Therapeutic effect of combined therapy with somatostatin and growth hormone for severe acute pancreatitis

Objective To evaluate the therapeutic effect of combined therapy with somatostatin and growth hormone in the treatment of severe acute pancreatitis(SAP).Methods Fifty-six SAP patients were randomized into two equal groups to receive somatostatin therapy or combined therapy with somatostatin and growth hormone. The changes in the plasma proteins,bacterial culture results,dual infection and CD4~+/CD8~+cell ratio were evalu- ated in the two groups after the treatments.Results Exclusive somatostatin treatment for 7 days did not result in significant changes in the plasm proteins([24.0±1.3]g/L before vs [26.0±1.5] g/L after therapy,P0.05), whereas combined therapy with somatostatin and growth hormone significantly increased the plasm proteins ([26.0±1.1]g/L vs [31.0±2.1] g/L,P0.05).Patients receiving exclusive somatostatin treatment had a bacterial culture positivity rate of 100%,which was significantly higher than that of the combined therapy group (60.7%,P0.05),and examination of the abdominal drains was more likely to produce positive results,with coliform bacillus and Bacillus proteus as the most eommon cause of infections.Dual infection occurred in 57.1%(14/28) of the patients with somatostatin treatment,similar to the incidence in the patients with combined therapy (50.0%[14/28],P0.05);but in the latter group,only 9 of the 14 patients were positive for fungal infection presented with clinical manifestations or signs,as compared with the former group in which all the 16 fungal infection- positive patients had clinical manifestations of varying severities.The CD4~+/CD8~+cell ratio tended to increase after the treatment in combined therapy group,but within the range comparable to that in somatostatin group(P0.05). Conclusion Somatostatin treatment combined with growth hormone may lower the risk of baeterial infeetions, reduce intestinal bacterial translocation,promote protein synthesis capacity,and protect the integrity of the intesti nal mucosal barrier in patients with SAP.(Shanghai Med J,2008,31:107-109)