急腹症脓毒症患者外周血单核细胞的活化和复方清下汤的治疗作用

Peripheral blood monocyte activation in acute abdominal diseases with sepsis and its treatment with fufang qingxia decoction

[目的]观察急腹症并发脓毒症患者外周血单核细胞肿瘤坏死因子的基因表达规律,探讨中药复方清下汤的治疗作用及可能机制。[方法]38例急腹症并发脓毒症患者随机分成两组,常规治疗组(常规组)和在常规治疗基础上给予中药复方清下汤治疗组(中药组)。另设10例健康志愿者为对照组。患者分别于入院24 h内、3 d、7 d采取外周静脉血,测定血清TNF-α和血浆内毒素(endotoxin,ET)含量,RT-PCR法检测外周血单核细胞TNF-αmRNA表达水平。[结果]常规组与中药组各时间点血浆ET和血清TNF-α水平均高于对照组(P<0.05)。同24h相比,第7天时中药组血浆ET和血清TNF-α水平均明显下降(P<0.05),且低于常规组(P<0.05)。24 h时常规组和中药组TNF-αmRNA表达水平同对照组相比明显升高[(0.430±0.201),(0.502±0.233),(0.071±0.045),P<0.01],至第7天时均明显降低[(0.227±0.058),(0.150±0.065),P<0.01],中药组比常规组下降更明显[(0.150±0.065),(0.227±0.058),P<0.05]。入院24 h和7 d时外周血单核细胞TNF-αmRNA的表达水平与血浆ET及血清TNF-α含量之间均呈显著正相关关系(r=0.473,P<0.05;r=0.782,P<0.01;r=0.575,P<0.05;r=0.787,P<0.01)。[结论]急腹症并发脓毒症时,存在外周血单核细胞活化,TNF-αmRNA表达增强,TNF-α分泌增多。中药复方清下汤可有效降低血液中内毒素及TNF-α水平,抑制外周血单核细胞的活化。

[Objective] To investigate the gene expression of tumor necrosis factor-alpha（TNF-α） in peripheral blood monocytes in acute abdominal diseases with sepsis and determine the treatment with fufang qingxia decoction.[Method] Thirty-eight patients with acute abdominal diseases accompanying sepsis were enlisted in this study.These patients were randomly divided into two groups.Group one received routine treatment,and the other was treated with fufang qingxia decoction served as Chinese traditional herb medicine（CTHM） group.Ten healthy individuals were selected as normal control.All the patients had APACHEⅡscores assessed.Peripheral blood samples were obtained within 24 h,on 3rd and 7th day.TNF-αwas examined by radio-immunoassay method.Plasma endotoxin was measured using a quantitative chromogenic LAL test.The total RNA was extracted from isolated peripheral blood monocytes,and the expression of TNF-α mRNA was evaluated by semi-quantitive RT-PCR.[Results] Compared with the healthy volunteers,significant increasing in serum TNF-α and plasma endotoxin levels was observed in both groups on the entry day,3rd and 7th day（P0.05）.On 7th day,the plasma endotoxin and TNF-α levels in CTHM group were significantly lower than those on the entry day （P0.05）,and both were significantly lower than routine group.The expression of TNF-α mRNA in the monocytes was significantly higher in both routine group and CTHM group than in normal control within 24 h of admission [（0.430±0.201）,（0.502±0.233）,（0.071±0.045）,P0.01].After treatment,TNF-α mRNA decreased significantly in both groups on 7th day,and the mRNA level was significantly lower in CTHM group [（0.150±0.065）,（0.227±0.058）,P0.05].The expression of TNF-αmRNA was positive correlation with plasma ET and serum TNF-α level（r=0.473,P0.05;r=0.782,P0.01;r=0.575,P0.05;r=0.787,P0.01） in 24 h and 7th day.[Conclusion] Peripheral blood monocytes are activated in acute abdominal diseases with sepsis accompanying with enhanced expression of TNF-α mRNA and increased release of TNF-α.Effectively decreasing the concentrations of plasma endotoxin and serum TNF-α and inhibitting TNF-α production by monocytes through transcriptional mechanism,fufang qingxia decoction may be one of the effective ways to treat sepsis.