血必净注射液治疗脓毒症急性肾损伤的临床疗效及对炎症因子的影响

Clinical efficacy of Xuebijing injection on acute kidney injury induced by sepsis and its effects on inflammatory cytokines

[目的]探讨血必净注射液治疗脓毒症致急性肾损伤(AKI)的临床疗效及对炎症因子的影响。[方法]选取2013年1月—2014年1月天津市天津医院收治的80例脓毒症伴发AKI患者,随机分为治疗组(42例)和对照组(38例)。对照组按脓毒症指南予以常规治疗;治疗组在常规治疗的基础上加用血必净注射液50 m L静滴,每日2次。两组疗程均为10 d。观察两组患者治疗前及治疗后第1、3、7、10天的尿素氮(BUN)、血肌酐(SCr)、尿量、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及急性生理学与慢性健康状态评分Ⅱ(APACHEⅡ)评分的变化;同时观察两组患者治疗后的平均住院天数并随访28 d病死率。[结果]与对照组比较,治疗组治疗后BUN、SCr、TNF-α、IL-6、IL-10水平及APACHEⅡ评分均明显下降,尿量明显增多;治疗组患者住院时间较对照组明显缩短(P<0.05),两组患者28 d病死率比较无统计学差异(P>0.05)。[结论]血必净注射液可以有效的保护脓毒症所致AKI患者的肾功能,并可改善患者病情及预后。其主要机制可能与血必净注射液能够同时下调促炎因子与抗炎因子水平,维持机体促炎-抗炎反应处于平衡状态,减轻炎症介质导致的损伤有关。

[Objective] To explore the clinical efficacy of Xuebijing injection on acute kidney injury induced by sepsis and its effects on inflammatory cytokines. [Methods] Eighty patients with acute kidney injury induced by sepsis who were admitted into the hospital from January 2013 to January 2014, were divided into two groups randomly： treatment group（n=42） and control group（n =38）. The control group were treated with routine therapy, while the treatment group were treated with routine therapy plus 50 m L Xuebijing injection, twice a day for consecutive 10 days. The levels of blood urea nitrogen（BUN）, serum creatinine（SCr）, tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）, interleukin-10（IL-10） and APACHEⅡscore were detected before treatment and on the first, third, seventh and tenth day after treatment in the two groups. After treatment the length of stay in hospital and 28 d mortality were observed in the two groups. [Results] Compared with the control group,the levels of BUN, SCr, TNF-α, IL-6, IL-10 and APACHEⅡscore were decreased significantly in the treatment group, and the urine volume was increased significantly. The length of stay in hospital in the treatment group was significantly shorter than that in the control group（P〈0.05）, and 28 d mortality had no significantly difference between the treatment group and control group（P〈0.05）. [Conclusion] Xuebijing injection can effectively protect the renal function of AKI patients induced by sepsis, improve their condition and prognosis. The principal mechanism may be relate to antagonism against endotoxin,inhibition release of pro-inflammatory and anti-inflammatory cytokines, maintaining the balance of pro-inflammatory and anti-inflammatory reaction,reducing the injury caused by inflammatory cytokines.