Effect of ulinastatin on the inflammatory response after video-assisted thoracic lobectomy in patients with lung cancer: a randomized controlled study

Abstract

Background:The first-line treatment for lung cancer is surgical resection, and one-lung ventilation (OLV) is the most basic anesthetic management method in lung surgery. During OLV, inflammatory cytokines are released in response to the lung tissue damage and promote local and contralateral lung damage through the systemic circulation. We designed a randomized, prospective study to evaluate the effect of the urinary trypsin inhibitor (UTI) ulinastatin on the inflammatory response after video-assisted thoracic lobectomy in patients with lung cancer.Methods:Adult patients aged 19 to 70 years, who were scheduled for video-assisted thoracic lobectomy surgery to treat lung cancer between May 2020 and August 2020, were enrolled in this randomized, prospective study. UTI (300,000 units) mixed with 100 mL of normal saline in the ulinastatin group and 100 mL of normal saline in the control group was administered over 1 h after inducing anesthesia.Results:The baseline (T0) interferon-γ (IFN-γ)/interleukin-4 (IL-4) ratio was not different between the groups (6941.3 ± 2778.7 vs. 6954.3 ± 2752.4 pg/mL, respectively; P > 0.05). The IFN-γ/IL-4 ratio was significantly higher in ulinastatin group at 30 min after entering the recovery room than control group (20,148.2 ± 5054.3 vs. 6674.0 ± 2963.6, respectively; adjusted P < 0.017).Conclusion:Administering UTI attenuated the anti-inflammatory response, in terms of INF-γ expression and the IFN-γ/IL-4 ratio, after video-assisted thoracic surgery in lung cancer patients.Trial registration:Clinical Research Information Service of Korea National Institute of Health (CRIS), KCT0005533.

Clinical efficacy of ulinastatin in the treatment of unliquefied pyogenic liver abscess complicated by septic shock: A randomized controlled trial

“…UTI is a glycoprotein purified from healthy human urine 30 , 31 , 32 , 33 , 37 that inhibits the activity of protein hydrolases and consists of 143 amino acids with a relative molecular mass of approximately 67,000. UTI inhibits inflammatory responses and modulate immune function.…”

“…Studies have shown 29 , 30 , 31 that UTI effectively modulates inflammatory factor release, reduces endotoxic responses, and improves ischemia‐reperfusion injury of the microcirculation in the treatment of infectious diseases, such as severe pneumonia, severe pancreatitis, and sepsis, thereby reducing clinical morbidity and mortality, and is widely used in clinical practice in China, Korea, and Japan. 30 , 31 , 32 , 33 There are few reports involving UTI in the treatment of unliquefied PLA. This study aimed to retrospectively analyze the effectiveness of UTI in treating UPLA‐SS and provide a foundation for clinical application.…”

“…It has been shown 27,28 that UTI can reduce the level of inflammatory mediators, protect mitochondria, scavenge oxygen‐free radicals and antiapoptotic cells in the endotoxic response by reducing the activation of p38MAPK. Studies have shown 29–31 that UTI effectively modulates inflammatory factor release, reduces endotoxic responses, and improves ischemia‐reperfusion injury of the microcirculation in the treatment of infectious diseases, such as severe pneumonia, severe pancreatitis, and sepsis, thereby reducing clinical morbidity and mortality, and is widely used in clinical practice in China, Korea, and Japan 30–33 . There are few reports involving UTI in the treatment of unliquefied PLA.…”