差异显著（P＜0．05）。治疗中少数患者（3．06％）发生静脉炎及注射部位疼痛等一些不良反应。以上结果表明：单独应用GM治疗与加用H2受体拮抗剂二组疗效相同，总有效率显著高于对照组。GM治疗急性水肿型胰腺炎具有缓解症状迅速，血尿淀粉酶恢复正常需时短的优点。而且不易复发，不良反应发生率低。因此GM可作为急性水肿型胰腺炎的首选药物，疗效可靠而又安全。     

加贝酯治疗急性胰腺炎的临床研究

目的 探讨国产加贝酯对急性水肿型胰腺炎的疗效和不良反应。 方法 应用加贝酯和一般常规治疗方法对158例年龄在20-60岁的急性水肿型胰腺炎患者进行多中心、随机、对照临床研究,其中加贝酯组81例,一般常规治疗(对照组)77例。 结果 加贝酯组显效率(74.1％)及总有效率(100％)均高于对照组(41.5％及94.8％),加贝酯组疗效显著优于对照组(P<0.01和P<0.05),且不良反应少而轻,除3例(3.7％)注射局部皮肤发红、疼痛,2例(2.4％)静脉炎,1例皮疹外,未发现肝、肾、心及血液损伤。 结论 国产加贝酯治疗急性胰腺炎起效迅速,疗效肯定,副反应少而轻。对60-80岁的急性胰腺炎患者亦有较好疗效。     

加贝酯治疗轻症急性胰腺炎的疗效观察

加贝酯（gabexate mesilate，GM）是非肽类的蛋白酶抑制剂，可抑制多种蛋白酶的活性。为观察加贝酯对轻症急性胰腺炎（mild acute pancreatitis，MAP）的治疗效果，我们于2003年6月～2005年3月，在常规治疗的基础上，运用国产加贝酯治疗MAP45例，取得了良好疗效，现报道如下。     

丙氨酰谷氨酰胺联合甲磺酸加贝酯治疗老年急性胰腺炎的疗效

[目的]探讨丙氨酰谷氨酰胺联合甲磺酸加贝酯治疗老年急性胰腺炎的临床疗效。[方法]纳入如皋市人民医院2017年2月~2019年2月收治的符合条件的急性胰腺炎患者共120例,按随机数字表法分为对照组和观察组,每组各60例。对照组在常规治疗基础上给予注射用甲磺酸加贝酯静脉滴注,前3 d为300 mg/d,3 d后为100 mg/d,1次/d。观察组在对照组基础上给予丙氨酰谷氨酰胺注射液静脉滴注,20 g/次,1次/d。2组均治疗14 d,比较2组患者的临床疗效、症状改善时间、血淀粉酶(AMY)、尿淀粉酶(UAMY)、血尿素氮(BUN)水平及免疫功能、肠道菌群和不良反应情况。[结果]治疗后,对照组和观察组的总有效率分别为75.86%、91.67%,2组差异有统计学意义(P<0.05);观察组腹胀、腹痛缓解和肠鸣音、体温恢复时间以及AMY、UAMY、BUN水平明显少于对照组(P<0.01);治疗后,观察组患者血IgA、IgG、CD4^+/CD8^+水平以及乳酸杆菌、双歧杆菌明显高于对照组,大肠杆菌、肠球菌明显低于对照组(P<0.01)。[结论]丙氨酰谷氨酰胺联合甲磺酸加贝酯治疗老年急性胰腺炎疗效确切、安全性好,可改善患者的免疫功能以及肠道菌群。     

加贝酯防治急性胰腺炎应用现状

甲磺酸加贝酯(gabexate mesilate,GM)是20世纪70年代日本研制的一种新的非肽类蛋白水解酶抑制剂,是第一个用于治疗胰腺炎的化学合成药物,分子质量为417,无免疫原性,副作用小。GM在人血中半衰期为55 s,由肝脏代谢,肾脏排泄,易于渗入胰腺组织。临床上常用于治疗急性胰腺炎(acute pancreatitis,AP)、慢性胰腺炎急性发作,还可用于治疗弥散性血管内凝血(DIC)。本文就其防治AP作用机制、疗效评价、剂量及用法作一综述。一、GM防治AP机制1.抑制胰蛋白酶原激活及其引起的级联反应:AP发病主要因为胰管阻塞、胰管内压力骤然增高、胰腺血液淋巴循环障碍等引起胰腺消化酶对其自身消化的一种急性炎症。各种胰酶在胰腺炎中的发病起关键作用。胰酶除消化自     

