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Journal of Chinese Integrative Medicine ›› 2005, Vol. 3 ›› Issue (2): 103-107.doi: 10.3736/jcim20050206

Special Issue: Traditional Chinese Medicine

• Original Clinical Research • Previous Articles     Next Articles

Immuno-modulatory effect of somatostatin combined with traditional Chinese medicine on severe acute pancreatitis at early stage: A randomized control trial

Wen-fu Tang,Mei-hua Wan,Lin Zhu,Guang-yuan Chen,Qing Xia,Xi Huang   

  1. Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
  • Received:2005-01-16 Online:2005-03-20 Published:2005-03-20
  • Contact: Xi Huang E-mail:huangren@fmmu.edu.cn

Objective

To evaluate the immuno-modulatory effect of short course administration of somatostatin (stilamin) continuously at early stage in patients with severe acute pancreatitis (SAP).

Methods

Thirty-nine patients with SAP (22 men, 17 women; the middle age was 49 years)were randomly allocated into control group (20 patients treated with non-surgical integrated traditional Chinese and Western medicine) and treatment group (19 patients treated with somatostatin administered intravenously at a dosage of 250 μg/h for consecutive 72 hours as well as the treatment for the control group). Laboratory parameters, including the expressions of CD3, CD4 and CD8 in lymphocytes (tested by flow cytometry) and C reactive protein (CRP), and indexes of therapeutic effect, including the occurrence of organic dysfunction, local complication and mortality between the two groups were compared. Another group of 30 healthy volunteers (19 men, 11 women; the middle age was 47 years) were recruited for testing the normal levels of CD3, CD4 and CD8.

Results

(1) The levels of CD3, CD4 and CD4/CD8 in lymphocytes before treatment in both groups were significantly lower than those in the healthy subjects (P<0.05), but there were no statistical differences between the two groups. At the 4th day, CD3, CD4 and CD4/CD8 increased significantly in the treatment group (P< 0.05) while no changes in the control group; the levels of CD4 and CD4/CD8 in the treatment group were also higher than those in the control group (P< 0.05). (2) The CRP levels of the 2 groups showed no statistical difference before and 4 days after the treatment, but the CRP level in the treatment group was significantly lower than that in the control group at the 7th day (P< 0.05). WBC count, serum levels of amylase, lipase, lactate dehydrogenase, aspartate aminotransferase, as well as the score of APACHE II in the treatment group recovered more quickly than those in the control group (P<0.05). (3) The occurrences of organic dysfunctions, local complications and mortality in both groups were not statistically different.

Conclusion

The short course administration of somatostatin continuously at early stage can reduce the inflammatory response, up-regulate the cell immune function and improve the conditions of the patients with SAP, but its effect on mortality and morbidity needs further study.

Key words: Acute pancreatitis, Somatostatin, Immune modulation, Chaiqin Chenqi Decoction, Integrated Chinese-Western therapy

CLC Number: 

  • R576.1

Tab 1

General patient data of 2 groups (Cases)"

Group n Age (years) Gender Cause of disease Severity degree
Male Female Cholelithiasis Alcohol High-fat food Others
Treatment 19 48±16 10 9 11 3 3 2 13 6
Control 20 50±15 12 8 12 2 4 2 12 8

Tab 2

Changes of laboratory parameters in 2 groups ($\bar{x}$±s)"

Group n WBC
(109/L)
AST
(U/L)
LDH
(U/L)
Cr
(μmol/L)
Amylase
(U/L)
Lipase
(U/L)
CRP
(mg/L)
APACHE Ⅱ score
Control group
Before treatment 20 16.87±6.23 328±160 465±214 126±36 1 097±342 1 296±413 289±136 14.5±4.3
4 days after treatment 20 13.12±5.17 261±103 318±143 93±26 792±148 1 056±389 236±92 11.2±2.9
7 days after treatment 20 10.68±3.39 195±89 240±103 78±17 336±85 698±235 163±77 6.3±1.9
Treatment group
Before treatment 19 16.63±6.15 319±156 456±201 123±34 1 158±359 1 315±426 295±139 14.6±4.4
4 days after treatment 19 12.32±4.98 196±74* 211±97* 89±23 446±109* 840±255* 184±76 10.5±2.6
7 days after treatment 19 7.29±3.05* 102±81* 166±78* 80±19 125±39* 254±97* 109±43* 4.2±1.1*

Tab 3

Expression of cell markers of lymphocytes in 3 groups($\bar{x}$±s, %)"

Group n CD3 CD4 CD8 CD4/CD8
Healthy volunteers 30 60.50±11.36 28.03±6.14 32.47±7.90 0.91±0.28
Control group
Before treatment 20 43.05±17.89Δ 13.76±9.39Δ 31.05±10.24 0.41±0.19Δ
4 days after treatment 20 47.24±15.19Δ 14.25±8.34Δ 32.95±14.61 0.43±0.21Δ
Treatment group
Before treatment 19 40.23±21.37Δ 11.38±8.23Δ 28.91±17.12 0.42±0.21Δ
4 days after treatment 19 53.43±17.73* 19.19±7.71*Δ▲ 33.06±18.18 0.65±0.26*Δ▲

Tab 4

Clinical results of 2 groups (Cases)"

Group n ARDS Ileus Gastrointestinal
hemorrhage
Renal
dysfunction
Sepsis Pseudocyst Pancreatic
infection
Referred for
surgery
Death
Control group 20 4 5 1 2 2 3 0 0 3
Treatment group 19 3 4 2 2 3 1 1 1 0
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