急腹症SIRS治疗中加用中药对细胞因子及其它炎症介质的影响

Influences of Chinese herbs added to the treatment of SIRS on cytokines and other inflammatory mediators

目的 :探讨急腹症SIRS治疗中加用中药对细胞因子及其它介质的影响。方法 :前瞻性研究 ,将 4 3例急腹症SIRS患者按病种及APACHE -II评分分层随机分为综合安慰组及综合中药组 (包括综合大清组和综合承气组 )。动态观察血IL - 6、TNFα、内毒素、LPO。结果 :综合中药组和综合大清组第 3天IL - 6显著降低 ,前者TNFα亦降低 (P <0 .0 5 ) ,各中药组第 3、7天内毒素及LPO均降低 (P <0 .0 5 )。各中药组时段 (第 1～ 3、4～ 7、8～ 14天 )累计便次日均数增多 (P <0 .0 1) ,其于第 1～ 3天与第 3天内毒素、IL - 6、LPO呈负相关 (r =- 0 .4 76 ,P =0 .0 0 4 ;r =- 0 .5 12 ,P =0 .0 4 3;r =- 0 .6 4 3,P =0 .0 0 )。结论 :在西医综合治疗基础上 ,大承气颗粒或并用清胆灵能降低SIRS阶段血IL - 6、TNFα、内毒素和脂质过氧化物 ,阻止全身炎症反应升级扩大。

Objective:To evaluate the influcences of Chinese Herbs added to the treatment of SIRS caused by acute abdominal diseases on cytokines and other inflammatory mediators.Methods:A prospective study on 43 patients,grouped under combined treatment+placebo(group A),and combined treatment+Chinese herbs(group B)through statified random according to kinds of disease and APACHE-II score;12 health persons served as normal control(group C).Then,group B was further divided into group B1 and group B2,Da Cheng Qi granule+Qing Dan Ling granules 5 and Da Cheng Qi granules 5 were applied respectively.Taking Chineses herbs per os at the beginning of observation,sometimes by enema for a given time of postoperation.Plasma IL-6,TNFα,endotoxin,serum LPO were determined dynamically.Results:IL-6 in group B and B1 decreased at day 3(P<0.05),so did TNFα in group B;endotoxin and LPO in group B,B1 and B2 reduced at day 3,7(P<0.05).Average stool number of times per day in group B,B1 and B2 decreased during day 1～3,4～7,8～14(P<0.01);that during day 1～3correlated with IL-6,endotoxin and LPO negatively at day3(r=-0.476,P=0.004;r=-0.512,P=0.043;r=-0.643,P=0.000).Conclusions:On the basis of Western medicine combined treatment,Qi granule+Qing Dan Ling granule or DaCheng Qi granules through relaxing the bowels and purgation,and clearing away heat and toxic material can reduce circulating IL-6,TNFα,endotoxin and LPO,thereby can alleviate (cytokine storm) attack and inflammatory injury,and further prevent MODS.