Clinical observational study on the efficacy of neutrophil elastase inhibitor in the treatment of sepsis-associated acute respiratory distress syndrome at high altitude areas

Liu Xiaoqin; Ma Qixia; Guo Litao; Shi Shenghui; Sun Bin; Xu Xuexia

doi:10.3760/j.issn.1673-4777.2026.05.008

Abstract：Objective To evaluate the therapeutic effect of sivelestat sodium,a neutrophil elastase(NE)inhibitor,on sepsis-associated acute respiratory distress syndrome(ARDS)at high altitude areas.Methods A total of 56 patients with sepsis-associated ARDS at high altitudes admitted to the Department of Critical Care Medicine,Qinghai Provincial People's Hospital from August 2023 to August 2024 were enrolled and randomly divided into observation group(27 cases)and control group(29 cases)by random number table method.Both groups received standard ARDS treatment as needed,and the observation group was additionally treated with sivelestat sodium on the basis of standard treatment.Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,sequential organ failure assessment(SOFA)score,oxygenation index,procalcitonin,interleukin-6(IL-6),white blood cell count,high-sensitivity C-reactive protein(hs-CRP)levels on day 1 and day 7 after admission were compared between the two groups.NE level was detected by enzyme-linked immunosorbent assay.Results There were no significant differences in APACHE Ⅱ and SOFA scores between the two groups on day 1(both P＞0.05).On day 7,APACHE Ⅱ and SOFA scores in both groups were lower than those on day 1,and SOFA score in the observation group was lower than that in the control group(all P＜0.05).There was no signifi-cant difference in oxygenation index between the observation group and the control group on day 1[130(107,174)vs 159(113,190)](Z=-1.369,P=0.171).Onday7,oxygenation index in both groups were higher than those on day 1(both P＜0.001),and that in the observation group was higher than that in the control group[286(240,316)vs 230(197,264)](Z=-3.281,P＜0.001).On day 1,there were no significant differences in white blood cell count,procalcitonin,IL-6 and hs-CRP levels between the two groups(all P＞0.05).On day 7,the above indicators in both groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).On day 1,there was no significant difference in NE level between the observation group and the control group[(56±4)μg/L vs(56±5)μg/L](t=-0.364,P=0.717).On day 7,NE levels in both groups were lower than those on day 1(both P＜0.05),and that in the observation group was lower than that in the control group[(48±4)μg/L vs(54±5)μg/L](t=4.620,P＜0.001).Conclusion Sivelestat sodium can significantly improve oxygenation index,alleviate organ injury and inhibit excessive inflammatory response in patients with sepsis-associated ARDS at high altitudes.