急性胰腺炎患者论文急性轻型胰腺炎论文

急性胰腺炎患者论文急性轻型胰腺炎论文

阿托伐他汀对急性轻型胰腺炎患者的疗效及其机制

【摘要】目的评估阿托伐他汀对急性轻型胰腺炎患者的疗效及其机制。方法收集235例急性胰腺炎患者，将Ranson评分低于3分患者定义为急性轻型胰腺炎，共116例，将患者随机分为对照组及治疗组，分别给予安慰剂(20 mg/qn，口服)及阿托伐他汀(20 mg/qn，口服)，共7 d。分别于入院时，第3天及第7天评估患者外周血白细胞总数、谷草转氨酶、尿素氮、总胆固醇、C-反应蛋白和降钙素原水平，同时行腹部增强CT扫描，采用CT严重指数评估两组患者胰腺炎症及渗出情况。结果第3天时，治疗组患者血浆C-反应蛋白明显低于对照组(P<0.05)，而白细胞总数、降钙素原及CT严重指数虽优于对照组，但差异无统计学意义；第7天时，治疗组患者外周血白细胞总数、C-反应蛋白、降钙素原水平明显低于对照组(P<0.05)，且共有8例患者由CTSI Ⅱ级改善为Ⅰ级，而对照组仅有4例(P<0.05)；两组患者谷草转氨酶、尿素氮和总胆固醇比较，差异无统计学意义。结论阿托伐他汀能够改善急性轻型胰腺炎患者全身及局部胰腺组织的炎症反应，其机制可能与阿托伐他汀能够下调C-反应蛋白及降钙素原表达有关。

【关键词】阿托伐他汀；急性轻型胰腺炎；疗效；机制

Efficacy and mechanism of Atorvastatin on patient with acute mild pancreatitis

Zhan Hai-yong,Huang Cong-wu.

Department of Gastroenterology, Second Affiliated Hospital of Shantou Medical University, Shantou 515041, China

【Abstract】Objective To investigate efficacy and mechanism of Atorvastatin on patient with acute mild pancreatitis. Methods 253 patients defined as acute pancreatitis(AP)were enrolled, and 116 patients with less than 3 points according to Ranson score were defined as mild acute pancreatitis and were randomly assigned into control group(placebo 20 mg/qn, p.o.)and therapeutic group(Atrovastatin 20 mg/qn, p.o.)for totally seven days. White blood cell(WBC), aspartate transaminase(AST), blood urine nitrogen(BUN), total cholesterol(TC), C-reactive protein(CRP,)and procalcitonin(PCT)of peripheral blood were evaluated, accompanying with enhanced abdominal computed tomography scan to evaluate systemic inflammation and exudation of pancreas by CT severe index(CTSI)at initial administration, the third day and the seventh day. Results At third day, compared control group, serum level of CRP was significantly lower in therapeutic group(P<0.05). WBC, PCT and CTSI in therapeutic group were better than control group, but the variation was not significant. At seventh day, compared control group, WBC, CPR and PCT were significantly lower in therapeutic group(P<0.05), and there were 8 patients in therapeutic group progressed from CTSI class Ⅱto

class I while only 4 patients in control group progressed to CTSI class I from class Ⅱ. There were no difference of AST, BUN and TC between the two groups.Conclusion Systemic inflammation and local pancreatic inflammation are ameliorated with Atorvastatin treatment, and the mechanism might be associated with down-regulation of serum CRP and PCT levels with Atorvastatin treatment.

【Key words】Atorvastatin; Acute mild pancreatitis; Efficacy; Mechanism

急性胰腺炎(acute pancreatitis，AP)是消化系统常见急症，可分为轻型水肿型及重型出血坏死型。研究表明全身炎症反应及胰腺局部炎症在AP发生发展中均起着关键的作用［1-2］，而他汀类药物具有调节炎症反应和保护血管内皮细胞的作用［3-4］，因此本研究拟初步探讨他汀类药物在急性轻型胰腺炎患者中的作用及其可能的机制。

1 资料与方法

1.1 一般资料收集从2008年6月至2010年12月在我院住院，结合患者临床症状，经血淀粉酶、脂肪酶及尿淀粉酶明确诊断为急性胰腺炎患者235例，根据Ranson评分标准［5］，将积分<3分患者定义为轻型胰腺炎，共116例，男86例，女30例，年龄(40.3±10.7)岁。

1.2 方法将116例患者随机分为治疗组(阿托伐他汀20 mg/qn，口服)和对照组(安慰剂20 mg/qn，口服)，入院后24 h内开始给药，共7 d。