乌司他丁和加贝酯治疗急性轻症胰腺炎疗效比较

2000年12月～2004年1月,我们对乌司他丁（UTI）和加贝酯（FOY）治疗急性轻症胰腺炎的疗效进行临床对比观察。现报告如下。     

早期肠内营养联合加贝酯治疗老年急性胰腺炎的疗效

目的分析早期肠内营养联合加贝酯治疗老年急性胰腺炎的临床价值。方法选择68例老年急性胰腺炎患者,按照随机数字表法将其分为观察组、对照组,对照组给予常规综合治疗,并实施肠外营养支持;在对照组基础上,观察组给予早期肠内营养联合加贝酯治疗,对比两组营养状况、免疫功能、血/尿淀粉酶变化情况及局部并发症、全身并发症发生情况。结果治疗前,两组营养指标、免疫功能指标比较,差异无统计学意义(P0.05);治疗后,两组营养指标、免疫功能指标均得到改善,且观察组营养指标、免疫功能指标明显优于对照组(P0.05)。治疗前,两组血淀粉酶、尿淀粉酶比较,差异无统计学意义(P0.05);治疗后,观察组血淀粉酶、尿淀粉酶明显较对照组低(P0.05);观察组胰腺感染、肺炎、呼吸衰竭、多器官功能障碍综合征(MODS)等并发症发生率明显较对照组低(P0.05)。结论早期肠内营养联合加贝酯治疗老年急性胰腺炎的临床效果显著,能够改善患者营养状态及免疫状态,实现降低患者并发症、促进康复的临床价值。     

从酶抑制观察加贝酯治疗急性胰腺炎的疗效

从酶抑制观察加贝酯治疗急性胰腺炎的疗效史淑君孙玉霞丁福祥吉林医学院附属医院消化内科１３２０１１Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｐａｎｃｒｅａｔｉｔｉｓ／ｄｒｕｇｔｈｅｒａｐｙ；ｍｅｓｙｌａｔｅｓ／ｔｈｅｒａｐｅｕｔｉｃｕｓｅ；ｇａｂｅｘａｔｅ／ｔｈ...     

加贝酯对急性胆囊炎临床疗效观察

加贝酯是一种非肽类蛋白水解酶抑制剂,主要用于胰腺炎的治疗。但近年来有人发现其还有松弛胆囊及0ddi括约肌的作用,我院自1999年7月至2000年2月,对急性胆囊炎患者应用加贝酯缓解疼痛,取得了满意的疗效,现将结果报道如下:     

Gabexate mesilate vs aprotinin in human acute pancreatitis (GA.ME.P.A.) A prospective, randomized, double-blind multicenter study

Summary The authors report the results of a randomized, double-blind multicenter clinical trial on the use of gabexate mesilate vs aprotinin in the therapy of acute pancreatitis. The size of the study sample and the end points chosen for evaluation of the early systemic complications of the pancreatitis—carefully selected targets for reliable assessment of the efficacy of any protease inhibitor—lead to the conclusion that gabexate mesilate is more efficacious than aprotinin in reducing the early complications of necrotizing acute pancreatitis, if administered within 72 h of onset of symptoms. Its good tolerability means that it can be used safely even at the dose of 3 g/24 h.     

Effects of Gabexate Mesilate (FOY) on Amylase and Phospholipase A<Subscript>2</Subscript> in Human Serum and Pancreatic Juice

The precise inhibitory action of gabexate mesilate (GM) on the various pancreatic enzymes remains unclear. We designed this study to investigate the enzyme inhibitory action of GM in the serum and directly in the pancreatic juice. We observed 16 cases with postoperative pancreatic drainage. Patients were randomly assigned to one of two groups, to receive GM at a dose of 600 mg/24 hr (treated group: 8 patients) or a physiological solution (control group: 8 patients) by continuous intravenous infusion. In both groups pancreatic juice and serum were sampled three times: before infusion began (T0) and at 12 hr (T1) and 24 hr after infusion ended (T2). At the end of the study, seven patients received octreotide and the volume of pancreatic secretion was determined. No statistical difference was observed in serum amylase and phospholipase A₂ activity in the treated and control groups. On the contrary, amylase and phospholipase A₂ activity in the pancreatic juice diminished significantly only in the treated group, and in these patients a GM metabolite was also detectable in the pancreatic secretion. The volume of pancreatic secretion decreased only after infusion of octreotide. The enzyme inhibition in the pancreatic gland itself and the central role of inhibition of phospholipase A₂ in the enzyme cascade responsible for activating other proteases, confirm the therapeutic use of GM in acute pancreatitis. An association of GM and octreotide during acute pancreatitis should be useful because of their different mechanisms.     

