四逆汤合五苓散联合常规疗法治疗脓毒症致急性肾损伤30例临床观察

Combined therapy of Sini decoction and Wuling powder on patients with acute renal injury induced by sepsis: a clinical observational study of 30 patients

目的评价四逆汤合五苓散联合常规疗法治疗脓毒症致急性肾损伤的临床疗效和安全性。方法选择我科于2017年1月至2018年12月收治的60例辩证为阳虚水停证的脓毒症致急性肾损伤患者,将其按照入院顺序进行编号,采用随机数字表法均分为两组,各30例,全部患者予以常规治疗和连续性肾脏替代疗法,观察组同时予以口服四逆汤合五苓散方剂治疗,两组患者疗程均为7 d。治疗结束时比较两组患者的急性生理与慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、器官衰竭评分(sequential organ failure assessment,SOFA)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin,IL-6)、IL-18水平及肾损伤标记物水平和预后情况。结果治疗前,两组患者各指标的差异均无统计学意义(均P> 0.05)。治疗结束时,两组患者APACHEⅡ评分[观察组(12.64±5.57)分,对照组(13.87±6.28)分]、SOFA评分[观察组(1.72±0.34)分,对照组(2.91±0.45)分]、血清TNF-α[观察组(142.95±19.36)ng/L,对照组(192.58±27.43)ng/L]、IL-6[观察组(76.19±9.25)ng/L,对照组(96.81±11.83)ng/L]、IL-18[观察组(43.67±4.19)ng/L,对照组(63.39±5.28)ng/L]水平、血肌酐(serum creatinine,Scr)[观察组(84.92±6.37)μmol/L,对照组(116.85±9.61)μmol/L];胱抑素C(cystatin C,Cys C)[观察组(1.26±0.14)mg/L[对照组(1.92±0.23)mg/L]、人中性粒细胞明胶酶相关载脂蛋白(neutropil gelatinase-associated lipocalin,NGAL)[观察组(59.18±4.12)ng/ml,对照组(67.61±5.41)ng/ml]均较其治疗前水平[APACHEⅡ:观察组(23.01±5.74)分,对照组(22.94±5.23)分;SOFA:观察组(5.13±0.67)分,对照组(4.92±0.73)分;TNF-α:观察组(227.61±31.92)ng/L,对照组(219.28±29.64)ng/L;IL-6:观察组(115.38±22.64)ng/L,对照组(118.95±21.79)ng/L;IL-18:观察组(82.91±6.17)ng/L,对照组(86.43±5.96)ng/L;Scr:观察组(141.26±15.68)μmol/L,对照组(143.47±16.37)μmol/L;Cys C:观察组(2.39±0.31)mg/L,对照组(2.41±0.37)mg/L;NGAL:观察组(85.37±6.45)ng/ml,对照组(84.97±7.49)ng/ml]明显降低,且观察组优于对照组,以上差异均有统计学意义(均P <0.05)。结论四逆汤合五苓散联合常规疗法治疗阳虚水停型脓毒症致急性肾损伤患者的临床疗效显著,还可明显改善其预后,它可能通过减轻患者机体的炎性反应来改善肾损伤,故该方案值得临床医生借鉴选用。

Objective To investigate the efficacy and safety of combined therapy of Sini decoction and Wuling powder on acute kidney injury induced by sepsis. Methods From January 2017 to December 2018, we selected 60 cases of acute kidney injury patients with syndrome differentiation of the Yang deficiency and Water retention, which were included in the study, and randomly divided into the control group and the observation group, with 30 cases in each group. All patients were treated with continuous renal replacement therapy and routine treatment, and patients in the observation group were additionally treated with Sini decoction and Wuling powder. Acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment(SOFA), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), IL-18, renal injury biomarkers and the analysed after seven-day treatment. Results Before treatment, there was no statistical difference in the baseline indexes between the two groups [APACHE Ⅱ scores:(23.01±5.74) vs(22.94±5.23);SOFA scores:(5.13±0.67) vs(4.92±0.73);TNF-α:(227.61±31.92) ng/L vs(219.28±29.64) ng/L;IL-6:(115.38±22.64) ng/L vs(118.95±21.79) ng/L;IL-18:(82.91±6.17) ng/L vs(86.43±5.96) ng/L;serum creatinine(Scr):(141.26±15.68)μmol/L vs(143.47±16.37)μmol/L;cystatin C(Cys C):(2.39±0.31) mg/L vs(2.41±0.37) mg/L;neutropil gelatinase-associated lipocalin(NGAL):(85.37±6.45) ng/ml vs(84.97±7.49) ng/ml]. After seven-day treatment, the indexes above were significantly lower than before treatment in both groups [APACHEⅡ scores:(12.64±5.57) vs(13.87±6.28);SOFA scores:(1.72±0.34) vs(2.91±0.45);TNF-α:(142.95±19.36) ng/L vs(192.58±27.43) ng/L;IL-6:(76.19±9.25) ng/L vs(96.81±11.83) ng/L;IL-18:(43.67±4.19) ng/L vs(63.39±5.28) ng/L;Scr:(84.92±6.37)μmol/L vs(116.85±9.61)μmol/L;Cys C:(1.26±0.14) mg/L vs(1.92±0.23) mg/L;NGAL:(59.18±4.12) ng/ml vs(67.61±5.41) ng/ml],and the observation group was lower than the control group(P<0.05). Conclusion On the basis of routine treatment, Sini decoction combined with Wuling powder can significantly improve renal function of patients with acute kidney injury caused by sepsis, which is classified to deficiency of the Yang deficiency and Water retention, by alleviating inflammatory reaction.