山莨菪碱联合血液净化治疗对百草枯中毒患者肺纤维化及血清MMP-9、TIMP1水平的影响

Effect of anisodamine combined with blood purification on pulmonary fibrosis,serum matrix metalloproteinase-9 and matrix metalloproteinase 1 levels in patients with paraquat poisoning

目的探讨山莨菪碱联合血液净化治疗对百草枯中毒患者肺纤维化及血清基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制物1(TIMP1)水平的影响。方法以2013年3月至2017年2月本院急诊科收治的84例百草枯中毒患者为研究对象,采用随机数字表法将其纳入观察组(山莨菪碱+血液净化)或对照组(血液净化),每组42例。比较两组治疗效果、肺纤维化相关指标以及血清MMP-9、TIMP1含量差异,并记录急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)发生率、ICU入住时间。结果观察组与对照组治疗总有效率(88.1%vs 69.0%)、治疗7 d高分辨率CT评分(8.4±0.9 vs 12.3±1.4)比较差异有统计学意义(P<0.05);同时,两组血清中透明质酸及Ⅳ型胶原蛋白呈现上升趋势,组间差异有统计学意义(P<0.05);治疗1 d后,观察组血清中MMP-9、TIMP1含量达到峰值,随后逐渐下降,对照组血清中MMP-9、TIMP1含量则一直呈上升趋势,组间差异有统计学意义(P<0.05);观察组与对照组ALI/ARDS发生率(11.9%vs 31.0%)、ICU治疗时间[(10.2±3.2)d vs(13.2±2.8)d]比较差异有统计学意义(P<0.05)。结论针对百草枯急性中毒患者,采用山莨菪碱联合血液净化方案可下调MMP-9、TIMP1表达,延缓肺纤维化进展,从而改善临床治疗效果。

Objective To investigate the effect of anisodamine combined with blood purification on pulmonary fibrosis and levels of serum matrix metalloproteinase-9(MMP-9)and matrix metalloproteinase 1(TIMP1)in patients with paraquat poisoning.Methods From March 2013 to February 2017,84 patients with paraquat poisoning admitted to our hospital were enrolled in the observation group(anisodamine+blood purification)or control group(blood purification),42 cases in each group.The curative effect,indexes related to pulmonary fibrosis,serum MMP-9 and TIMP1 levels were compared between the two groups.The incidence of acute lung injury/acute respiratory distress syndrome(ALI/ARDS)and intensive care uni(ICU)admission time were recorded.Results There was significant difference(P<0.05)in the total effective rate(88.1%vs 69.0%)and the high-resolution computed tomography(CT)score after 7 days of treatment(8.4±0.9 vs 12.3±1.4)between the observation group and the control group.At the same time,the serum levels of hyaluronic acid and typeⅣcollagen in the two groups showed an upward trend with significant difference(P<0.05).After 1 day of treatment,the serum levels of MMP-9 and TIMP1 in the observation group reached a peak,then gradually decreased,with significant difference(P<0.05).The incidence of ALI/ARDS in the observation group and the control group(11.9%vs 31.0%)and the duration of ICU treatment[(10.2±3.2)d vs(13.2±2.8)d].Conclusions For patients with acute paraquat poisoning,the combination of anisodamine and blood purification can down-regulate the expressions of MMP-9 and TIMP1 and delay the progression of pulmonary fibrosis,thus improving the clinical therapeutic effect.