血必净对急性呼吸窘迫综合征患者炎性反应的影响

Effects of Xuebijing injection on inflammatory response in patients with acute respiratory distress syndrome

目的 观察血必净注射液对急性呼吸窘迫综合征（ARDS）患者血清和支气管肺泡灌洗液（BALF）降钙素原（PCT）以及肿瘤坏死因子（TNF-α）、白介素6（IL-6）、白介素8（IL-8）的影响,探讨血必净注射液对ARDS患者炎性反应的调节机制.方法 选择60例ARDS患者作为研究对象,随机分为两组,研究组（30例）予以血必净注射液100 ml加入5%葡萄糖注射液150 ml静滴,连用7 d;对照组（30例）予以5%葡萄糖注射液250 ml静滴,连用7 d.观察用药前和用药后7 d患者血清和BALF中PCT、TNF-α、IL-6、IL-8的变化.结果 治疗前所有患者BALP和血清中PCT显著高于正常.治疗后研究组血清和BALF中PCT显著性下降（t=2.882,t=2.657,均P＜0.01）,而对照组变化不显著（P＞0.05）.治疗前所有患者TNF-α、IL-6和IL-8显著升高（均P＜0.05）.治疗后研究组患者TNF-α、IL-6和IL-8显著下降（t=2.686、2.654、2.893,均P＜0.05）,而对照组未见明显变化（均P＞0.05）.研究组死亡8例,病死率为26.7%;对照组死亡10例,病死率为33.3%（x2=4.214,P＜0.05）.结论 血必净注射液可显著降低ARDS患者BALP和血清中PCT浓度,降低血清细胞因子的表达,具有抗炎、改善氧合的作用,降低ARDS患者病死率,可应用于ARDS的临床救治.

Objective To evaluate the effects of Xuebijing injection on inflammatory response in patients with acute respiratory distress syndrome（ARDS） by the changes of the level of PCT in bronchoalveolar lavage fluid （BALF） and plasma so as well as serum tumor necrosis factor-α（TNF-α） 、interleukin-6（IL-6） and interleukin-8（ IL-8）. Methods Sixty patients treated at the intensive care unit（ICU） were recruited in this study;these subjects satisfied the diagnostic criteria for ARDS. They were randomly classified into two groups： study group （ 30 patients） in which patients were given Xuebijing injection 100ml and 5% Glucose injection 150 ml daily,and control group（30 patients） patients were given 5% Glucose injection 250ml daily. The changes of the level of PCT in BALF and plasma so as well as serum TNF-α,IL-6 and IL-8 were monitored before intervention and seven days later. Results The level of PCT in BALF and plasma before intervention were statistically higher than normal（ t= 2.882、2.657 all P 〈0.01 ）while decreased significantly seven days later （ all P 〈 0.01 ） in study group but fewer change in control group （ all P 〉0.05 ）. Levels of TNF-α,IL-6 and IL-8 were statistically higher than normal before intervention（ all P 〈 0.05 ） while decreased significantly seven days later（ all P 〈0.01 ）in study group but fewer change in control group（ all P 〉0.05 ）. The mortality of patients was 26.7% （ study group） and 33.3% （ control group） （ all P 〈 0.05 ） respectively.Conclusion Xuebijing injection could lower the level of PCT in BALP and plasma of patients with ARDS,played the role of antiinflammatory and improving the oxygenation, and could to reduce the mortality of patients.