乌司他丁对多器官功能障碍综合征患者体内高级氧化蛋白产物和C反应蛋白的影响

目的 探讨蛋白酶抑制剂乌司他丁对多器官功能障碍综合征(MODS)患者体内高级氧化蛋白产物(AoPP)和C反应蛋白(CRP)的影响.方法 72例MODS随机分为乌司他丁治疗(乌司他丁组,36例)和常规治疗(对照组,36例),乌司他丁组在对照组治疗的基础上,给予乌司他丁10 030 U·kg-1·d-1静脉注射,2次/d,连用7 d.两组患者均于治疗前,治疗3 d、5 d、7 d取外周静脉血,采用分光光度法和免疫比浊法检测血清AOPP、CRP浓度,并通过软件分析两组患者急性生理与慢性健康状况(APACHE)Ⅲ评分的变化,同时记录3 d、5 d、7 d和28 d两组患者生存或死亡情况.测定36例健康志愿者(健康组,36例)AOPP和CRP浓度作为正常值对照.结果 治疗前两组AOPP和CRP浓度显著高于健康对照组(P<0.05),治疗前乌司他丁组和对照组患者的AOPP和CRP浓度差异无统计学意义(P>0.05);治疗后3 d、5 d、7 d乌司他丁组和对照组血清CRP和AOPP浓度均较治疗前逐步下降(P<0.05);与对照组相比,乌司他丁组患者AOPP和CRP浓度下降更显著(P<0.05),APACHE Ⅲ评分降低更明显(P<0.05),同时28 d病死率显著降低(P<0.05).结论 乌司他丁可显著降低AOPP和CRP的浓度,减轻MODS患者体内氧化应激损伤和炎性反应,从而缓解临床症状,改善疾病的预后.

Effects of ulinastatin on serum concentrations of advanced oxidation protein products and C-reactive protein in patients with multiple organ dysfunction syndrome

Objective To investigate the effects of ulinastatin on serum concentrations of advanced oxidation protein products and C-reactive protein in patients with multiple organ dysfunction syndrome(MODS).Methods Seventy-two patients with MODS were randomly divided into ulinastatin group(n=36) and control group(n=36).The serum concentrations of advanced oxidation protein products and C-reactive protein in two groups were determined before therapy and after 3d,5d and 7d of therapy.Acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ)for patients were recorded before therapy and after 3d,5d,7d of therapy.Mortality within 28d was also compared between the two groups.The serum concentrations of advanced oxidation protein products and C-reactive protein in 36 healthy volunteers were detected as normal control.Results The concentrations of AOPP and CRP in patients with MODS before therapy were significantly higher than those obtained from healthy volunteers(P<0.05), whereas no obvions difference was found between the two groups.However,the levels of AOPP and CRP in patients with MODS were significantly decreased after 3d,5d,7d of therapy.Compared with control group,AOPP concentrations and CRP levels were markedly attenuated and APACHE Ⅲ scores decreased significantly in ulinastatin group(P<0.05).The mortality in ulinastatin group was also improved more significantly than that in control group(P<0.05).Conclusion Ulinastatin can decrease the concentrations of serum AOPP and CRP in patients with MODS,so as to alleviate the damage resulting from oxidative stress and inflammation,contributing to improve the outcome in patients with MODS.