乌司他丁对老年脓毒症患者血清微小核糖核酸-23b和炎症因子的影响及其临床疗效

Effect of ulinastatin on serum microribonucleic acid-23b and inflammatory factors in elderly patients with sepsis and its clinical efficacy

摘要:

目的 探讨乌司他丁对老年脓毒症患者血清微小核糖核酸-23b(miR-23b)、炎症因子的影响及其临床疗效。方法 采用随机、单盲、对照试验设计,选取2017年3月至2018年1月张家口市中医院急诊科救治的脓毒症患者64例,随机数字表法分为对照组32例和观察组32例。对照组给予常规治疗,观察组在常规治疗的基础上给予注射用乌司他丁30万U,静脉滴注,1次/8h。2组患者均连续治疗7 d。检测2组患者治疗前后血清炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)]以及miR-23b水平变化,应用急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭估计(SOFA)评分、多器官功能障碍(MODS)评分评估患者健康状况,并比较2组患者临床疗效。采用SPSS 17.0软件进行数据分析,组间比较采用t检验、χ²检验或秩和检验。结果 治疗前对照组与观察组患者miR-23b表达量分别为(0.87±0.10)和(0.86±0.09)ng/μl,治疗7 d后依次为(1.73±0.21)和(1.91±0.26)ng/μl；与治疗前比较,治疗后2组患者miR-23b表达量均显著升高(P＜0.05)；与对照组比较,观察组治疗后miR-23b表达量显著升高,差异均有统计学意义(t=2.112,P=0.037)。与治疗前相比,治疗7 d后2组患者TNF-α、IL-6、hs-CRP水平及APACHEⅡ、SOFA、MODS评分均显著降低(P＜0.05)；治疗7 d后,与对照组比较,观察组患者上述指标亦均显著降低,差异有统计学意义(P＜0.05)；治疗7 d后对照组和观察组治疗总有效率分别为75.0%(24/32)和90.6%(29/32),差异有统计学意义(Z=-2.375, P=0.018)。结论 乌司他丁可能通过调控miR-23b表达来减轻机体炎症反应并改善脓毒症患者预后,值得临床推广应用。

Abstract:

Objective To investigate the effect of ulinastatin on serum levels of microribonucleic acid-23b (miR-23b) and infla-mmatory factors in elderly patients with sepsis and evaluate its clinical efficacy for sepsis. Methods A single-blind randomized controlled trial was devised on 64 sepsis patients admitted in the Emergency Department of our hospital from March 2017 to January 2018. They were randomly divided into the control group (n=32, conventional treatment) and the observation group (n=32, intravenous injection of 300 000 U ulinastatin, one time/8 h, on the basis of conventional therapy). The serum levels of inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high sensitivity C-reactive protein (hs-CRP), and the expression of miR-23b were detected in the 2 groups before and 7 d after treatment. Acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ), sequential organ failure estimation (SOFA) score, and multiple organ dysfunction syndrome (MODS) score were used to evaluate the patients′ health status, and the clinical efficacy were compared between the 2 groups. SPSS statistics 17.0 was used for data analysis, and Student′s t test, Chi-square test or rank sum test was employed for comparison between groups. Results The expression levels of miR-23b were (0.87±0.10) and (0.86±0.09) ng/ml, respectively, in the control group and observation group before treatment, and the levels were increased to (1.73±0.21) and (1.91±0.26) ng/ml in 7 d after treatment (P<0.05). The increase was more significant in the observation group than in the control group (t=2.112, P=0.037). Compared with before treatment,the levels of TNF-α, IL-6 and hs-CRP, and the scores of APACHE Ⅱ, SOFA and MODS in the 2 groups were obviously decreased after 7 d of treatment (P<0.05); and the decreases of the above indices were more remarkable in the observation group (P<0.05). The total effective rate was 75.0%(24/32) in the control group, and 90.6%(29/32) in the observation group, with statistical difference between them (Z=-2.375, P=0.018). Conclusion Ulinastatin effectively alleviates inflammatory responses and improves the prognosis in sepsis patients, which may be through regulating miR-23b expression, and it is worthy of clinical promotion.