Multicentre comparative study of two schedules of gabexate mesilate in the treatment of acute pancreatitis

Aim. To compare the efficacy of two different schedules of gabexate mesilate (900 mg/day, or 1, 500 mg/day) in the treatment of severe acute pancreatitis.Setting. Forty-two Italian medical and surgical centres took part in the study.Study design. A multicentre, prospective, open label, comparative, parallel-group, randomized study.Methods. The patients enrolled in the study had acute pancreatitis as demonstrated by typical abdominal pain and baseline serum amylase concentrations more than twice the upper normal limit, findings compatible with acute pancreatitis at imaging techniques, and a Glasgow criteria score of ≥3. Patients were randomly assigned to one of the two schedules of treatment with gabexate mesilate being administered intravenously for at least 7 days. The minimum clinically relevant difference (delta), between groups, in incidence of complications due to acute pancreatitis, during the first month of the study treatment, was predefined as equal to 10%.Results. A total of 199 patients were assigned to gabexate mesilate 900 treatment and 189 to gabexate mesilate 1,500. Complications developed in 88 patients within one month of beginning treatment 44/199: patients (22.1%) in the gabexate mesilate 900 group and 44/189 patients (23.3%) in the gabexate mesilate 1, 500 group (difference 1.2%; 95% confidence interval: −7.2; 9.5%).Conclusions. Gabexate mesilate 900 mg per day is as effective as gabexate mesilate 1500 mg per day in reducing the complications due to acute pancreatitis.     

加贝酯在ERCP诊治术后的临床应用评价

目的观察加贝酯在预防ERCP术后引起的高淀粉酶血症和急性胰腺炎的有效性。方法两组行ERCP的病人,试验组应用加贝酯。观察试验组和对照组患者术后血清淀粉酶的变化。结果试验组术后高淀粉酶血症及急性胰腺炎发生率明显低于对照组(P<0.05)。结论加贝酯能有效预防ERCP术后高淀粉酶血症及急性胰腺炎的发生。     

Effectiveness of gabexate mesilate in acute pancreatitis

Since the effectiveness of gabexate mesilate in patients with acute pancreatitis is controversial, a metaanalysis of the published literature was conducted to address this problem. Five randomized trials were identified by our literature search. Three end points (mortality, complications, and complications requiring surgery) were evaluated. The results of our metaanalysis indicate that the treatment with gabexate mesilate does not affect mortality at 90 days (P=0.27), but significantly reduces the incidence of complications requiring surgery (odds ratio=0.61, 95% CI: 0.41–0.89;P<0.05) and of complications in general (odds ratio=0.69, 95% CI: 0.54–0.89;P<0.05). Because the drug proves to be beneficial only to a low proportion of the treated patients, its clinical impact seems to be small. A pharmacoeconomic evaluation shows that its use in all patients with acute pancreatitis would imply a very high cost for preventing each complication. The administration of the drug to select patients who are at higher risk of complications could have a better cost-effectiveness ratio. However, specific studies on this point are still lacking.     

Acute Myeloid Leukemia Developing with Acute Pancreatitis Mimicking Autoimmune Pancreatitis

A 33-year-old man was admitted to our hospital for fever and abdominal pain. A blood analysis revealed pancytopenia and increased serum pancreatic enzymes with disseminated intravascular coagulation. A detailed examination revealed acute pancreatitis, with diffuse swelling of the pancreas and diffuse beaded dilatation of the main pancreatic duct, which mimicked autoimmune pancreatitis complicated by acute myeloid leukemia. Systemic cytotoxic chemotherapy led to the remission of leukemia and pancreatitis. We hypothesized that the etiology of acute pancreatitis was invasion of leukemia cells. Acute pancreatitis is rare as a symptom of leukemia; however, we should consider the possibility of leukemia during the differential diagnosis of acute pancreatitis.     

抗氧化剂治疗重症急性胰腺炎的临床研究

目的对抗氧化剂治疗重症急性胰腺炎的有效性分析。方法一个随机、安慰剂对照实验,将2002年4月—2006年10月44例患者分成两组,每组22例,抗氧化剂组使用N-乙酰半胱氨酸、硒剂、维生素C静脉滴注,安慰剂组使用安慰剂,治疗7d,在6个观察时间点记录患者的APACHE-Ⅱ评分,Marshall器官功能障碍评分,LODS器官功能障碍评分和血清抗氧化剂水平。结果抗氧化剂组在治疗后3~7d,APACHE-Ⅱ评分明显低于安慰剂组,差异有统计学差异（P〈0.05）,多器官功能障碍发生人数也低于安慰剂组,差异有统计学差异（P〈0.05）,抗氧化剂组病死率为4.5%,安慰剂组病死率高达18%,重症监护时间及住院时间均明显缩短。结论抗氧化剂在治疗重症急性胰腺炎时,能有效减少重症急性胰腺炎及其并发症的发生率和病死率,减轻细胞损害。     

善得定治疗急性胰腺炎的体会

作者对比观察了善得定对急性胰腺炎的治疗作用，其剂量为0.1-0.15mg，每4－6h一次，皮一注射。在85例水肿型胰腺炎中，15例应用善得定治疗。结果显示，善得定治疗组转手术率显著低于非善得定组（P＜0．05），未合并感染的12例坏死性胰腺炎均采取非手术治疗，其中3例应用善得定治疗，其合并症全部消失，明显优于对照组。合并感染的67例坏死性胰腺炎均予以手术治疗，病情严重的14例，用善得定治疗，结果显示可减少并发症及其严重度。