Effect of alprostadil combined with bifidobacterium on intestinal barrier function and occludin level in patients with acute pancreatitis
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摘要: 目的 探讨前列地尔联合双歧杆菌对急性胰腺炎患者的疗效及对肠屏障功能和闭合蛋白水平的影响。方法 选择2019年1月—2020年6月期间本院收治的112例急性胰腺炎患者，按照入院先后编号，根据奇偶数将患者分成研究组和对照组，各56例。对照组患者静脉推注前列地尔注射液，研究组患者在对照组的基础上加服双歧杆菌四联活菌片。比较2组患者临床疗效、临床表现缓解时间、炎症因子、闭合蛋白、肠道黏膜屏障功能指标及不良反应等参数。结果 治疗后，研究组患者总有效率为96.43%，明显高于对照组的78.57%(χ2=8.163，P=0.004)；研究组患者腹痛、肠鸣音、体温和血清淀粉酶等临床表现缓解时间明显低于对照组(P< 0.05)；2组患者TNF-α、IL-6和IL-8等炎性水平明显降低，且研究组患者上述诸指标明显低于对照组(P< 0.05)；2组患者D-乳酸、二胺氧化酶和内毒素等明显降低，且研究组患者肠道黏膜屏障功能指标明显低于对照组(P< 0.05)；2组患者闭合蛋白水平明显提高，且研究组患者闭合蛋白水平明显高于对照组(P< 0.05)；治疗期间，2组患者均出现转氨酶升高、白细胞减少及瘙痒等不良反应，但差异无统计学意义(P>0.05)。结论 双歧杆菌四联活菌片联合前列地尔注射液应用于急性胰腺炎，可有效提高临床疗效，缩短临床表现缓解时间，减轻炎症反应，优化肠道黏膜屏障功能指标，增加闭合蛋白表达，安全性高，值得临床推广。Abstract: Objective To explore the effect of alprostadil combined with bifidobacterium on intestinal barrier function and occludin in patients with acute pancreatitis.Methods 112 patients with acute pancreatitis treated in our hospital from January 2019 to June 2020 were selected. According to the serial number of admissions, the patients were divided into study group(n=56) and control group(n=56). Patients in the control group were treated with alprostadil injection, while patients in the study group were treated with alprostadil injection and bifidobacterium. The clinical efficacy, remission time of clinical manifestation, inflammatory factors, closed protein, intestinal mucosal barrier function and adverse reactions were compared between the two groups.Results After treatment, the total effective rate of the study group was 96.43%, which was significantly higher than that of the control group(78.57%)(χ2=8.163,P=0.004). The remission time of clinical manifestations such as abdominal pain, intestinal sound, body temperature and serum amylase in the study group were significantly lower than those in the control group(P< 0.05). The inflammatory levels of TNF-α, IL-6 and IL-8 in the study group were significantly lower than those in the control group, and the levels of D-lactic acid, diamine oxidase and endotoxin in the study group were significantly lower than those in the control group, and the intestinal mucosal barrier function in the study group was significantly lower than that in the control group. The level of occludin protein in the two groups was significantly increased, and the level of occludin protein in the study group was significantly higher than that in the control group(P< 0.05). During treatment, two groups showed elevated transaminase, white blood cell reduction and itching, but the difference was not statistically significant(P>0.05).Conclusion The application of bifidobacterium quadruple viable bacteria tablets combined with alprostadil in acute pancreatitis can effectively improve the clinical curative effect, shorten the remission time of clinical manifestations, reduce the inflammatory reaction, optimize the intestinal mucosal barrier function index, and enhance the expression of occludin protein, which is safe and worthy of clinical promotion.
