猪苓汤合复元活血汤治疗严重闭合性肾损伤临床观察及对血清细胞因子表达的影响

Clinical Observation of Zhuling Tang Combined with Fuyuan Huoxue Tang in Treatment of Severe Closed Renal Injury and Their Effects on Serum Cytokines Expression

目的:观察猪苓汤合复元活血汤治疗严重闭合性肾损伤患者的临床疗效,探讨血清白细胞介素(IL)-6,IL-8,IL-10和肿瘤坏死因子(TNF)-α在治疗过程中的含量变化及临床意义。方法:将80例严重闭合性肾损伤患者按随机数字表法分为治疗组和对照组,各40例。对照组采用常规西医治疗,治疗组在对照组的基础上内服猪苓汤合复元活血汤。观察两组患者外周血白细胞、住院时间、镜下血尿消失时间、肾包膜下及肾周血肿开始吸收时间,治疗2,4,12周后复查CT观察肾周血肿变化情况,采用酶联免疫吸附试验(ELISA)检测两组第0.5,1,2,3,5,7 d血清IL-6,IL-8,IL-10,TNF-α的表达。结果:治疗后治疗组住院时间、肾包膜下及肾周血肿开始吸收时间、镜下血尿消失时间均较对照组明显缩短(P<0.05);治疗后外周血白细胞(WBC)下降显著优于对照组(P<0.01),外周血血红蛋白(HGB)升高显著优于对照组(P<0.01)。治疗2,4,12周后肾周血肿吸收情况显著优于对照组(P<0.01)。治疗组IL-6,IL-8,TNF-α的含量在早期时段均显著低于对照组(P<0.01),治疗组IL-10的含量在早期时段均显著高于对照组(P<0.01)。结论:猪苓汤合复元活血汤治疗闭合性肾损伤疗效明显,且在早期可降低促炎因子IL-6,IL-8,TNF-α的产生,促进抗炎因子IL-10的产生,抑制患者的炎症反应。提示猪苓汤合复元活血汤可能通过调节细胞因子抑制炎症反应,发挥其治疗作用。

Objective： To observe the clinical efficacy of Zhuling Tang combined with Fuyuan Huoxue Tang in the treatment of severe closed renal injury and investigate its effects and clinical significance on serum interleukin（ IL）-6,IL-8,IL-10 and tumor necrosis factor（ TNF）-α levels in the course of treatment. Method：The 80 patients with severe closed renal injury were randomly divided into treatment group（ 40 cases） and control group（ 40 cases）. Patients in control group received conventional western medicine treatment,and patients in treatment group orally took Zhuling Tang combined with Fuyuan Huoxue Tang based on the treatment in control group. The peripheral blood leukocytes, length of hospital stay, disappearance time of hematuria under microscope,beginning time of perirenal hematoma absorption and renal subcapsular hematoma absorption were observed. CT was taken in 2,4,12 weeks to observe the changes of perirenal hematoma,and the IL-6,IL-8,IL-10 and TNF-α expression levels were detected by enzyme-linked immunosorbent assay（ ELISA） in 0. 5,1,2,3,5,7 d. Result： After treatment,the length of hospital stay,beginning time of perirenal hematoma absorption and renal subcapsular hematoma absorption,and disappearance time of hematuria under microscope in treatment group were significantly shorter than those in control group（ P〈0. 05）,the declined number of white blood cells in peripheral blood was significantly higher than that in control group（ P〈0. 01）,and the increased number of hemoglobin in peripheral blood was significantly superior to that in control group（ P〈0. 01）. At 2,4 and 12 weeks after treatment,the absorption of perirenal hematoma in treatment group was significantly better than that of control group（ P〈0. 01）. The levels of IL-6,IL-8 and TNF-α in treatment group were significantly lower than those in control group in earlier periods（ P〈0. 01）,and the level of IL-10 in the treatment group was significantly higher than that in control group in earlier periods（ P〈0. 01）. Conclusion： Zhuling Tang combined with Fuyuan Huoxue Tang has obvious clinical efficacy in the treatment of closed renal injury,which can reduce the production of proinflammatory cytokines IL-6,IL-8 and TNF-α,promote the production of anti-inflammatory factor IL-10,and inhibit the inflammatory reaction of the patients. Therefore,its mechanism may be associated with regulating the cytokines and inhibiting inflammatory reaction.