目的 探讨血液灌流(HP)联合血液透析滤过(HDF)对重症急性胰腺炎(SAP)患者血清Visfatin、Ghrelin表达的影响.方法 选取2015年6月～2017年6月就诊于东阳市中医院的88例SAP患者,按照随机数字表法分为对照组和观察组,每组各44例.其中对照组在常规治疗方法基础上加以HDF法,观察组则在常规疗法基础上采用HP联合HDF治疗,于入院时及入院第1天、第7天,第14天采集血清,比较两组患者生化指标及Visfatin、Ghrelin表达水平的差异,此外比较两组患者胃肠道功能恢复时间、腹痛缓解时间及撤离呼吸机时间.结果 入院时、入院第1天、入院第7天、入院第14天,两组患者的肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白介素-6(IL-6)水平及Visfatin、Ghrelin水平均逐渐降低,差异均有高度统计学意义(P＜0.01).入院第7天、入院第14天两组患者血清TNF-α、CRP、IL-6水平及Visfatin、Ghrelin水平与入院时及入院第1天比较,差异均有统计学意义(P＜ 0.05);入院第7天、入院第14天观察组TNF-α、CRP、IL-6水平及Visfatin、Ghrelin水平均低于对照组,差异均有统计学意义(P＜0.05).观察组胃肠道功能恢复时间、腹痛缓解时间及撤离呼吸机时间均明显短于对照组,差异均有高度统计学意义(P＜0.01).结论 HP联合HDF治疗SAP能有效缓解患者体内炎性反应,降低visfatin、Ghrelin表达水平,临床效果良好.%Objective To investagate the effect of hemoperfusion (HP) combined with hemodiafiltration (HDF) treatment on expression of serum Visfatin and Ghrelin in patients with severe acute pancreatitis (SAP).Methods From June 2015 to June 2017,88 patients with SAP in Dongyang Hospital of Traditional Chinese Medicine were selected,and divided into control group and observation group by random number table,with 44 cases in each group.The control group was treated with HDF method on the basis of conventional treatment,and the observation group was treated with HP combined with HDF method on the basis of conventional treatment.The serum was collected at admission,the first,seventh and fourteenth days of hospitalization.The biochemical parameters,Ghrelin,Visfatin levels between two groups were compared,and the gastrointestinal function recovery time,abdominal pain relief time and evacuation of ventilator time of two groups were compared.Results At admission,the first,seventh and fourteenth days of hospitalization,the tumor necrosis factor-or (TNF-α),C-reactive protein (CRP),interleukin-6 (IL-6),Visfatin and Ghrelin levels in both groups were all decreased gradually,the difference were highly statistically significant (P ＜ 0.01).The TNF-α,CRP,IL-6,Visfatin and Ghrelin levels of patients in both groups on the seventh and fourteenth days of hospitalization were compared with that at admission and the first days of hospitalization,the difference were statistically significant (P ＜ 0.05).The TNF-α,CRP,IL-6,Visfatin and Ghrelin levels in observation group on the seventh and fourteenth days of hospitalization were lower than those control group,the difference were statistically significant (P ＜ 0.05).The gastrointestinal function recovery time,abdominal pain relief time and evacuation of ventilator time in observation group were lower than those control group,the difference were highly statistically significant (P ＜ 0.01).Conclusion HP combined with HDF can effectively relieve the inflammatory response in patients and reduce the expression level of visfatin Ghrelin,and the clinical effect is good.
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