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表 1 2组受试者基线资料比较
X±S，例 组别 研究组
(n=56)对照组
(n=56)t/χ2 P 年龄/岁 60.34±
3.0160.84± 3.22 0.849 0.398 体质量指数 24.53±2.09 24.87± 1.99 0.882 0.380 病程/h 12.03±1.88 11.87± 2.76 0.359 0.721 文化程度 2.126 0.345 初中及以下 28 27 中专或高中 24 28 大专及以上 4 1 病因 2.639 0.267 胆源性 30 27 酒精性 21 18 高三酰甘油 5 11 性别 1.434 0.231 男 34 40 女 22 16 吸烟史 0.265 0.607 是 8 10 否 48 46 饮酒史 1.734 0.188 是 6 11 否 50 45 疾病严重程度 1.348 0.245 轻症 37 31 重症 19 25 基础疾病 糖尿病 8 10 0.265 0.607 高血压 13 9 0.905 0.341 高血脂 5 8 0.783 0.376 
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表 2 2组患者临床疗效比较
例(%) 组别 治愈 显效 好转 无效 总有效 研究组(n=56) 28 18 8 2 54(96.43) 对照组(n=56) 18 16 10 12 44(78.57) χ2 8.163 P 0.004
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表 3 2组患者临床表现缓解时间比较
d，X±S 组别 缓解时间 腹痛 肠鸣音 体温 血清淀粉酶 研究组(n=56) 2.81±0.23 2.43±0.28 3.25±0.40 5.70±0.62 对照组(n=56) 4.70±0.36 4.18±0.32 4.68±0.38 7.88±0.70 t 33.107 30.799 19.396 17.446 P < 0.001 < 0.001 < 0.001 < 0.001
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表 4 2组患者炎症因子比较
ng/L，X±S 组别 TNF-α IL-6 IL-18 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 研究组(n=56) 18.79±2.31 7.21±1.181) 125.03±15.11 50.42±10.101) 49.59±5.19 32.44±4.421) 对照组(n=56) 18.46±2.56 13.58±1.211) 124.05±14.12 87.24±9.981) 48.90±5.21 38.01±4.491) t 0.716 16.073 0.355 19.405 0.702 6.616 P 0.475 < 0.001 0.724 < 0.001 0.484 < 0.001 与同组治疗前比较，1)P < 0.05。
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表 5 2组患者肠道黏膜屏障功能指标比较
X±S 组别 D-乳酸/(mg·L-1) 二胺氧化酶/(U·L-1) 内毒素/(EU·L-1) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 研究组(n=56) 4.65±0.43 2.68±0.241) 20.81±5.20 7.81±1.211) 89.34±16.20 32.09±10.421) 对照组(n=56) 4.72±0.40 3.70±0.201) 19.87±4.12 13.10±2.101) 91.72±15.30 45.48±9.451) t 0.892 24.433 1.060 16.333 0.799 7.123 P 0.374 < 0.001 0.291 < 0.001 0.426 < 0.001 与同组治疗前比较，1)P < 0.05。
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表 6 2组患者闭合蛋白水平比较
ng/L，X±S 组别 闭合蛋白 t P 治疗前 治疗后 研究组
(n=56)105.74±
13.11131.43±
10.281)11.540 < 0.001 对照组
(n=56)106.12±
13.78119.32± 10.311) 5.740 < 0.001 t 0.150 6.224 P 0.881 < 0.001 与同组治疗前比较，1)P < 0.05。
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表 7 2组患者不良反应发生率比较
例 组别 转氨酶升高 白细胞减少 瘙痒 总发生率/% 研究组(n=56) 1 1 3 8.93 对照组(n=56) 1 1 2 7.14 χ2 0.121 P 0.728
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[1] Greenberg JA, Hsu J, Bawazeer M, et al. Clinical practice guideline: management of acute pancreatitis[J]. Can J Surg., 2016, 59(2): 128-140. doi: 10.1503/cjs.015015
[2] van Dijk SM, Hallensleben N, van Santvoort HC, et al. Acute pancreatitis: recent advances through randomised trials[J]. Gut, 2017, 66(11): 2024-2032. doi: 10.1136/gutjnl-2016-313595
[3] 付彬, 李俊, 袁佳. 急性胰腺炎并发多器官功能障碍综合征的研究进展[J]. 中国现代医药杂志, 2019, 21(12): 105-108. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHTY201912029.htm
[4] 王春友, 杨明. 急性胰腺炎诊治指南(2014)解读——急性胰腺炎外科诊治难点分析[J]. 临床外科杂志, 2015, 23(1): 11-13. doi: 10.3969/j.issn.1005-6483.2015.01.005
[5] McCluskey SV, Kirkham K, Munson JM. Stability of Alprostadil in 0.9% Sodium Chloride Stored in Polyvinyl Chloride Containers[J]. Int J Pharm Compd, 2017, 21(2): 150-153.
