甘草酸二铵治疗急性肺损伤的临床观察

Effects of diammonium glycyrrhizinate on the patients with acute lung injury

目的初步观察甘草酸二铵（商品名：甘利欣）治疗急性肺损伤（ALI）的临床效果。方法将入选60例需进行机械通气治疗病例随机分为甘草酸二铵治疗组和对照组，每组30例。对照组采用肺保护性通气策略为主的综合ICU治疗，治疗组则在综合ICU治疗基础上加用甘草酸二铵2mg／（kg·d）静脉滴注。分别检测两组病例治疗前及治疗后第1、3、7天的血清TNF-α、IL-10浓度，比较两组患者治疗前及治疗第7天的氧合指数（PaO2／FiO2）、肺损伤评分、急性生理和慢性健康状况评分Ⅱ（APACHEII）及病死率情况。结果甘草酸二铵治疗组治疗后第3天及第7天TNF-α浓度下降，IL—10浓度有所升高，与对照组比较，差异有统计学意义（P〈0．05）。甘草酸二铵治疗组治疗后肺损伤评分、APACHE11评分较对照组更低，而PaO2／FiO2有所增加，与对照组比较差异均有统计学意义（P〈0．05）；甘草酸二铵治疗组ALI病死率有所降低，但与对照组比较，差异无统计学意义（P〉0．05）。结论静脉注射甘草酸二铵对ALI患者有一定的治疗作用，能抑制炎症因子TNF—α的释放，同时促进抗炎介质IL-10的表达，从而减轻肺损伤程度，部分降低ALI病死率。

Objective To evaluate the effect of diammonium glycyrrhizinate on the patients with acute lung injury （ALI）. Methods Sixty patients with ALI who required mechanical ventilation were randomly divided into two groups： diammonium glycyrrhizinate treatment group （n = 30 ） and control group （n = 30 ）. The diammonium glyeyrrhizinate treatment group was treated with diammonium glycyrrhizinate at a dose of 2 mg/（kg·d） besides normal therapy. The control group did not receive diammonium glycyrrhizinate. All the patients＇ arterial blood gas, acute physiology and chronic health evaluation II （ APACHE II ） score and lung injury score were measured at baseline and 7th day after the diammonium glycyrrhizinate infusion, and the final disease mortality was calculated. The concentration of TNF-α and IL-10 in serum were observed by ELISA at baseline and 1st, 3rd, 7th day. Results Compared with control group, TNF-α levels decreased and IL- 10 levels increased at 3rd,7th day in diammonium glycyrrhizinate treatment group, there were significant differences between two groups（P 〈 0.05 ）. In diammonium glycyrrhizinate treatment group, patients＇ PaO2/FiO2 increased, and lung injury score and APACHE II score decreased after the diammonium glycyrrhizinate infusion, the differences were significant between two groups （ P 〈 0. 05 ）, but the final disease mortality had no significant differences （P 〉 0. 05 ）. Conclusion The results suggest that diammonium glycyrrhizinate has a protective effect on the patients with ALI during mechanical ventilation mainly by down - regulating the expression of TNF - α, and up - regulating the expression of IL - 10, and can partly decrease the final mortality.