清热解毒通里攻下法辅助西医治疗重症急性胰腺炎疗效及对炎性细胞因子、肠道微生态的影响

Effect of adjuvant therapy of Qingre-Jiedu Tongli-Gongxia with symptomatic treatment with western medicine on severe acute pancreatitis and its influence on inflammatory cytokines and intestinal microecology

目的观察清热解毒通里攻下法辅助西医治疗重症急性胰腺炎疗效及对炎性细胞因子、肠道微生态的影响。方法将110例重症急性胰腺炎患者随机分为2组,对照组55例给予西医对症干预治疗,观察组55例在此基础上加用清热解毒通里攻下法辅助治疗,观察2组临床症状改善时间、实验室指标恢复正常时间及治疗前后主要证候积分变化情况,检测2组治疗前后血清白细胞介素-6(IL-6)、IL-10、IL-15、肿瘤坏死因子-α(TNF-α)、淀粉酶、二胺氧化酶(DAO)、D-乳酸水平及肠道肠杆菌、肠球菌、双歧杆菌及乳酸菌数量,统计2组临床疗效。结果观察组腹痛、腹胀缓解时间,肠鸣音、血象、血尿淀粉酶恢复正常时间均显著短于对照组(P均<0. 05); 2组治疗后上腹疼痛、恶心呕吐、发热、黄疸、舌红苔白薄、脉细或滑数积分及血清IL-6、IL-15、TNF-α、淀粉酶、DAO、D-乳酸水平和肠杆菌、肠球菌数量均显著降低(P均<0. 05),治疗后血清IL-10水平及双歧杆菌、乳杆菌数量均显著提高(P均<0. 05),且观察组治疗后以上指标改善情况均显著优于对照组(P均<0. 05);观察组临床治疗总有效率显著高于对照组(P <0. 05)。结论清热解毒通里攻下法辅助西医治疗重症急性胰腺炎可有效促进胃肠道功能恢复,减轻相关症状体征及机体炎症反应,并有助于改善胃肠黏膜屏障功能。

Objective It is to observe the curative effect of adjuvant therapy of Qingre-Jiedu Tongli-Gongxia with symptomatic treatment with western medicine on severe acute pancreatitis and its influence on inflammatory cytokines and intestinal microecology. Methods 110 patients with severe acute pancreatitis were randomly divided into two groups. 55 patients in the control group were treated with western medicine for symptomatic intervention. 55 patients in the observation group were treated with Qingre-Jiedu Tongli-Gongxia method for adjuvant therapy based on the therapy in the control group. The time of symptom improvement, the recovery time of laboratory indicators and the changes of the main syndrome scores before and after treatment were observed in both groups. The levels of serum interleukin-6 （IL-6）, IL-10, IL-15 and tumor necrosis factor-α （TNF-α）, amylase, diamine oxidase （DAO）, D-lactic acid and intestinal enterobacteria, enterococci, bifidobacteria and lactic acid bacteria count were detected before and after treatment in both groups. The curative effects of the two groups were evaluated. Results In the observation group, response time of abdominal pain and distention , recovery time of bowel sounds, blood picture, and amylase in blood and urine in the observation group were significantly shorter than those in the control group （ P 〈0.05）. After treatment, the scores of upper abdominal pain, nausea and vomiting, fever, jaundice, red tongue with thin and white coating, thin or slip pulse and the levels of serum IL-6, IL-15, TNF-α, amylase, DAO, D-lactic acid, the number of enterobacter and enterococcus were significantly decreased （ P 〈0.05）, while the level of serum IL-10 and the number of bifidobacteria and lactobacilli were significantly increased after treatment in both groups （ P 〈0.05）, and the improvements of the above indicators in the observation group were significantly better than those in the control group （ P 〈0.05）. The total effective rate of clinical treatment of the observation group was significantly higher than that of the control group （ P 〈0.05）. Conclusion The therapy of Qingre-Jiedu Tongli-Gongxia with symptomatic treatment with western medicine can effectively promote the recovery of gastrointestinal function, reduce the related symptoms and signs and the body＇s inflammatory response, and help to improve the gastrointestinal mucosal barrier function in the treatment of severe acute pancreatitis.