河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (8): 920-925.doi: 10.3969/j.issn.1007-3205.2021.08.012

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乌司他丁联合肾上腺皮质激素对脓毒症患儿肠黏膜屏障功能、NGAL、TREM-1水平的影响

  

  1. 1.河北省保定市儿童医院消化内科，河北 保定  071000；2.河北省保定市儿童医院保健科，河北 保定 071000；
    3.河北省保定市儿童医院PICU科，河北 保定 071000；4.河北省保定市儿童医院新生儿科，河北 保定 071000
  • 出版日期:2021-08-25 发布日期:2021-08-27
  • 作者简介:王改（1983-），女，河北保定人，河北省保定市儿童医院副主任医师，医学硕士研究生，从事儿科疾病诊治研究。
  • 基金资助:
    保定市科技计划项目（1941ZF062）

Effect of ulinastatin combined with adrenal cortex hormones on intestinal mucosal barrier function, NGAL and TREM-1 levels in children with sepsis

  1. 1.Department of Gastroenterology, Children′s Hospital of Baoding City, Hebei Province, Baoding 
    071000, China; 2.Department of Health Care, Children′s Hospital of Baoding City, Hebei 
    Province, Baoding 071000, China; 3.Department of PICU, Children′s Hospital of 
    Baoding City, Hebei Province, Baoding 071000, China; 4.Department of 
    Neonatology, Children′s Hospital of Baoding City, Hebei Province, 
    Baoding 071000, China
  • Online:2021-08-25 Published:2021-08-27

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摘要： 目的  探究乌司他丁联合肾上腺皮质激素对脓毒症患儿肠黏膜屏障功能、中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase associated lipocalin，NGAL）、可溶性髓样细胞触发性受体1（soluble triggering receptor expressed on myeloid cells-1，TREM-1）水平的影响。
方法  选取我院接诊的82例脓毒症患儿作为研究对象，按照随机数字表法分为乌司他丁组和联合治疗组41例。乌司他丁组采用乌司他丁进行治疗，联合治疗组在乌司他丁组基础上增加肾上腺皮质激素进行治疗。采用血气分析仪检测乳酸（ lactic acid，LA）水平；采用急性生理和慢性健康（acute physiology and chronic health，APACHEⅡ）评分评估疾病严重程度。采用酶联免疫吸附测定法（enzyme-linked immunosorbent assay，ELISA）检测肝素结合蛋白 （heparin-binding protein，HBP）、前白蛋白（prealbumin，PA）、视黄醇结合蛋白（retinol-binding protein，RBP）、白细胞介素6（interleukin-6，IL-6）、白细胞介素10（interleukin-10，IL-10）、二胺氧化酶（diamine oxidase，DAO）、肠脂肪酸结合蛋白（intestinal fatty acid binding protein，IFABP）、D-乳酸、NGAL、TREM-1水平。采用全自动生化分析仪检测肌酸激酶同工酶（creatine kinase isoenzyme，CK-MB）、肌钙蛋白I（troponin I，cTnI）水平。采用流式细胞仪检测免疫功能指标。观察2组患儿LA值、治疗效果，并计算LCR。
结果  与乌司他丁组相比，联合治疗组LA、HBP、IL-6、CK-MB、cTnI、CD8+、DAO、IFABP、D-乳酸、NGAL、TREM-1水平、APACHEⅡ评分较低（P＜0.05）。与乌司他丁组相比，联合治疗组LCR，PA、RBP、IL-10、CD3+、CD4+、NK水平以及治疗总有效率较高（P＜0.05）。
结论  乌司他丁联合肾上腺皮质激素可有效改善儿童脓毒症患儿临床症状，促进肠黏膜屏障功能恢复正常，下调NGAL、TREM-1水平，值得在临床上推广应用。


关键词: 脓毒症, 乌司他丁, 肾上腺皮质激素类

Abstract: Objective  To explore the effects of ulinastatin combined with adrenal cortex hormones on intestinal mucosal barrier function, neutrophil gelatinase-associated lipocalin(NGAL), and soluble myeloid cell triggered receptor-1(TREM-1) level in children with sepsis. 
Methods  A total of 82 children with sepsis admitted to our hospital were selected as research subjects, and were divided into the ulinastatin group(n=41) and the combination treatment group(n=41) according to the random number table method. The ulinastatin group was treated with ulinastatin, and the combination treatment group was treated with adrenal cortex hormones on the basis of the ulinastatin group. A blood gas analyzer was used to detect the level of lactic acid(LA), and the acute physiology and chronic health(APACHEⅡ) score was used to assess the severity of the disease. Enzyme-linked immunosorbent assay(ELISA) was used to detect heparin-binding protein(HBP), prealbumin(PA), retinol-binding protein(RBP), interleukin-6(IL-6), interleukin-10(IL-10), diamine oxidase(DAO), intestinal fatty acid binding protein(IFABP), D-lactic acid, NGAL and TREM-1 levels. An automatic biochemical analyzer was used to detect creatine kinase isoenzyme(CK-MB) and troponin I(cTnI) level. Immune function indicators were detected by flow cytometry. The LA value and therapeutic effect of the two groups of children were observed, and the LCR was calculated. 
Results  Compared with the ulinastatin group, the combination treatment group had lower LA, HBP, IL-6, CK-MB, cTnI, CD8+, DAO, IFABP, D-lactic acid, NGAL, TREM-1 levels, and APACHE Ⅱ scores(P＜0.05). Compared with the ulinastatin group, the combination treatment group had higher levels of LCR, PA, RBP, IL-10, CD3+, CD4+, NK and the total effective rate of treatment(P＜0.05). 
Conclusion  Ulinastatin combined with adrenal cortex hormones can effectively improve the clinical symptoms of children with sepsis, promote the normalization of the intestinal mucosal barrier function, and lower the levels of NGAL and TREM-1. Therefore, it is worthy of clinical popularization and application.


Key words: sepisis, ulinastatin, adrenal cortex hormones

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