前列地尔对脓毒症急性肝损伤的保护作用研究

发布时间：2018-03-13 02:22

  本文选题：脓毒症　切入点：肝损伤　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究是通过观察前列地尔(ALPROSTADIL PGE1)对脓毒症所导致的急性肝损伤患者肝功能(谷丙转氨酶ALT、谷草转氨酶AST),肝脏排泄功能(总胆红素STB、直接胆红素CB),APACHEⅡ评分,血清TNF-α、血清沉默信号调节因子蛋白1(Sirt1)表达水平影响及变化,并进一步研究和探讨前列地尔对脓毒症急性肝损伤患者炎症反应及肝脏功能的影响。方法:本研究选取了2016年01月-2016年12月间入住大连医科大学附属第二医院中心ICU内80例脓毒症急性肝损伤患者,其年龄分布在50-90岁,随机分为PGE1治疗组(A组,n=40)和标准抗脓毒症治疗组(B组,n=40)。入选的全部脓毒症急性肝损伤患者均给以标准规范的药物抗脓毒症治治疗(sepsis3.0标准)以及液体复苏,A组在此基础上同时予以PEG1 10ug(加入生理盐水10ml)治疗,12小时一次,持续1周治疗;应用药物后再分别监测两组患者治疗前及治疗后第1、3、5、7天患者血谷丙转氨酶ALT、谷草转氨酶AST、总胆红素STB、直接胆红素CB、APACHEⅡ评分、血清TNF-α、血清沉默信号调节因子蛋白1(Sirt1)。采用SPSS21.0软件包统计学软件对本研究结果进行统计学分析。并对治疗前后组内患者ALT、AST、STB、CB、APACHEⅡ评分、血清TNF-α、血清沉默信号调节因子蛋白1(Sirt1)各时间点数据采用均数标准差表示,p0.05表示差异有统计学意义。结果:A组血清ALT、血清AST在治疗后第1天较治疗前上升,第3天患者ALT、AST较前下降(P0.05),患者第5、7天ALT、AST较入科时明显下降,有统计学意义(P0.05);B组患者未应用前列地尔治疗,血清ALT、血清AST在治疗后第1、3天ALT均较入科时升高(P0.05),第7天ALT、AST较入科时下降(P0.05)。A组血清ALT、血清AST水平在治疗后的第5、7天均低于B组同期水平(P0.05)。A组血STB、血CB在治疗后第1天较治疗前上升(P0.05),第3天患者STB、CB较前下降(P0.05),患者第5、7天STB、CB较入科时明显下降,有统计学意义(P0.05);B组患者血STB、血CB在治疗后第1、3天AST均较入科时升高(P0.05),第7天血STB、血CB较入科时下降,有统计学意义(P0.05)。A组血STB、血CB水平在治疗后的第3天、第5天、第7天均低于B组同期水平(P0.05)。A组患者APACHEⅡ评分在治疗后第5天、第7天较治疗前明显下降,与入科时差异具有统计学意义(P0.05);B组APACHEⅡ评分在治疗后第7天APACHEⅡ评分较治疗前下降(P0.05),与入科时差异具有统计学意义(P0.05)。A组APACHEⅡ评分在治疗后的第3天、第5天、第7天均低于B组同期水平(P0.05)。A组Sirt1浓度治疗后第1天较治疗前下降,与入科时差异具有统计学意义(p0.05),治疗后第3天、第5天、7天较治疗前明显升高,与入科时差异具有统计学意义(p0.05);B组Sirt1浓度治疗后第1天较治疗前下降,(p0.05),第3天较治疗前升高,(P0.05),第5天、7天较治疗前明显升高,与入科时差异具有统计学意义(p0.05)。但A组治疗后在第3、5、7天Sirt1浓度均高于于同期B组水平(p0.05)。A组TNF-α浓度治疗后第1天较治疗前明显升高(p0.05),治疗后第5天、7天较治疗前明显下降,与入科时差异具有统计学意义(p0.05);B组TNF-α浓度治疗后第1天较治疗前明显升高(p0.05),第5、7天较治疗前下降,与入科时差异具有统计学意义(p0.05)。但A组患者应用前列地尔治疗后在第1、3、5、7天TNF-α浓度均低于同期B组水平(p0.05)。结论:前列地尔能够促进脓毒症所致急性肝损伤患者肝功能恢复,减轻脓毒症时的炎症反应,减轻肝脏损伤,促进患者肝功能恢复。
[Abstract]:Objective: the purpose of this study is through the observation of alprostadil (ALPROSTADIL PGE1) in patients with liver function caused by acute liver injury on sepsis (alanine aminotransferase ALT and aspartate aminotransferase (AST), hepatic excretion function of total bilirubin direct bilirubin, STB, CB) APACHE score, serum TNF-, serum silence signal regulator 1 (Sirt1) expression level change and influence, and further research and discussion of alprostadil inflammation and liver function of patients with sepsis with acute liver injury. Methods: This study selected from December 2016 01 months -2016 years in the Second Affiliated Hospital of Dalian Medical University center ICU in 80 cases of acute liver injury in patients with sepsis the age distribution, at the age of 50-90, were randomly divided into PGE1 treatment group (group A, n=40) and standard anti sepsis treatment group (group B, n=40). All acute liver injury in patients with sepsis sepsis were selected by the Standard Specification for drugs against sepsis Sepsis treatment (sepsis3.0) and fluid resuscitation, A group based on PEG1 10ug (also be added 10ml saline) for 12 hours, 1 weeks of treatment; application of drugs respectively after the two groups were monitored before and after treatment 1,3,5,7 days in patients with serum alanine aminotransferase ALT aspartate AST STB, total bilirubin, direct bilirubin, CB, APACHE score, serum TNF-, serum silence signal regulating factor protein 1 (Sirt1). Statistical software package for the results of this study were analyzed by SPSS21.0 software. And the patients before and after treatment in group ALT, AST, STB, CB, APACHE score. Serum TNF-, serum silence signal regulating factor protein 1 (Sirt1) at each time point data using mean standard deviation, P0.05 said the difference was statistically significant. Results: the serum ALT of A group, the serum AST in first days after treatment compared with those before treatment, third days in patients with ALT, A ST杈冨墠涓嬮檷(P0.05),鎮ｈ，

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