血必净对严重脓毒症患者血管内皮细胞相关促炎因子和凝血因子的影响

Effect of XueBiJing injection upon related proinflammatory factors and blood coagulation factors of vascular endothelial cells in severe septic patients

目的探讨血必净注射液对严重脓毒症患者血管内皮细胞相关促炎症因子和凝血因子的影响。方法将52例严重脓毒症患者随机分为常规治疗组（A组）与血必净治疗组（B组）。在相同的常规治疗基础上，B组给予血必净注射液100ml加入0．9％氯化钠100ml中静脉滴注，每天1次，持续7d。A组则给予同等量的0．9％氯化钠作为对照。A、B两组患者治疗前及治疗后第3、7天分别抽血检测血清内血管内皮细胞（VEC）相关促炎症因子和凝血因子水平。促炎症因子包括血管细胞黏附分子（VCAM-1）和细胞间黏附分子（ICAM-1）。凝血因子包括一氧化氮（NO）、抗凝血酶Ⅲ（AT-Ⅲ）、血栓调节蛋白（TM）、组织纤溶酶原激活物（TPA）、VWF因子（VWF）、纤溶酶原激活物抑制物（PAI-1）；并统计两组患者的28d病死率。结果B组患者28d的病死率为32．1％（9／28），低于A组的62．5％（15／24），差异有统计学意义（P〈0．05）。治疗第7天B组患者VEC诱导的促炎症因子VCAM-1和ICAM-1明显低于A组；VEC诱导的抗凝（NO、AT—Ⅲ、TM）和促纤溶物质（TPA）、促凝（VWF）和纤溶抑制因子（PAI-1）都明显高于A组（P〈0．05）。结论血必净注射液能够改善严重脓毒症患者的病情，降低病死率，其机制可能与其稳定血管内皮细胞，改善严重炎症反应和凝血功能紊乱有关。

Objective To evaluate the effect of Xue Bijing injection in related proinflammatory factors and blood coagulation factors of vascular endothelial cell in severe septic patients. Methods Fiftytwo patients were randomly divided into Xue Bijing injection treatment group （ Group B） and control group （ Group A）. Both groups were treated with routine integration treatment, and additionally, patients in Group B received Xue Bijing injection 100 ml intravenous once a day for 7 days while those in Group A received an equal quantity of normal saline as placebo. The changes of VCAM-1, ICAM-1, NO, AT-Ⅲ, TM, TPA, VWF and PAI-1 in blood serum were tested at Day 0, 3, 7. And the mortality was calculated at Day 28. Results The 28-day mortality rate was 32. 1% （9/28） in Group B while that of Group A was 62. 5% （15/24）. There was a significant difference between two groups（P 〈0. 05）. The concentrations of blood serum VCAM-1 and ICAM-1 were significantly lower in Group B than Group A. And the concentrations of blood serum NO, AT-Ⅲ, TM, TPA, VWF and PAI-1 were significantly higher in Group B than Group A. Conclusion Xue Bijing injection improves a patient＇s condition and reduces 28-day mortality of severe septic patients. The reason may be that it can stabilize vascular endothelial cell to improve serious inflammatory reaction and blood coagulation dysfunction.