Protective Effect Of Somatostatin To Intestinal Barrier Function Of Elderly Sepsis Patients

Sepsis is a serious and life-threatening disease,characterized by high incidence,high mortality and high treatment costs,now becoming one of the most leading causes of death among critically ill patients in ICU,which posed a great threat to human healt.Intestinal mucosal barrier includes immune barrier and nonimmune barrier barrier(mechanical barrier,chemical barrier,bacterial barrier).Complete intestinal mucosal barrier not only can monitor,isolate bacteria,and maintain the dynamic balance of bacterial flora,but also can prevent bacteria and toxic entering the body,providing barrier protection for human body.On the one hand,Sepsis can lead to intestinal mucosal barrier dysfunction or damage,On the other hand,intestinal mucosal barrier dysfunction may also induce or aggravate sepsis,which can lead to multiple organ dysfunction and organ failure.Elderly patients with sepsis are not only with the characters of advanced age,low immunity,intestinal function already degraded,but also often accompanied by a variety of underlying diseases.Therefore,intestinal mucosal barrier function is more susceptible to damage in elderly patients with sepsis.However,there are few clinical studies on the elderly patients with sepsis,especially those with intestinal barrier dysfunction.At present,laboratory examination of the intestinal mucosal barrier function are mainly concentrated on ischemia,injury,intestinal mucosa permeability and pathological examination,etc.A large number of basic studies have confirmed that the ideal diagnostic indexes of intestinal barrier function are plasma bacterial endotoxin(BT),plasma diamine oxidase(DAO)and plasma D-lactate(D-lac).BT is a component of lipopolysaccharide in the cell wall of gram negative bacteria,under normal circumstances,there are a lot of bacteria and endotoxin in digestive tract and only a small amount of endotoxin is absorbed into the blood.DAO is an intracellular oxidase and widely found in the intestinal villus epithelial cells,It is a useful index to reflect the damage of intestinal mucosa and has a high sensitivity and specificity.When the pathogenic factor causes intestinal mucosal epithelial damage,DAO is released into the blood,and the content and activity is increased.D-lactate is a index reflection of the intestinal mucosa damage and permeability,under normal circumstances gastrointestinal tract contains a large number of different types of bacteria,which restrict each other.When immune function decreased,the intestinal mucosal injury,application of broad-spectrum antibiotics,It can cause intestinal dysbacteriosis,opportunistic bacterial overgrowth and bacterial translocated.A large number of bacterial metabolites D-Lac through the damaged intestinal mucosa into the blood circulation.Therefore,the damage and permeability of intestinal mucosal barrier can be detected by detecting the levels of BT,DAO and D-lac in blood,respectively.Somatostatin(SST),a kind of neuroendocrine peptides,was widely used in acutepancreatitis,portal hypertension,and endocrine system diseases etc.Somatostatin is widely distributed in the human body.Besides the effects of inhibitory of pancreatic enzyme secretion and intestinal fluid secretion,relaxation of the sphincter of Oddi functions,more and more studies showed that somatostatin could inhibit inflammatory reaction,decrease endotoxin level,inhibit oxidative damage,cell protection and immunoregulation etc.The intestinal mucosa is the largest target organ of SST.Combined with the pharmacological effects and many animal experimental results of somatostatin,It can be seen that somatostatin may play a certain role in the protect on the intestinal mucosal barrier injury caused by sepsis,but there is still in lack of support of clinical evidence.In our study,we choose elderly patients with sepsis as study object,through dynamic monitoring of PCT,BT,DAO,D-lac and other inflammatory and intestinal barrier index,to evaluate the early protective role of SST to intestinal barrier function of selected critically elderly patients.At the same time,the study also recorded the patient's APACHE II score length of ICU stay and 28 d mortality.To provide SST 's clinical evidence for the prevention and treatment of intestinal barrier dysfunction in elderly patients with sepsis.?Objective?(1)To obtain the clinical evidence of SST can reduce inflammatory indexs,protect intestinal mucosal barrier,and improve clinical outcomes on elderly patients with sepsis.(2)To confirm protective effect of SST by reducing inflammatory reaction,immune regulation,antioxidation and reducing bacterial translocation and other aspects.(3)To provide investigate optimization program of early treatment about elderly patients with sepsis evidence for clinical practice.?Methods?Select the elderly patients with sepsis admitted to our ICU from April 2016 to January 2017(Age>60),To satisfy the criteria for the diagnosis of sepsis,based on the criteria for the international guidelines for the treatment of sepsis and septic shock in 2016.According to the diagnosis and exclusion criteria,The patients were randomly categorized in basic treatment group(n=22)and SST treatment group(n=22).Blood samples of elderly patients with sepsis were obtained for detection of PCT,BT,DAO,D-lac levels at days 0,1,2,3,7(D0,D1,D2,D3,D7)after admission,respectively using colloidal gold immunochromatography and enzyme method to detect the levels of PCT,BT,DAO and Dlactate.While Two groups patients' APACHE II dynamic scores,length of ICU stay and 28 d mortality were also be recorded at the same time.?Results?(1)At admission,the patients' demographics and clinical characteristics: APACHE II scores,plasma values of PCT,BT,DAO and D-Lac were similar in both groups(P>0.05).(2)During treatment,the patients' APACHE II scores,plasma values of PCT,BT,DAO and D-Lac were declining in both groups,while the SST group showed a significantly decrease.Comparied with conventional therapy group,the APACHE II scores on D3,D7,PCT,DAO on D3,D7 day,BT on D1,D2,and D-lac on D3 were significantly lower in SST group(P<0.05).But the levels of PCT,BT,DAO and D-Lac were no significant differences on D7(P>0.05).(3)At all time points,there were significant positive correlations between plasma values of BT,DAO and D-Lac(P<0.05).And the the plasma levels of BT,DAO and DLac were also positively associated with APACHE II scores,plasma values of PCT,(P<0.05),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).?Conclusion?(1)SST can improve the prognosis of elderly patients with sepsis and reduce ICU stay,while has no significant effect on reducing 28 d mortality.(2)SST can reduce inflammatory response,immunoreaction and bacterial translocated in elderly patients with sepsis.(3)SST can play a certain protective role in intestinal barrier function in elderly patients with sepsis.