摘要
目的探讨Ⅲ型前胶原肽（PⅢP）在大黄为主中药组方序贯治疗急性百草枯中毒（APP）患者的变化及临床意义。方法选择哈励逊国际和平医院2013年3月至2016年12月收治的轻-中度APP患者104例，按随机数字法将患者分为A组（血液灌流组）30例、B组（大黄为主中药组方联合血液灌流组）34例及C组（大黄为主中药组方联合持续血液灌流组）40例。3组患者均在治疗前及治疗后3 d和7 d，检测肿瘤坏死因子-α（TNF-α）、白介素-18（IL-18）、丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-PX）活性及序贯器官功能衰竭评分（SOFA）的变化，于治疗前及治疗后3、7、10、14 d检测PⅢP水平；同时观察患者治疗前、治疗后7 d及14 d肺部CT的变化，采用Pearson相关检验分析APP患者血PⅢP水平与百草枯浓度的相关性，采用χ^2检验比较28 d病死率情况。结果治疗前3组患者TNF-α、IL-18、MDA、PⅢP、SOD、GSH-PX活性和SOFA评分比较，差异无统计学意义（P＞0.05）。治疗后3 d，3组患者TNF-α、IL-18、MDA水平和SOFA评分较治疗前升高，A组升高明显，SOD、GSH-PX活性均降低，A组降低显著，差异有统计学意义（P＜0.05）；治疗后7 d，3组患者TNF-α、IL-18、MDA水平和SOFA评分较治疗后3 d降低，C组降低显著，SOD和GSH-PX活性升高，C组升高显著，差异有统计学意义（P＜0.05）。治疗后3、7、10、14 d，3组患者PⅢP水平逐渐升高，C组升高缓慢，各组间比较差异有统计学意义（P＜0.05）。治疗后7 d，C组患者肺部CT表现以磨玻璃样改变为主；治疗后14 d，C组患者以两侧肺野出现小片状渗出性改变和胸膜下的不规则线影为主，其比例高于A、B组，而A、B组大多数患者已出现肺间质病变，其比例均高于C组，且A组高于B组，各组间比较差异有统计学意义（P＜0.05）。APP患者血中PⅢP水平与百草枯浓度呈正相关（r=0.310，P=0.001）；3组患者病死率分别为53.33%、44.12%和25.00%，差异有统计学意义（P＜0.05）。结论大黄为主中药组方联合持续血液灌流对APP患者的疗效显著，能降低PⅢP、TNF-α、IL-18和MDA水平，提高SOD和GSH-PX活性，减轻患者肺纤维化程度，有效降低患者病死率。PⅢP为APP患者肺纤维化的评价指标，为指导APP患的者治疗提供有意义的临床价值。
Objective To investigate the clinical value of type Ⅲ procollagen peptide （P Ⅲ P） in sequential treatment with Rheum officinale Ball. as a main agent in a traditional Chinese medicine recipe in patients with acute paraquat poisoning （APP）. Methods A total of 104 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from March 2013 to December 2016 were divied into three groups ： A group （ n = 30, routine therapeutic agents coupled with a single hemoperfusion） , B group （n = 34, treated by Rheum officinale Ball. as a main agent in a traditional Chinese medicine recipe coupled with a single hemoperfusion）, C group （n =40, treated by Rheum officinale Ball. as a predominant agent in a traditional Chinese medicine recipe and sequential continuous hemoperfusion）. Before and 3 days and 7 days after treatment, tumor necrosis factor ct （TNF-α）, interleukin-18 （IL-18）, maleic dialdehyde （MDA）, superoxide dismutase （SOD） and glutathione peroxidase （GSH-PX） of patients were detected, and the change of sequential organ failure assessment （SOFA） scores were observed. Before and 3 days, 7 days, 10 days and 14 days after treatment, ProP were detected, and the changes of lung CT in three groups were observed before and 7 days, 14 days after treatment. Pearson correlation test was used to analyze the correlation between P Ⅲ P in patients with APP and the concentration of paraquat, and the outcomes in 28 days were compared with ehi square test. Results At admission, there were no differences in the levels of plasma TNF-α, IL-18, MDA, PⅢP, SOD, GSH- PX and SOFA scores among three groups （P 〉 0.05）. At 3 days after treatment, the levels of plasma TNF- ct, IL-18, MDA and SOFA scores were elevated in three groups compared with those at admission, especially in group A were increased significantly, whereas the activity of plasma SOD and GSH-PX were decreased in thress groups, especially in group A decreased most significantly （ P 〈 0. 05 ）. At 7 days after treatment, the levels of plasma TNF-α, IL-18, MDA and SOFA scores were lower than those at 3 days after treatment in three groups especially those in group C decreased most significantly （ P 〈 0. 05 ）, whereas the activities of plasma SOD and GSH-PX were higher than those at 3 days after treatment especially in group C decreased most significantly （P 〈0.05）. At 3 days, 7 days, 10 days, 14 days after treatment, the level of P Ⅲ P were increased gradually in three groups, especially in group C increased most slowly with statistically significant difference between the groups （ P 〈 0.05 ）. At admission, there were no statistically significant difference in the features of lung CT among three groups （ P 〉 0. 05 ）. At 7 days after treatment, lung CT mainly manifested ground glass lesions in C group. At 14 days after treatment, lung CT mainly manifested small size of the exudative changes and the irregular line of pleura in C group with higher proportion of those changes than that in A, B group, while pulmonary interstitial changes were found in the lung CT of A and B groups with higher proportion of these changes than that in C group, and those A group was higher than those in B group （P 〈 0. 05 ）. The level of serum P HI P in patients with APP was positively correlated with the concentration of paraquat （ r = 0. 310, P = 0. 001 ）. The mortality rate of three groups were 53.33% , 44. 12% and 25.00%, respectively, with significant difference among three groups （P 〈 0.05 ）. Conclusion The clinically therapeutic effect of sequential treatment with Rheum officinale Ball. as a main agent in a traditional Chinese .medicine in patients with APP was distinct. It could decrease the levels of PⅢP, TNF-α, IL-18 and MDA, enhance the expression of SOD and GSH-PX, reduce pulmonary fibrosis in patients and the mortality rate of patients. The P Ⅲ P is the evaluation index of pulmonary fibrosis and can provide useful clinical value for the treatment of patients with APP.
作者
王维展
齐洪娜
肖青勉
高珣
朱保月
李伟
刘永建
李敬
王璞
Wang Weizhan Qi Hongna Xiao Qingmian C.ao Xun Zhu Baoyue Li Wei Liu Yongjian Li Jing Wang Pu(Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, Chin)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2017年第11期1240-1246,共7页
Chinese Journal of Emergency Medicine
基金
河北省科技计划项目（162777109D）
关键词
急性百草枯中毒
Ⅲ型前胶原肽
中药
血液灌流
肺纤维化
氧化应激
Acute paraquat poisoning
Type Ⅲ procollagen peptide
Traditional Chinese medicine
Hemoperfusion
Pulmonary fibrosis
Oxidative stress
