衡炎方对严重脓毒症免疫调控的前瞻性研究

目的 观察衡炎方对严重脓毒症患者免疫调控机制的影响.方法 将入选的严重脓毒症患者按随机数字表法分为两组,最终衡炎方组22例,对照组23例.衡炎方组在对照组西医综合治疗措施基础上,每日口服(或胃管内注入)衡炎方组成:僵蚕10 g,蝉蜕10 g,姜黄10 g,大黄(后下)3 g,黄芪10 g,麦冬10 g,红参10 g,牡丹皮10 g,桃仁10 g,红花10 g等]50 ml,每日3次,连服7 d.于治疗前及治疗后1、3、7 d记录两组患者排便次数及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,检测CD3+、CD4+、CD8+ T淋巴细胞及白细胞介素(IL-6、IL-10)、肿瘤坏死因子-α(TNF-α).结果 与对照组同期比较,衡炎方组治疗后7 d,排便次数明显增多,APACHEⅡ评分及IL-6、IL-10、IL-6/IL-10比值和TNF-α均明显下降,而CD3+、CD4+、CD8+T淋巴细胞均明显增高,差异均有统计学意义排便次数(次):2.1±0.7比0.6±0.6;APACHEⅡ评分(分):13.8±5.6比16.8±5.6;IL-6(ng/L):45(32,89)比80(41,116);IL-10(ng/L):4.2(3.6,9.8)比6.6(3.5,10.6);IL-6/IL-10比值:10.6(7.2,24.8)比12.8(7.6,28.8);TNF-α(ng/L):4.2±2.6比5.6±2.7;CD3+:6.59±2.80比5.65±2.92,CD4+:3.65±2.17比3.25±2.46,CD8+:2.73±1.29比2.26±1.48,P<0.05或P<0.01].结论 衡炎方具有双向调节脓毒症免疫紊乱,减轻脓毒症患者全身炎症反应,改善脓毒症患者免疫抑制的作用.

Abstract：

Objective To observe the role of Hengyan medicinal recipe (衡炎方) on the regulation of immunity in patients with severe sepsis. Methods Patients with severe sepsis included in the study were randomly divided into two groups. Hengyan medicinal recipe group (n=22), in which patients were treated with Hengyan medicinal recipe 50 ml, 3 times daily, for 7 days.The recipe was composed of Bombyx batryticatus (僵蚕) 10 g, Cicada slough (蝉蜕) 10 g, Curcuma (姜黄) 10 g, Rhubarb (大黄) 3 g, Radix astragalus (黄芪) 10 g, Radix ophiopogonis (麦冬) 10 g, Red ginseng (红参) 10 g, Paeony (牡丹皮) 10 g, Walnut kernel (桃仁) 10 g, Safflower (红花) 10 g, combined with western medicine treatment.The patients in control group (n=23) were treated with western medicine same as above. In all patients the number of bowel movement and the scores of acute physiology and chronic health evaluationⅡ (APACHEⅡ) were recorded. Blood was taken for the determination of the levels of interleukins (IL-6, IL-10), tumor necrosis factor-α (TNF-α), CD3+, CD4+, CD8+ T cell before and 1, 3, 7 days after the treatment. Results Compared with the control group, the number of bowel movement, scores of APACHEⅡ and IL-6, IL-10, IL-6/IL-10, TNF-α in Hengyan medicinal recipe group were decreased significantly at 7 days, while the levels of CD3+, CD4+, CD8+ T cell were increased significantly the number of bowel movement (times): 2.1±0.7 vs. 0.6±0.6, APACHEⅡ score: 13.8±5.6 vs. 16.8±5.6, IL-6 (ng/L): 45 (32, 89) vs. 80 (41, 116), IL-10 (ng/L): 4.2 (3.6, 9.8) vs. 6.6 (3.5, 10.6), IL-6/IL-10: 10.6 (7.2, 24.8) vs. 12.8 (7.6, 28.8), TNF-α (ng/L): 4.2±2.6 vs. 5.6±2.7, CD3+: 6.59±2.80 vs. 5.65±2.92, CD4+: 3.65±2.17 vs. 3.25±2.46, CD8+: 2.73±1.29 vs. 2.26±1.48, P<0.05 or P<0.01]. Conclusion Hengyan medicinal recipe could not only reduce the systemic inflammation, but also plays a role in bidirectional regulation of the immune disturbance to ameliorate immune suppression of sepsis patients.