摘要
目的:探讨解毒祛瘀法治疗脓毒症毒热内盛证的疗效及对促炎因子和血管内皮细胞功能的影响。方法:纳入脓毒症毒热内盛证患者60例,随机分为治疗组和对照组,每组各30例。治疗组患者在西医常规治疗基础上加用解毒祛瘀中药,对照组患者在西医常规治疗基础上加用安慰剂,两组治疗疗程均为10 d。观察两组的临床疗效,比较两组患者的中医证候评分、急性生理学及慢性健康状况评分系统(APACHEⅡ)评分、感染相关器官功能衰竭评分系统(SOFA)评分,检测两组患者的白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、可溶性血管内皮细胞蛋白C受体(sEPCR)及血栓调节蛋白(TM)的水平。结果:①治疗后,治疗组的临床总有效率为86.67%,对照组的临床总有效率为73.33%,治疗组的疗效优于对照组(P<0.01)。②治疗后,治疗组患者的中医证候评分、APACHEⅡ评分、SOFA评分均较治疗前显著降低(P<0.01),对照组患者的中医证候评分、APACHEⅡ评分亦显著降低(P<0.01),且治疗组患者的中医证候评分明显低于对照组(P<0.01)。③治疗后,两组患者的IL-6、TNF-α水平较治疗前均明显降低(P<0.01),且治疗组患者的TNF-α水平明显低于对照组(P<0.01);治疗组IL-6、TNF-α治疗前后的差值明显高于对照组(P<0.05)。④治疗后,治疗组患者的TM水平较治疗前明显降低(P<0.05),且治疗组患者的sEPCR、TM治疗前后差值亦明显高于对照组(P<0.05)。结论:解毒祛瘀法可提高脓毒症患者的临床疗效,改善其中医证候,减少促炎因子的释放,其作用机制可能与改善患者的血管内皮细胞功能有关。
Objective: To explore the efficacy of therapy of removing toxin and resolving stasis in treating sepsis patients with syndrome of internal toxin-heat exuberance and its influence on the proinflammatory cytokines and the function of vascular endothelial cells. Methods: Sixty sepsis patients with syndrome of internal toxin-heat exuberance were selected and randomly divided into the treatment group and control group, 30 cases in each group. The patients in the treatment group were treated with conventional western medicine combined with Chinese medicine of removing toxin and resolving stasis, and the patients in the control group were treated with conventional western medicine combined with placebo, with a course of 10 days. The clinical efficacy was observed, the scores of Chinese medical syndrome, acute physiology and chronic health evaluation system(APACHEⅡ) and sepsis-related organ failure assessment(SOFA) were compared in both groups, and the levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), soluble vascular endothelial cell protein C receptor(sEPCR) and thrombomodulin(TM) were detected. Results:①After treatment, the total effective rate of the treatment group was 86.67% and that of the control group was 73.33%. The therapeutic effect of the treatment group was better than that of the control group(P<0.01).②After treatment, the scores of Chinese medical syndrome, APACHEⅡ and SOFA in the treatment group were significantly decreased compared with before treatment(P<0.01), the scores of Chinese medical syndrome and APACHEⅡ in the control group were also significantly decreased(P<0.01), and the score of Chinese medical syndrome in the treatment group was lower than that in the control group(P<0.01).③After treatment, the levels of IL-6 and TNF-α in both groups were obviously decreased compared with before treatment(P<0.01), and the level of TNF-α in the treatment group was lower than that in the control group(P<0.01);the D-value between before and after treatment on the levels of IL-6 and TNF-α in the treatment group were higher than those in the control group(P<0.05).④After treatment, the level of TM in the treatment group was markedly decreased compared with before treatment(P<0.05), and the D-value between before and after treatment on the levels of sEPCR and TM in the treatment group were higher than those in the control group(P<0.05). Conclusion: Therapy of removing toxin and resolving stasis can enhance the clinical efficacy in treating patients with sepsis, improve the Chinese medical syndrome and reduce the release of proinflammatory cytokines, and its mechanisms may be related to improvement on the function of vascular endothelial cells.
作者
陈莉云
李淑芳
计高荣
CHEN Liyun;LI Shufang;JI Gaorong(Department of Emergency and 1 nfection, Shuguang Hospital Affilicated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021 , China)
出处
《上海中医药大学学报》
CAS
2019年第3期24-28,共5页
Academic Journal of Shanghai University of Traditional Chinese Medicine
基金
上海市科委科研基金资助项目(13401904500)
关键词
解毒祛瘀法
脓毒症
促炎因子
血管内皮细胞功能
therapy of removing toxin and resolving stasis
sepsis
proinflammatory cytokine
vascular endothelial cell function
