大承气颗粒剂和清胆灵对胆胰疾病所致全身性炎症反应的影响

Effects of Da Cheng Qi Granules and Qing Dan Ling Granules on Systemic Inflammatory Reactions Caused by Biliary Tract and Pancreatic Diseases

目的 :探讨大承气颗粒剂和清胆灵对胆胰疾病所致全身性炎症反应的影响。 方法 :对 66例急腹症病人进行前瞻性研究 ;将内毒素血症期、SIRS及MODS患者分别按病种及APACHE Ⅱ评分 ,分层随机分为综合安慰组和综合中药组 ,对后者根据病种使用大承气颗粒剂或清胆灵 ;动态观察血LPO、TNFα、IL 6、内毒素等的变化。 结果 :内毒素血症期 ,综合中药组第1dLPO及第 3d内毒素降低 ,用清胆灵 1d后LPO降低 (P <0 0 5) ,第 3d有降低趋势 ;SIRS阶段 ,大承气颗粒剂或并用清胆灵于用药 3、7d能显著降低急性胰腺炎或胆道感染伴结石者LPO、内毒素 (P <0 0 5) ,第 3d大承气颗粒剂并清胆灵能降低胆道感染伴结石者IL 6、TNFα(P <0 0 5) ;MODS阶段 ,大承气颗粒剂用药 3、7d分别降低内毒素、TNFα(P <0 0 5)。 结论 :清胆灵、大承气颗粒剂具有一定的抗全身性炎症反应的作用 ,能降低LPO、TNFα、IL 6及内毒素水平。清胆灵清除或抑制ROS产生 ,大承气颗粒剂主要通过通里攻下 ,减少内毒素等所致ROS形成 ;用药 3～ 6d ,每天大便 4次以上 。

To evaluate the effects of Da Cheng Qi granules and Qing Dan Ling granules on systemic inflammatory reaction caused by biliary tract and pancreatic diseases. Methods:A prospective study on 66 patients,treated with Da Cheng Qi granules and/or Qing Dan Ling granules,taken per os initially,some patients by enema postoperatively.Results:All LPO,endotoxin,TNF α and IL 6 levels at every time point in group A(combined treatment+placebo) for endotoxemia,stage(only LPO and endotoxin),SIRS and MODS were significantly higher than those in group C(normal control).At endotoxemia stage,LPO levels in the group B1(combined treatment+Qing Dan Ling granules)and group B(combined treatment+Chinese herbs)were lower than those in group A on day 1( P <0.05),so was endotoxin in group B on day 3;there was a downward tendency for LPO in group B and B1 and for endotoxin in group B1 on day 3.During SIRS,LPO and endotoxin levels in group B3(combined treatment+Da Cheng Qi granules)and group B4(combined treatment+Da Cheng Qi granules+Qing Dan Ling granules)were reduced on day 3,7( P <0.05);IL 6 and TNF α levels in group B4 were reduced on day 3( P <0.05).During MODS,endotoxin content in group B(combined treatment+Da Cheng Qi granules)decreased on day 3( P <0.05),so did TNF α on day 7.[WT5HZ]Conclusion:[WT5BZ]Qing Dan Ling granules and Da Cheng Qi granules have some effects against systemic inflammatory reaction (SIR)by reducing the circulating LPO,TNF α,IL 6 and endotoxin levels.Qing Dan Ling granules mainly gets rid of ROS or restrains its generation;Da Cheng Qi granules decreases ROS mainly through relaxing the bowels and purgation,lessening ROS production induced by endotoxin.To obtain good effect of reducing LPO,it is suggested these two kinds of granules taken per os for 3～6 days and keeping four times of defecation or more per day.