Protective Effect Of Ulinastatin To Intestinal Barrier Function Of Elderly Septic Patients

Sepsis is a systemic inflammatory response syndrome or SIRS caused by infection now becoming one of the most common causes of death among critically ill patients. It is a common complication of severe infection, burns, trauma, shock and surgery, which can further develop to septic shock, Multiple Organ Dysfunction Syndrome(MODS). As the most vulnerable and most commonly affected organ during sepsis, gastrointestinal tract have a close relationship with the occurrence and development of sepsis. gastrointestinal tract is not only a organ of digestion and absorption, but also an organ with functions of immune, endocrine and barrier function.Complete gastrointestinal tract can prevent microbes and toxic products from entering the body,providing barrier protection for human body. The constituent parts of intestinal barrier are immunologic barrier. mechanical barrier, chemical barrier and biological barrier. Elderly patients with sepsis are not only with the characters of easy ischemic subject by anatomy structure, but also already degraded, plus the factors of senility, low immunity and often accompanied by a variety of underlying diseases. Therefore intestinal barrier function of elderly patients with sepsis is more susceptible to injury.Ulinastatin(UTI) is a kind of glycoprotein extracted from human urine, and it’s a broad spectrum protease inhibitor. The physicochemical roles of UTI mainly includes following three aspects: inhibition of hydrolysis enzyme of protein, carbohydrate and lipid; stable membrane structure, inhibit excessive release of inflammatory mediators; and improve microcirculation and tissue perfusion. Consequently, UTI’s clinical application is very broad, such as acute pancreatitis, acute circulatory failure, acute lung injury, severe infection, burns and large surgery, moreover, it could block the development of these deseases to SIRS or MODS. Compare the protection measures of intestinal barrier function and UTI’s pharmacological effects, we infer that UTI could may have some effect on intestinal mucosal barrier function coping with damage caused by sepsis.In our study, we choose elderly patients with sepsis as study object, to observe the protective effect of UTI to intestinal barrier function of elderly patients with sepsis by monitoring changes of indicators of inflammatory and intestinal barrier. At the same time we alsorecorde the patients’ APACHE II scores, length of ICU stay and 28 d mortality to further discuss UTI’s effect on prognosis, provide the basis for the application of clinical.Objective(1) To obtain the clinical evidence of UTI in terms of improving outcomes, reducing inflammatory markers and intestinal barrier protection on elderly patients with sepsis.(2) UTI confirmed by reducing the release of inflammatory mediators, reduce intestinal bacterial translocation and other aspects of the intestinal barrier function play a protective role(3) To investigate optimization program of early treatment about elderly patients with sepsis,and provide evidence for clinical practice.MethodsSelect the elderly patients with sepsis admitted to our ICU from March 2014 to March 2015(Age ≥ 60, the diagnostic criteria of sepsis reference to criteria developed by Surviving Sepsis Campaign:International Guidelines for Management of Severe Sepsis and Septic Shock: 2012). All patients randomly divided into basic treatment group(n=34) and UTI treatment group(n=34). Peripheral blood of elderly patients with sepsis were routinely collected at days 0, 2, 3, 7(D0, D2, D3, D7) after admission, respectively using enzyme-linked immunosorbent assay and enzymatic spectrophotometer method to detect the levels of IFABP,DAO and D-lactate. While patients’ APACHE II scores, length of ICU stay and 28 d mortality should also be recorded at the same time.Results(1) At admission, the patients’ APACHE II scores, plasma values of PCT, TNF-α, IFABP,DAO and D-Lac were similar in both groups(P>0.05).(2) During treatment, the patients’ APACHE II scores, plasma values of PCT, TNF- α,IFABP, DAO and D-Lac were declining in both groups, while the UTI group showed a significantly decline. Comparied with conventional therapy group, the APACHE II scores,plasma values of TNF-α and IFABP were always significantly lower in UTI group(P<0.05),the plasma values of PCT, DAO and D-Lac were significantly lower at D2 and D3(P<0.05), butnot at D7(P>0.05).(3) At all time points, there were significant positive correlations between plasma values of IFABP, DAO and D-Lac(P<0.01). And the the plasma levels of IFABP, DAO and D-Lac were also positively associated with APACHE II scores, plasma values of PCT, TNF-α(P<0.01), but not with length of ICU-stay(P>0.05).(4) After treatment, 28 d mortality did not differ significantly between the two groups(P>0.05).Conclusions(1) UTI can improve the prognosis of elderly patients with sepsis and reduce ICU stay,while has no significant effect on reducing 28 d mortality.(2) UTI can reduce inflammatory response in elderly patients with sepsis.(3) UTI has a protective effect on intestinal barrier function in elderly patients with sepsis.