[Clinical value of the early use of ulinastatin in patients with moderately severe or severe acute pancreatitis]

Objective: To observe the clinical efficacy and the effects on serum inflammatory factors of early use of ulinastatin in patients with moderately severe or severe acute pancreatitis (MSAP/SAP). Methods: This prospective, randomized, controlled trial was conducted in the First Affiliated Hospital of Soochow University from September 2013 to May 2016. A total of 42 cases were enrolled and assigned into either observation group or conventional treatment group (n=21 each). The conventional treatment group received somatostatin, while the observation group received somatostatin combined with ulinastatin. After treatment, clinical characteristics, serum indicators, clinical complications and serum level of inflammatory factors were analyzed. Results: Intra-abdominal pressure and relief time of abdominal pain were significantly decreased in observation group [ (10.4±2.1) cmH(2)O; (2.5±1.2) d ] compared with the conventional treatment group [ (11.7±2.2) cmH(2)O; (3.33± 1.2) d ], P<0.05. White blood cells (WBC) were lower in observation group than those in conventional treatment group [ (11.2±1.8) ×10(9)/L vs (12.5±2.3) ×10(9)/L; P<0.05 ]. After treatment serum levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-α(TNF-α) in observation group [ (30.5±3.3), (34.7± 6.5), (22.6±4.0) μg/L] were significantly lower than those in conventional treatment group [ (39.6±4.0), (40.9±3.4), (33.1±6.6) μg/L], P<0.05. There were no differences between the two groups in modified CT severity index (MCTSI), recovery time of defecation, ICU length of stay, serum amylase, C-reactive protein (CRP) and incidence rates of clinical complications. Conclusions: The early use of ulinastatin in the patients with MSAP/SAP can down-regulated the levels of TNF-α, IL-6 and IL-8, reduce the inflammatory response, decrease intra-abdominal pressure and shorten abdominal pain time. It was beneficial and worthy of wider popularization.