血必净注射液对创伤后ARDS患者支气管肺泡灌洗液sTREM-1的影响

Effect of Xuebijing injection on sTREM-1 in bronchoalveolar lavage fluid of patients with ARDS after trauma

目的探讨血必净注射液对创伤后ARDS患者支气管肺泡灌洗液可溶性髓样细胞触发受体1(s TREM-1)的影响。方法将2015年1月~2016年12月从潍坊医学院附属医院急诊科或其他创伤外科转入重症监护病房(EICU和ICU)的30例创伤后ARDS患者作为研究对象,按随机双盲原则将其分为常规治疗组和血必净治疗组,各15例。常规治疗组给予治疗原发病、机械辅助通气、激素及营养支持等综合治疗,血必净治疗组患者在常规处理基础上加用血必净。两组分别于治疗前及治疗第3天、7天用纤维支气管镜采集患者的支气管肺泡灌洗液(BALF),并采用ELISA法检测其TNF-α、IL-6、IL-8和s TREM-1浓度,记录两组损伤严重程度评分(injury severity score,ISS)、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、氧合指数(Pa O2/Fi O2)、机械通气时间、重症监护室住院时间和治疗后7d死亡情况。结果常规治疗组和血必净治疗组间机械通气时间和重症监护室住院时间差异有统计学意义(P<0.05),而两组7d死亡率差异无统计学意义(P>0.05);其余监测指标在治疗前差异无统计学意义(P>0.05),两组患者治疗后APACHEⅡ评分、氧合指数及BALF中TNF-α、IL-6、IL-8和s TREM-1浓度均明显下降,且血必净治疗组下降更明显,差异有统计学意义(P<0.05)。结论血必净注射液可显著降低创伤后ARDS患者支气管肺泡灌洗液s TREM-1浓度,减轻肺部炎症反应,且BALF中s TREM-1浓度可作为判断创伤后ARDS患者肺部炎症反应程度的指标,并有助于治疗效果的观察与评价。

Objective To investigate the effect of Xuebijing injection on s TREM-1 in bronchoalveolar lavage fluid of traumatic ARDS patients. Methods From Jan 2015 to Dec 2016, 30 patients with post-traumatic ARDS in the intensive care ward（EICU and ICU） from the emergency department and other department of trauma surgery in the Affiliated Hospital of Weifang Medical University were selected as the subjects. The patients were randomly divided into two groups： conventional treatment group and Xuebijing treatment group,with 15 cases in each group.The conventional treatment group were given the treatment of primary disease, mechanical ventilation, glucocorticoid and nutritional support and other comprehensive treatment measures,and Xuebijing group were treated with Xuebijing injection on the basis of routine treatment. The concentrations of TNF-α,IL-6,IL-8 and s TREM-1 in bronchoalveolar lavage fluid of each group were measured by ELISA before and after treatment on 3,7 days,and recorded the injury severity score,the APACHE Ⅱ score,oxygenation index,mechanical ventilation time, hospitalization time and 7 d mortality after treatment. Results The differences of mechanical ventilation time and ICU stay time between conventional treatmemt group and Xuebijing treatment group were statistically significant（P〉0.05）,but there was no significant difference in 7 d mortality between the two groups（P〉0.05）. There was no significant difference in the other monitoring indexes before treatment（P〉0.05）.The APACHE Ⅱ score, oxygenation index and the levels of TNF-α,IL-6,IL-8 and s TREM-1 in BALF were significantly decreased after treatment,and the Xuebijing group decreased more significantly,the difference was statistically significant（P〉0.05）. Conclusion Xuebijing injection can significantly reduce s TREM-1 concentration in BALF of the trauma ARDS patients,effectively control post-traumatic inflammation. The change of s TREM-1 concentration in BALF can judge the degree of pulmonary inflammation in patients with ARDS after trauma,and contribute to observe and evaluate the therapeutic effect.