清胰汤对SAP合并感染患者单核细胞HLA-DR表达的影响

目的探讨清胰汤对重症急性胰腺炎（SAP）并发感染患者单核细胞HLA—DR表达的影响。方法33例SAP合并感染患者随机分成3组：SAP并发感染组（Ⅱ组）、GM-CSF治疗组（Ⅲ组）、清胰汤治疗组（Ⅳ组）；选取7例SAP未并发感染患者为对照组（Ⅰ组）；各组均予常规治疗，Ⅲ、Ⅳ组在常规治疗基础上加用GM-CSF或清胰汤治疗，一周后检测外周血WBC，血淀粉酶，ET，CRP，IL-6以及单核细胞HLA—DR表达率。结果Ⅱ、Ⅲ、Ⅳ组患者在各项血清学指标均高于Ⅰ组，单核细胞HLA-DR表达水平低于Ⅰ组（P〈0．05）；而Ⅲ、Ⅳ组患者各项指标较Ⅱ组明显改善（P〈0．05）。结论SAP并发感染患者存在单核细胞免疫功能缺陷，而清胰汤治疗能够改善这种免疫功能障碍以及过度炎症反应。

Objective To investigate the effect of Qingyi decoction on HLA-DR expression of the monocytes in the infectious patients with severe acute pancreatitis （ SAP ） . Method 33 infectious patients with SAP were randomly divided into three groups： SAP complicated by infection group （ Ⅱ ） , SAP complicated by infection treated by GM-CSF （ Ⅲ） , SAP complicated by infection treated by Qingyi decoction （ Ⅳ ） . Besides, 7 SAP patients without infection were recruited to control group （ Ⅰ ）. All patients received routine comprehensive treatment after hospitalization, while group Ⅲ and group Ⅳ patients additionally received GM-CSF or Qingyi decoction as an adjutant therapy. All groups were treated for 7 days. The peripheral blood WBC, amylase, ET, IL-6, CRP were detected, and HLA-DR expression of monocytes were detected. Result The HLA-DR expression level of group Ⅱ, group Ⅲ and group IV patients were lower than groupⅠ （ P〈0.05 ） , and the every serum index in them were higher than group Ⅰ （ P〈0.05 ） . Compared with the patients in group Ⅱ, the every serum index and the HLA-DR expression level of patients in groupllI and group IV were ameliorated （ P〈0.05 ） . Conclusion Monocyte anergy is present in patients with severe acute pancreatitis, and SAP patients with infection are more severe. Furthermore, the treatment of Qingyi decoction can ameliorate monocytes-mediated immune function of SAP patients with infection and soften excessive inflammatory response.