[6] Esaiassen E, Hjerde E, Cavanagh JP, et al. Bifidobacterium Bacteremia: Clinical Characteristics and a Genomic Approach To Assess Pathogenicity[J]. J Clin Microbiol, 2017, 55(7): 2234-2248. doi: 10.1128/JCM.00150-17
[7] 中华医学会外科学分会胰腺外科学组. 急性胰腺炎诊治指南(2014)[J]. 临床外科杂志, 2015, 23(1): 1-4. doi: 10.3969/j.issn.1005-6483.2015.01.001
[8] 吴育美, 李继昌, 刘海霞, 等. 乌司他丁治疗急性胰腺炎的临床疗效及对患者血清炎性因子水平的影响[J]. 现代生物医学进展, 2017, 17(7): 1331-1334.
[9] James TW, Crockett SD. Management of acute pancreatitis in the first 72 hours[J]. Curr Opin Gastroenterol, 2018, 34(5): 330-335. Lee PJ, Papachristou GI. New insights into acute pancreatitis[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(8): 479-496. doi: 10.1097/MOG.0000000000000456
[10] 韩坤. 前列地尔治疗重症急性胰腺炎的临床效果及对肠道黏膜屏障功能和胃肠动力的影响[J]. 中国医药, 2018, 13(9): 1365-1368. doi: 10.3760/j.issn.1673-4777.2018.09.021
[11] 孙婷婷, 邓国炯, 郭春辉, 等. 双歧杆菌四联活菌片联合乳果糖对乙肝肝硬化患者肠道菌群和肠黏膜屏障功能及肝功能水平的影响[J]. 中国微生态学杂志, 2019, 31(8): 915-918, 922.
[12] Ren YF, Wang MZ, Bi JB, et al. Irisin attenuates intestinal injury, oxidative and endoplasmic reticulum stress in mice with L-arginine-induced acute pancreatitis[J]. World J Gastroenterol, 2019, 25(45): 6653-6667. doi: 10.3748/wjg.v25.i45.6653
[13] Zhang XM, Zhang ZY, Zhang CH, et al. Intestinal Microbial Community Differs between Acute Pancreatitis Patients and Healthy Volunteers[J]. Biomed Environ Sci, 2018, 31(1): 81-86.
[14] Fei S, Li W, Xiang L, et al. Protective Effect of Alprostadil on Acute Pancreatitis in Rats via Inhibiting Janus Kinase 2(JAK2)/STAT3 Signal Transduction Pathway[J]. Med Sci Monit, 2019, 25: 7694-7701. doi: 10.12659/MSM.919148
[15] 韩坤. 前列地尔治疗重症急性胰腺炎的临床效果及对肠道黏膜屏障功能和胃肠动力的影响[J]. 中国医药, 2018, 13(9): 1365-1368. doi: 10.3760/j.issn.1673-4777.2018.09.021
[16] Zhao G, Zhuo YZ, Cui LH, et al. Modified Da-chai-hu Decoction regulates the expression of occludin and NF-κB to alleviate organ injury in severe acute pancreatitis rats[J]. Chin J Nat Med, 2019, 17(5): 355-362.
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