大柴胡汤对重症中暑患者TLR4信号通路相关因子的影响

Effect of Dachaihu Decoction on Correlation Factors of TLR4Signaling Pathways in Patients with Severe Heatstroke

目的:观察大柴胡汤对重症中暑患者的临床疗效及对Toll样受体4(Toll-like receptor4,TLR4)信号通路相关因子的影响。方法:53例重症中暑患者随机分为两组,对照组采用西医常规治疗,治疗组在对照组治疗基础上辅以大柴胡汤治疗。观察两组治疗第5天,第10天APACHEII评分、TLR4信号通路相关因子的变化;对比两组ICU住院时间以及28天总死亡率。结果:治疗组28天死亡率14.81%(4/27)低于对照组30.77%(8/26),但无统计学差异(χ2=1.122,P=0.2895);治疗组ICU住院时间(11.35±7.81)天,短于对照组(18.46±11.65)天(t=2.619,P=0.0116);治疗组第5天,第10天血清TLR4、高迁移率族蛋白B1(HMGB1)、核转录因子-κB(NF-κB)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及APACHEII评分等指标的改善方面均优于对照组(P<0.01)。结论:大柴胡汤能抑制重症中暑患者TLR4信号通路介导的全身炎症反应,缩短患者ICU的住院时间、改善预后。

Objective： To observe the curative effect of Dachaihu Decoction for patients with severe heatstroke as well as the influence of the correlation factors of Toll-like receptor4 （TLR4） signaling pathways. Methods： 53cases of patients with severe heatstroke were randomly divided into treatment group and controlled group. Both groups were treated with western regular medicine treatment, while Daehaihu Decoction was also used in the treatment group. Observing APACHEII scores, and correlation factors of TLR4signaling pathways with the two groups in the 5day and 10day of treatment. Compared with the two groups of ICU length of hospital stay, and 28days total mortality. Results： The total mortality rates of the treatment group was 14. 81% （4/27） that was no better than the controlled group which was 30.77% （8/26） （X2 = 1. 122, P = 0. 2895 ） ; Length of time in ICU of the treatment group （ 11.35±7. 81 ） d was shorter than the controlled group （ 18. 46±11.65 ） d （ t = 2. 619, P = 0. 0116） ; In the 5day and lOday of treatment, compared with the controlled group, serum levels of TLR4, high mobility group protein B1 （HMGB1）, nuclear transcription factor-kb （ NF-kB）, interleukin 6 （IL-6）, tumor necrosis factor α （TNF-α） and APACHE II scores in the therapy group improved significantly （P〈0. 01 ）. Conclusion： Dachaihu Decoction can inhibit the systemic inflammatory response through the TLR4signaling pathways in patients with severe heatstroke, shorten the length of hospital stay, and improve prognosis of ICU patients.