千金苇茎汤加味联合西医治疗对接受机械通气的重症肺炎患者呼吸力学、Th17与Treg细胞因子失衡及动脉血气分析指标的影响

Effects of modified Qianjin-Weijing decoction combined with western medicine on respiratory mechanics,Th17 and Treg cytokine imbalance and arterial blood gas analysis in patients with severe pneumonia undergoing mechanical ventilation

目的观察千金苇茎汤加味联合西医治疗对接受机械通气的重症肺炎患者呼吸力学、Th17与Treg细胞因子失衡及动脉血气分析指标的影响。方法将82例接受机械通气治疗的重症肺炎患者随机分为2组。对照组41例予西医常规治疗;治疗组41例在对照组治疗基础上加用千金苇茎汤加味治疗。2组均治疗14 d后统计疗效,观察比较2组治疗前、治疗后24 h、治疗后48 h及撤机前的呼吸力学指标变化情况[包括气道峰压(PIP)、呼吸做功(WOB)、气道阻力(Raw)及肺动态顺应性(Cdyn)],比较2组治疗前后Th17与Treg细胞因子[包括γ-干扰素(IFN-γ)、白细胞介素(IL)6、IL-17、IL-4、IL-10及转化生长因子-β(TGF-β)]、动脉血气分析指标{包括动脉血氧分压[p(O_2)]、二氧化碳分压[p(CO_2)]、血氧饱和度(SaO_2)、氧合指数、乳酸(Lac)及p H值}、临床肺部感染评分(CPIS)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及Murray肺损伤评分变化情况,以及2组临床症状恢复正常时间(包括体温、肺部湿啰音及肺部致密影)、血液指标恢复正常时间[包括白细胞计数(WBC)、降钙素原及C反应蛋白(CRP)]、机械通气时间、住院时间及撤机成功率情况。结果 2组治疗后24 h、治疗后48 h及撤机前呼吸力学指标与本组治疗前比较,PIP、WOB及Raw水平均降低(P<0.05),Cdyn水平均升高(P<0.05),且治疗组治疗后24 h、治疗后48 h及撤机前对各呼吸力学指标改善均优于对照组同期水平(P<0.05);2组治疗后Th17与Treg细胞因子与本组治疗前比较,IFN-γ、IL-6及IL-17水平均降低(P<0.05),IL-4、IL-10及TGF-β水平均升高(P<0.05),且治疗组治疗后对各细胞因子改善均优于对照组(P<0.05);2组治疗后动脉血气分析指标与本组治疗前比较,p(O_2)、Sa O_2、氧合指数及p H值水平均升高(P<0.05),p(CO_2)及Lac水平均降低(P<0.05),且治疗组治疗后对p(O_2)、SaO_2、氧合指数及Lac水平改善均优于对照组(P<0.05);2组治疗后CPIS评分、APACHEⅡ评分及Murray肺损伤评分与本组治疗前比较均明显降低(P<0.05),且治疗组治疗后CPIS评分、APACHEⅡ评分及Murray肺损伤评分均低于对照组(P<0.05);治疗组临床症状恢复正常时间、血液指标恢复正常时间、机械通气时间及住院时间均短于对照组(P<0.05),撤机成功率高于对照组(P<0.05)。结论千金苇茎汤加味联合西医治疗对接受机械通气的重症肺炎临床效果确切,可明显改善患者呼吸力学指标,改善动脉血气指标,抑制Th17细胞炎症因子释放,促进Treg细胞抗炎细胞因子释放,恢复Th17与Treg细胞比例平衡,降低CPIS评分、APACHEⅡ评分及Murray肺损伤评分,促进临床症状及血液指标恢复正常,缩短机械通气时间及住院时间,提高撤机成功率。

Objective To observe the effect of modified Qianjin-weijing decoction combined with western medicine on respiratory mechanics,Th17 and Treg cytokine imbalance and arterial blood gas analysis in patients with severe pneumonia undergoing mechanical ventilation.Methods 82 patients with severe pneumonia undergoing mechanical ventilation were randomly divided into 2 groups.41 cases in control group were treated by conventional western medicine;41 cases in treatment group were treated by Qianjin-Weijing decoction on the basis of the control group treatment.The therapeutic effects were evaluated after 14 days in both groups,the changes of respiratory mechanical indexes of the 2 groups before treatment,24 h after treatment,48 h after treatment and the breathing machine before the withdrawal were compared[including airway peak pressure(PIP),respiratory work(WOB),airway resistance(Raw)and lung dynamic compliance(Cdyn)].The Th17 and Treg cytokines[including interferon gamma(IFN-γ),interleukin(IL)6,IL-17,IL-4,IL-10,and transforming growth factor beta(TGF-beta)],and arterial blood gas analysis index[including arterial blood oxygen pressure p(O 2),carbon dioxide pressure p(CO 2),oxygen saturation(SaO 2),oxygen index,lactic acid,and lactic acid),clinical pulmonary infection score(CPIS),acute physiology and chronic health status score system II(APACHE II)score and the change of Murray lung injury score were compared before and after treatment in the 2 groups.The recovery of normal time of 2 groups of clinical symptoms(including body temperature,lung rale,lung densification),and the recovery of blood fluid index[including white blood cell count(WBC),procalcitonin,C reactive protein(CRP),duration of mechanical ventilation,length of stay and success rate of weaning were compared in the 2 groups.Results Compared with before treatment,the levels of PIP,WOB and Raw decreased significantly(P<0.05),and the level of Cdyn increased(P<0.05)at 24 hours after treatment,48 hours after treatment and before weaning.The improvement of each respiratory mechanics index was better in the treatment group than in the control group at 24 hours after treatment,48 hours after treatment,and before weaning(P<0.05).Compared with before treatment,the levels of IFN-γ,IL-6,and IL-17 in Th17 and Treg cytokines were lower in the two groups after treatment(P<0.05),and the levels of IL-4,IL-10,and TGF-βwere increased(P<0.05),and the improvement of each cytokine in treatment group after treatment was better than that in the control group(P<0.05).The index of arterial blood gas analysis after treatment in the 2 groups was compared with that of the group before treatment,the levels of p(O 2),SaO 2,oxygenation index and pH were increased(P<0.05),and the levels of p(CO 2)and Lac decreased(P<0.05),and the improvement of p(O 2),SaO 2,oxygenation index and the level of Lac in the treatment group were better than those in the control group(P<0.05).The CPIS scores,APACHE II scores,and Murray lung injury scores after treatment in both groups were significantly lower than those before treatment(P<0.05),and the CPIS scores,APACHE II scores,and Murray lung injury scores were lower in treatment group after treatment than in the control group(P<0.05).The time of recovery of clinical symptoms,recovery of normal blood parameters,mechanical ventilation and length of stay in the treatment group were shorter than those in the control group(P<0.05),and the success rate of weaning was higher than that in the control group(P<0.05).Conclusion Qianjin-Weijing decoction combined with western medicine has a definite clinical effect on severe pneumonia patients undergoing mechanical ventilation.It can significantly improve the respiratory mechanics index,improve the arterial blood gas index,inhibit the release of Th17 cytokines,and promote the release of anti-inflammatory cytokines of Treg cells,and can recover the balance of Th17 and Treg cells,reduce the CPIS score,APACHE II score and Murray lung injury score,promote the recovery of clinical symptoms and blood parameters,shorten the mechanical ventilation time and hospital stay,and improve the success rate of weaning.