内镜介入术后配合扶正逐瘀联合清热解毒中药治疗急性梗阻性化脓性胆管炎继发全身炎症反应的研究

Effect of Chinese medicinal herbs combined with endoscopic treatment on acute obstructive suppurative cholangitis with secondary systemic inflammatory response

目的观察内镜介入术后配合扶正逐瘀联合清热解毒中药治疗急性梗阻性化脓性胆管炎(AOSC)继发全身炎症反应(SIRS)的疗效和机制。方法将45例AOSC继发SIRS患者随机分为3组,每组15例。均行内镜介入术,术后对照组仅给予西医常规治疗,清热解毒组在西医常规治疗基础上加服清热解毒中药,扶正逐瘀组在清热解毒组的基础上加服扶正逐瘀中药。检测3组术前和术后第8天血白细胞计数(WBC)、降钙素原(PCT)、自然杀伤细胞(NK细胞)、T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)水平,统计3组住院时间。结果 3组术前WBC计数、PCT、NK细胞、CD4+、CD8+、CD4+/CD8+比较差异均无统计学意义(P均>0.05)。术后第8天,3组血WBC计数、PCT水平均明显低于术前(P均<0.05);扶正逐瘀组NK细胞、CD4+、CD4+/CD8+均明显高于术前(P均<0.05),CD8+明显低于术前(P<0.05)。清热解毒组与对照组各指标水平比较差异均无统计学意义(P均>0.05),扶正逐瘀组各指标改善情况均明显优于对照组(P均<0.05),扶正逐瘀组CD4+、CD8+、CD4+/CD8+改善情况均明显优于清热解毒组(P均<0.05)。3组住院时间比较差异无统计学意义(P均>0.05)。结论扶正逐瘀联合清热解毒中药对AOSC继发SIRS具有辅助治疗效果,机制可能是通过提高机体的免疫力以促进感染的恢复。

Objective It is to observe the curative effect and mechanism of Fuzheng Huayu and Qingre Jiedu Chinese medicinal herbs combined with endoscopic treatment on acute obstructive suppurative cholangitis（ AOSC） with secondary systemic inflammatory response（ SIRS）. Methods 45 patients with AOSC and secondary SIRS were randomly divided into three groups：clearing heat and detoxicating group,Fuzheng Huayu ＋ clearing heat and detoxicating group and control group. Every group has 15 cases. All the groups were treated with endoscopic therapy,and after operation they were treated with normal western medicine,furthermore,clearing heat and detoxicating group and Fuzheng Huayu group were given respective Chinese medicine. Before the treatment and on the 8th day the levels of serum white blood cell count（ WBC）,procalcitonin（ PCT）,T lymphocyte subpopulation（ CD4＋,CD8＋,CD4＋/ CD8＋） and natural killer cell（ NK cell） were detected and hospitalization time was recorded in the three groups. Results There was no significant difference in the levels of WBC,PCT,NK cell,CD4＋,CD8＋,CD4＋/ CD8＋before operation among the three group（ P〉0. 05）. On the 8th day after operation,the levels of WBC,PCT were lower than that before operation in the three groups（ P〈0. 05）,that of NK cell and CD4＋,CD4＋/ CD8＋were higher while CD8 ＋ was higher after treatment than that before operation in Fuzheng Huayu group（ P〈0. 05）,and the improvements were better than that in clearing heat and detoxicating group. There was no significant difference in every index above between clearing heat and detoxicating group and control group（ P〉0. 05）,but the improvements of every index in clearing heat and detoxicating group and Fuzheng Huayu group were better than that in control group. Conclusion Fuzheng Zhuyu combined with Qingre Jiedu Chinese medicine have auxiliary therapy effect on AOSC with secondary SIRS,the mechanism may be through improving the body＇s immunity to speed up the recovery of infection.