摘要
目的:观察加味大承气汤治疗湿热蕴结型高脂血症性急性胰腺炎的疗效,探讨作用机制。方法:将贵州中医药大学第一附属医院收治的110例湿热蕴结型高脂血症性急性胰腺炎患者随机分为对照组和观察组,各55例,两组患者均给予低分子肝素钙、胰岛素及前列地尔注射液等常规治疗。对照组在常规治疗基础上给予化滞柔肝颗粒;观察组在常规治疗基础上给予加味大承气汤治疗。治疗7 d,比较两组患者的临床疗效、中医证候评分、胃肠功能恢复情况、急性胰腺炎床旁指数(BISAP)评分、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、炎性因子[肿瘤坏死因子(TNF)-α,白细胞介素-6(IL-6),C反应蛋白(CRP)]水平,氧化应激[丙二醛(MDA),氧化型谷胱甘肽(GSSG),总抗氧化能力(T-AOC)]指标水平,总胆固醇(TC),甘油三酯(TG),高、低密度脂蛋白胆固醇(HDL-C,LDL-C)血脂指标,安全性评价。结果:观察组临床疗效明显优于对照组(Z=3.353,P<0.05),且总有效率52/55(94.55%)高于对照组的41/55(74.55%)(χ^(2)=8.419,P<0.01);与本组治疗前比较,治疗后两组患者腹痛、大便不通、胸闷、发热评分均明显降低,且观察组腹痛、大便不通、胸闷、发热评分低于对照组(P<0.05);观察组的胃管留置时间、排气时间、排便时间和肠鸣音恢复时间低于对照组(P<0.05)。与本组治疗前比较,治疗后两组患者BISAP,APACHEⅡ评分均明显降低,且观察组BISAP,APACHEⅡ评分低于对照组(P<0.05)。与本组治疗前比较,治疗后两组患者血清TNF-α,IL-6和CRP水平均明显降低,且观察组血清TNF-α,IL-6和CRP水平低于对照组(P<0.05)。与本组治疗前比较,治疗后两组患者血清MDA,GSSG水平均明显降低,T-AOC明显升高,且观察组血清MDA,GSSG水平低于对照组,T-AOC水平高于对照组(P<0.05)。治疗后观察两组TC,TG,LDL-C水平降低,HDL-C水平升高,且TC,TG,LDL-C水平低于对照组,HDL-C水平高于对照组(P<0.05)。结论:加味大承气汤治疗湿热蕴结型高脂血症性急性胰腺炎临床疗效确切,可改善中医证候和患者症状,降低炎性因子,抑制机体氧化应激,改善血脂水平,且具有较好的安全性,值得临床推广应用。
Objective: To explore the efficacy and mechanism of modified Da Chengqitang in treating hyperlipidemic acute pancreatitis(HLAP)with damp heat accumulation syndrome. Method: A total of 110 patients with HLAP with damp heat accumulation syndrome treated at our hospital were randomly divided into control group and observation group,with 55 cases in each group,both groups were treated with low molecular weight heparin calcium,insulin and alprostadil injection. Control group was given Huazhironggan granules in addition to the basic therapy,while observation group was given modified Da Chengqitang in addition to the basic therapy. After 7 days, the clinical efficacy, traditional Chinese medicine(TCM)syndrome score,gastrointestinal function recovery,acute pancreatitis bedside index(BISAP),acute physiology and chronic health status Ⅱ(APACHE Ⅱ),inflammatory factors,such as tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP),oxidative stress,such as malondialdehyde(MDA),oxidized glutathione(GSSG),total antioxidant capacity(T-AOC),total cholesterol(TC),triglyceride(TG),high and low density lipoprotein(HDL-C,LDL-C)blood lipid indicators and safety were evaluated. Result: The clinical efficacy of observation group was significantly better than that of control group(Z=3.353,P<0.05),and the total effective rate of observation group was 94.55%,which was higher than 74.55% of control group(χ^(2)=8.419,P<0.01).After treatment,the scores of abdominal pain,stool obstruction,chest tightness and fever in observation group were significantly lower than those of control group(P<0.05). The gastric tube indwelling exhaust time,defecation time and recovery time of bowel sounds in observation group were significantly lower than those of control group(P<0.05). The scores of BISAP and APACHE Ⅱ in two groups were significantly decreased,and the BISAP and APACHE Ⅱ scores of observation group were lower than control group(P<0.05). After treatment,the serum levels of TNF-α,IL-6 and CRP in observation group were significantly lower than those in control group. The levels of serum MDA,GSSG in two groups were significantly decreased,whereas the T-AOC level was significantly increased;and the level of serum MDA,GSSG observation group was lower than control group,while the T-AOC level was higher than control group(P<0.05). After treatment,the levels of TC,TG and LDL-C in two groups were decreased,while the level of HDL-C was increased,the levels of TC,TG and LDL-C in observation group were lower than those in control group,and the HDL-C was higher than that control group(P<0.05). Conclusion: modified Da Chengqitang has a definite clinical efficady in treating HLAP with damp heat accumulation syndrome,and can alleviate TCM syndrome and patient symptoms,reduce inflammatory factors,inhibit oxidative stress of the body. It has a good safety,and is worthy of clinical application.
作者
刘国雄
匡桥贵
喻欣荷
刘访
王宇
俞洋
陈杨
LIU Guo-xiong;KUANG Qiao-gui;YU Xin-he;LIU Fang;WANG Yu;YU Yang;CHEN Yang(The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine(TCM),Guiyang 550001,China;Guizhou University of TCM,Guiyang 550001,China;Puding County Hospital of TCM,Anshun 562100,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2021年第5期91-97,共7页
Chinese Journal of Experimental Traditional Medical Formulae
基金
贵州省中医药管理局中医药、民族医药科学技术研究课题项目(QZYY-2019-092)。
关键词
高脂血症性
急性胰腺炎
湿热蕴结型
加味大承气汤
临床疗效
淀粉酶
炎性因子
氧化应激
血脂
hyperlipidemic
acute pancreatitis
damp heat accumulation syndrome
modified Da Chengqitang
clinical efficacy
amylase
inflammatory factors
oxidative stress
blood lipid
