Effect of ulinastatin combined with early enteral nutrition on severe acute pancreatitis and its effect on nuclear factor-κB and Toll-like receptor 4
10.3760/cma.j.cn115455-20200601-00691
- VernacularTitle:乌司他丁联合早期肠内营养治疗重症急性胰腺炎的疗效及对核因子κB和Toll样受体4的影响
- Author:
Zhiqiang LONG
;
Jing CHEN
;
Yan CHEN
;
Ming MA
- From:
Chinese Journal of Postgraduates of Medicine
2021;44(2):153-157
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the effect of ulinastatin combined with early enteral nutrition on severe acute pancreatitis and its effect on nuclear factor-κB(NF-κB) and Toll-like receptor 4 (TLR4).Methods:Ninety severe acute pancreatitis patients who were treated in Central Hospital of Lijin County from January 2016 to January 2020 were selected and were divided into U+EEN group (ulinastatin combined with early enteral nutrition therapy) and EEN group (early enteral nutrition therapy) by random number table method, with 45 patients in each group. Curative effect, complications, nutritional indicators, immunoglobulins and inflammatory factors were detected and compared with analysis of variance. Western blot was used to detect the expression of NF-κB and TLR4 in pancreatic tissue in two groups.Results:The hospitalization time, ICU admission time, intestinal ventilation time, hospitalization costs and organ failure rate, pancreatic cysts, diabetes, chronic pancreatitis, incidence of sepsis in U + EEN group were lower than those in EEN group: (2.1 ± 0.4) months vs. (2.4 ± 0.6) months, (16.9 ± 2.1) d vs. (21.7 ± 2.8) d, (23.7 ± 3.8) d vs. (27.4 ± 4.1) d, (11.4 ± 1.5) thousand Yuan vs. (14.1 ± 2.1) thousand Yuan and 8.9%(4/45) vs. 20.0%(9/45), 13.3%(6/45) vs. 28.9%(13/45), 11.1%(5/45) vs. 24.4%(11/45), 8.9%(4/45) vs. 26.7%(12/45), 6.7%(3/45) vs. 22.2%(10/45), and the differences were statistically significant ( P<0.05). The levels of prealbumin (PA), albumin (ALB) and total protein (TP) after treatment in U + EEN group were higher than those in EEN group: (107.4 ± 6.5) mg/L vs. (102.8 ± 4.7) mg/L, (46.1 ± 3.5) g/L vs. (43.4 ± 2.8) g/L, (55.9 ± 3.4) g/L vs. (53.7 ± 3.1) g/L, and the differences were statistically significant ( P<0.05). The levels of IgG, IgA, IgM after treatment in U+EEN group were higher than those in EEN group: (10.5 ± 1.6) g/L vs. (9.5 ± 1.3) g/L, (8.9 ± 1.4) mg/L vs. (8.3 ± 1.2) mg/L, (60.5 ± 3.6) mg/L vs. (55.9 ± 3.4) mg/L, the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 in U+EEN group were lower than those in EEN group: (25.1 ± 2.9) mg/L vs. (30.6 ± 4.1) mg/L, (20.1 ± 1.9) mg/L vs. (24.6 ± 1.5) mg/L, (17.8 ± 1.9) mg/L vs. (20.1 ± 2.3) mg/L, and the differences were statistically significant ( P<0.05). The expressions of NF-κB and TLR4 protein in pancreatic tissue of patients in U + EEN group were significantly lower than those in EEN group (0.3 ± 0.2 vs. 0.5 ± 0.2, 0.2 ± 0.1 vs. 0.5 ± 0.1, P<0.05). Conclusions:Ulinastatin combined with early enteral nutrition can significantly improve the nutritional status and immune function and improve the prognosis of patients with severe acute pancreatitis, which may be related to ulinastatin′s reduction effect of NF-κB and TLR4′s expressions.
