乌司他丁对脓毒症患者肝脏及凝血功能的影响

Effect of ulinastatin on liver and coagulation functions in patients with sepsis

摘要

目的 探讨乌司他丁能否改善脓毒症患者的肝脏功能及凝血功能。方法 回顾性分析2013年6月1日至2022年2月28日西安交通大学第一附属医院ICU收治的266例脓毒症患者的临床资料,将患者分为乌司他丁组和对照组,对患者的基线资料进行比较,通过单因素和多因素Logistic回归进行预后分析。通过倾向性评分匹配消除基线资料差异后再次比较结局指标。结果 共纳入266例患者,其中使用乌司他丁组186例,对照组80例。多因素Logistic回归分析显示,乌司他丁是肝功能改善(OR=4.022,P=0.002)、SIC评分减轻(OR=2.657,P=0.007)的保护因素,特别是非肝炎脓毒症患者的肝功能改善(OR=4.412,P=0.008)、SIC评分减轻(OR=3.006,P=0.015)的保护因素,能降低院内死亡风险(OR=0.370,P=0.043)；经倾向性评分成功匹配65对患者,Logistic回归分析明确乌司他丁利于肝功能改善(OR=2.444,P=0.041)。结论 使用乌司他丁可改善非肝炎背景的脓毒症患者肝脏及凝血功能,降低院内死亡风险。

Abstract

Objective To investigate whether ulinastatin can improve liver function and coagulation function in patients with sepsis. Methods The clinical data of 266 patients with sepsis admitted to ICU of The First Affiliated Hospital of Xi'an Jiaotong University from June 1, 2013 to February 28, 2022 were retrospectively analyzed. The patients were divided into two groups: ulinastatin group and control group, and their baseline data were compared. Prognostic analysis was conducted using univariate and multivariate Logistic regression, and outcome measures were recompared after propensity score matching was applied to eliminate baseline differences. Results This study enrolled 266 patients, comprising 186 treated with ulinastatin and 80 controls. Multivariate Logistic regression analysis demonstrated that ulinastatin was an independent protective factor associated with improved liver function (OR=4.022, P=0.002) and a reduction in the SIC score (OR=2.657, P=0.007). This protective effect was particularly evident in the subgroup of non-hepatitis sepsis patients, showing benefits for liver function improvement (OR=4.412, P=0.008), SIC score reduction (OR=3.006, P=0.015), and a lower risk of in-hospital mortality (OR=0.370, P=0.043). Following successful propensity score matching (65 pairs), Logistic regression confirmed that ulinastatin favored liver function improvement (OR=2.444, P=0.041). Conclusion Ulinastatin confers benefits to septic patients without underlying hepatitis, including improved liver and coagulation function, as well as a reduced risk of in-hospital mortality.

关键词

乌司他丁 / 脓毒症 / 肝脏功能 / 凝血

Key words

ulinastatin / sepsis / liver function / coagulation

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基金资助

国家自然科学基金资助项目(82472191)

陕西省重点研发计划项目(2021GXLH-Z-099)